HomeMy WebLinkAboutpitkin.eh.264320101010 (1976)PERMIT NUM�ER
I
Owner
Owner's
Contract
Address
System'E
Address
Legal DE
Lot Size
Number
Owner's
PLOT P" .... .....
Type of Individual Se Wage Disposal System
Type of Soil or Soil dlassification
Proximal Location oflBedrock/ 2�e / ,/d� U
Proximal Location of Ground Water Table ! ��1 ��eWED —6XF4 K
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PITKIN COUNTY HEALTH DEPARTMENT
76076 RECEIPT NUMBER �/[ v
nL___ P1 -
Percolation Test Dat Minutes Per Inch
Minimum Recommended Absorption System Size �� /:77�
Minimum Recommended Tank Size //(Y)co rhLZ-e�S — 7100 (2614"6J � �
NOTICE
Special Conditions oll Issue: When properly signed for issuance, this application
�1��, becomes your permit. Application valid one year from
date. If an individual sewage disposal permit is issued
for property on which no building permit has been
issued, the individual sewage disposal permit shall
expire 120 days after its issuance if construction has
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 suc than es.
Approved for Issuance By
Date /
FINAL INSPECTIO APPROVAL ate
(Drawing of System n Back)
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER �/4n'� L. C'LL= PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
&t; i (IRC -6 [/< <
LOCATION OF TEST HOLES /1)0 /
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 24 our soak
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TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Time
Drop Time
Drop Time
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Percolation Rate Each' IH e
Average Rate`
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Comments on soil or sit
r
Signature � Dete
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