HomeMy WebLinkAboutpitkin.eh.264316402001 (1975-78): -A
PERMIT NUMB R
Owner
Owner's Mailing Add s —
Contracto r
Address
System's Contractor's Name
Address
Legal Description
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(PIITKIN COUNTY HEALTH DEPARTMENT
i RECEIPT NUMBER
Phone No. —,L—=
Phone No.
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Lot Size �� AC�(/--)—___) Type of Building by Use
Number of Bedrooms
Owner's Signature
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PLOT PLAN: ATTACHE AS REQUIRED
Type of Individual Sewage Dispose
Type of Soil or Soil Classificati
Proximal Location of Bedrock
Proximal Location of Ground 1
Type of Water Supply /VG
Date �Z/
Percolation Test Date Minutes Per Inch
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
S ecianditions of Issue: NOTICE
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p When properly signed for issuance, this application
EOMI TGA /NC? LODE 6X66 VA F /oA) dbecomes your permit. Application valid one year from
ate. If an individual sewage disposal permit is issued
for property on which no building permit has been
Q oi W W issued, the individual sewage disposal permit shall
expire 120 days after its issuance If construction has
���O�/ O�/�j f� not been commenced. Any change in plans or speci-
/ , fications after the permit has been issued invalidates
the permit, unless approval is secured from the Health
Officer for uch than s.
Approved for Issuance By Date
FINAL INSPECTION APPROVA Date
(Drawing of System on Back)
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER a �b PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
TEST HOLE No. 2
TEST HOLE No. 3
Three (3) test holes required per system
Drop Time
Drop Time
Test Hole Depths (24" minimum)
32 f(
g ,t
Diameter of Test Holes
fl 05
Water remaining after 8 hour soak
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TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Dro- Time
Drop Time
Drop Time
/n
fl 05
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0 tf
5
3
Percolation Rate Each Hole
Average Rate 6��
Comments on soil or site:
Signature
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Date`
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COLORADO STATE DEPARTMENT OF PUBLIC HEALTH
Water Pollution Control Commission
4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner) : J) C,' 171.
Mail Address: City /5 S/":7 iZ, Phone:
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW:
(Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, location of potable water wells,
soil percolation test holes, soil profiles in test holes.)
1. Location of Facility: County ( r T/ c-/ /x/ City or Town
Legal Description Lot size:
2. Type of area and facility - Number of persons to be served:
Subdivision Motel Restaurant Trailer Court
Other: /71/7
3• Source of domestic water: Public(name):
Private: Well Depth Other !�,C bept' to First Ground Water Table
4. Is facility within boundaries of City or Sanitation District:
If so, name:
5. Distance to nearest sewer system:! 'Z///
Have negotiations been attempted with owner to connect:
If rejected, give reason:
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours:_d/o 7-/-e2/c
7. Name, address & telephone of person who made soil absorption tests:
8. Name, address & telephone of person responsible for design of the system:
A,l� � �3i/c/C ,l /.lei77-1*-" ".e'z") L//!e-
9.
9• Est. bid opening date: y ,/ w Est. Completion date:-c/'.
ate:c/'Est. Project Cost:
Date:
Signature of Owner
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ell
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K & B PLUMBING & HEATINQ
HAROLD WESTLEY ,6
310 - 19th ST.
GLENWOOD SPRINGS, COLORADO !SIGN
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