HomeMy WebLinkAboutpitkin.eh.264305300002 (1978)(CDU)Document Layout
(From Most Recent to Oldest Permit)
Permit
Application
Log Sheet/Notes & Photos
Communications.
As -built Design
Engineer Design
Soil Information
Water Permit & Information
Second System on property
Third System.etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER -- ZJ`007 RECEIPT NUMBER A�XG3
Owner d &_ J �1dP ✓1 Phone No. C1 S 3 -1 3
Owner's Mailing Address (fi(')j �yyso
Contractor 5--2 ( F Phone No.
Address
System's Contractor's Name ) +— }1 •mut^
Address
Legal Description i� ✓L �- �9 ��(/V %J� 6 711
Lot Size 1 b Type of Building by Use
Number of Bedrooms 3 Type of Water Supply
Owner's Signature �`� ��ti" '" Date 1
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Disposal System >EPTI IL //1NIC —
Type of Soil or Soil Classificati
Proximal Location of Bedrock
Proximal Location of Ground Water Table NOT %%FT /V% EQ --G',�Ef Me %ti/A 8 FT-
Percolation
rPercolation Test Date, /7� r' S Minutes Per Inch—
Minimum Recommended Absorption System Size 3Z SC , � r —; 7 le /X z%� /B2 -w feAw,-wl
Minimum Recommended Tank Size /000 Gil Z_"NS-
Special Conditions of Issue: NOTICE
When properly signed for Issuance, this application
AaSCkPTJ oAJ F-JEe n i"1�5� fie f1 'V/,V/MVM becomes your permit. Applicationdisposal
salld One year from
sued
tlete. If an individual Nwege tlispo Nl permli b Issued
of /0 0 GET reo.H 10O7ABL E Lf/fgT`&� for property which no dipe mit has been
issued, flee individual sewagege dlspoNl permit shell
S UPPP y (WEA L) . expire 120 days after IO Issuance If construction has
not been commenced. Any change in plans or wocl-
ficetions after the permit has been Issued Invalidates
the permit, unless approval is "cured from the Health
Officer for such chang—els.
Approved for Issuance By —Date—
FINAL
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+#N+XeNNNY Ya►eNN•
FINAL INSPECTION APPROVAL Date /Z
(DIa[wiing of System on Back)
_[
ON
I ve-p-
IV
i
ff
,1000 ggLLON �ICOWLOAo
CoNckenE !L�EPrfc--M k
95.
DR►VE
STANDARD BACTERIOLOGICAL WATER TEST
SNOWMASS WATER SANITATION DISTRICT
P.D. BOK 5100
SNOW MASS VILLAGE, CO 81615
w Sample
SEE REVERSE FOR TIME LIMITATIONS. SAMPLING INSTRUCTIONS AND DEFINITIONS.
LAB -MICRO 106(RPv. 379) UODM
UNSUITABLE ❑
FOR TEST
MEMBRANE FILTER
DIRECT
LoOabon
VERIFIED
NAME OF
SAMPLE TAKEN: DATE
TIME_ SUPPLY
CHLORINE
COUNTY -SAMPLER-
RESIDUAL MG/L
( I COMMUNITY SUPPLY
( I ROUTINE DISTRIBUTION SYSTEM SUPPLY
( I NON COMMUNITY
I ) CHECK SAMPLE ( ) PROCESS WATER
( ) OTHER PUBLIC
( I RAW I I GROUND ( ) SURFACE
( I PRIVATE
I 1 SPECIAL PURPOSE SAMPLE
-NOTE: IF ALL INFORMATION IS NOT SUPPLIED. THE SAMPLE WILL
BE DISCARDED.
COLIFORM/100 ML
REMARKS:
UURYL SULFATE BROTH
2
RETURN TO
SEE REVERSE FOR TIME LIMITATIONS. SAMPLING INSTRUCTIONS AND DEFINITIONS.
LAB -MICRO 106(RPv. 379) UODM
UNSUITABLE ❑
FOR TEST
NY al
MEMBRANE FILTER
DIRECT
VERIFIED
U
4
h
ADJUSTED
COUNT:
COLIFORM/100 ML
0:
UURYL SULFATE BROTH
2
14
21
3
b
H
2
an
MPN
COLIFORM 100 ML
O
�
RESULTS GREATER THAN ONE
COLIFORM PER 100 ML INDICATES
NON-COMPLIANCE WITH MINIMUM
DRINKING WATER STANDARDS +
NY al
S
STANDARD BACTERIOLOGICAL WATER TEST
SHOWMASS WATER 8 SANITATION DISTRICT
P.O. BOX 5700
SNOWMASS VILLAGE. CO. SIBIS
SampM Location
NAME OF
SAMPLE TAKEN: DATE ._TIME- - SUPPLY
- CHLORINE
COUNTY SAMPLED RESIDUAL MG/L
( I COMMUNITY SUPPLY I 1 ROUTINE DISTRIBUTION SYSTEM SUPPLY
( 1 NON COMMUNITY ( I CHECK SAMPLE I 1 PROCESS WATER
I I OTHER PUBLIC ( I RAW I I GROUND I I SURFACE
( I PRIVATE I I SPECIAL PURPOSE SAMPLE
"NOTE: IF ALL INFORMATION IS NOT SUPPLIED. THE SAMPLE WILL
BE DISCARDED.
REMARKS:
RETURN TO Jerald Carnett
ADDRESS P.P. L'ox 4357
CITY-STATE �'Tj �^ '1' .' T �+
SEE REVERSE FOR TIME LIMITATIONS. SATAPLING INSTRUCTIONS AND DEFINITIONS
-
LAO -MICRO IDS (FIN 77%LOOM
DRINKING
0-140
UNSUIW
FOR TE
RESULTS
MEMBRANE FILTER
DIRECT
VERIFIED
U
4
y
ADJUSTED
y
COUNT:
_ COLIFORM/100 MIL
Z
LAURYL SULFATE BROTH
>
r
ti
2/
^x
IB
BOB
Q2
MEN
COLIFORM/100ML
V
DRINKING
0-140