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HomeMy WebLinkAboutpitkin.eh.264320404002 (1978)t PITKIN COUNTY HEALTH DEPARTMENT PERMIT NUMBER —1��� � - RECEIPT NUMBER r� Owner ��i /r-/- -1 --P-Ce -/ ll LLS Phone No. Owner's Mailing Address7� C) S LL,/` N Contractor ---:--SAN1E- E- -4- 9,CAHAM / SEs %3 Phone No. Address SA 1\",! E System's Contractor's Name Address Legal Description ['C)7- 3 C r, E, S,RU H C aE K Lot Size �2 �C l� E S Type of Building by Use & ES IDF-,I-yL- Number of Bedrooms `3 Type of Water Supply �ll I Owner's Signature Date �01VZ7�( PLOT PLAN: ATTACHED AS REQUIRED TVDe of Individual Sewage Disposal System Type of Soil or Soil Classificati Proximal Location of Bedrock �c� Proximal Location of Ground Water Table �"Dcf�ie,gt- IFF S / C- /A Alk -- Percolation Test Date Minutes Per Inch Minimum Recommended Absorption System Size 06 Minimum Recommended Tank Size Adon 6A/ a NOTICE Special Conditions of Issue: when properly signed for issuance, this application {� 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 (3 �1. ,�to0erloltl t�4) Two I k401 R ED. Approved for Issuance By ! -2-o49 sQ IF &I'S o / (1 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 such changes. FINAL INSPECTION APPROVAI,��n// Date (Drawing of System on Back) PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER Z� PHONE MAILING ADDRESS LEGAL DESCRIPTION OF PROPERTY LOCATION OF TEST HOLES Three (3) test holes required per system Test Hole Depths (24" minimum) Diameter of Test Holes Water remaining after 8 hour soak TEST HOLE No.1 TEST HOLE No. 2 TEST HOLE No. 3 Drop Time Drop Time Drop Time f �i V A Nib 440 &0C PercolationRate Each Hole Average Rate — Comments on soil or site: Signature ': . Date 1 /�J tet►` �� ON� Y/ _ - &4 , ISR fete CO _=__310 _ ,[)DRESS------ INS ar�D nE�'�+' vS SEE REVERSE FOR TI ONS, SA TRUC LAB -MICRO 106(Rev 3'79)1OOM UNSUITABLE U Sl ANL 311CTERIO�LO MR1�3L1�►WIgISENN:TE$T SNO•--..ASS WATE P.0. 6015700 VILLAGE, C0' gy615 ample Location f DIRECT SNOWMIASS NAME OF VERIFIED SUPPLY �— TIME� CHLORINE MG/L DATE��— y SAMPLETAKEW RESIDUAL���� SAMPLER�� Ap,IUST COUNT COUNTY---� ROUTINE WSTRIRUTIONPROCESS WATER SUPPLY 1( )I SAI:IPLE ( ) COMMUNITY CHECK ) SURFACE ( )GROUND l .. ( ) NON COMMUNITY ( ) RAW ) SPECIAL PURPOSE SAMPLE ) OTHER PUBLIC 24 ( ( ( ) PRIVATE THE SAMPLE WILL IS NOT SUPPLIED, 4B ..NOTE: IF ALL INFORMATION BE DISCARDED. —_� I GB �— � REMARKS: PI� M RETURN TO NON-COMPLIANCE WATER STANDARDS. ,[)DRESS------ INS ar�D nE�'�+' vS SEE REVERSE FOR TI ONS, SA TRUC LAB -MICRO 106(Rev 3'79)1OOM UNSUITABLE U FOR TEST RESULTS W MEMBRANE FILTER ++ W = s 0 U I4 y COLIFORM / 100 ML LAURYL SULFATE BROTH .. a 3 F- O Z O COLIFORM / 100 ML D RESULTS GREATER ML IHANNDICATES COLIFORM PER 100 ML WITH MINIMUM a ;� o NON-COMPLIANCE WATER STANDARDS. DRINKING ti A' - STANDARD BACTERIOLOGICAL WATER TESTS SNOWMASS -R & SANITATION DISTRICT V . BOX 5700 (� SNM!Ih. & VILLAGE, CO. 81615 0plef S{ ti Sa p e LDcatlon N NAME OF IME �'�+SUPPLY SAMPLE TAKEN: DAT �..� _ _/CHLORINE �- MG/L _SAMPLER 6 4 RESIDUAL COUNTY ( ) COMMUNITY SUPPLY ( ) ROUTINE DISTRIBUTION SYSTEM SUPPLY ( ) NON COMMUNITY ( ) CHECK SAMPLE ( ) PROCESS WATER RAW OROUND ( ) SURFACE ( OTHER PUBLIC ( ) (RIVATE (PECIAL PURPOSE SAMPLE E ••NOT. IF ALL INFORMATION IS NOT SUPPLIED, THE SAMPLE WILL BE DISCARf.UEL NELSON REMARKS: ASPENIr PITK.IN RETURN TO ADDRESS CITY-STATE ix SAMPLING INSTRUCTIONS AND DEFINITIONS. SEE REVERSE FOR TIME LIMITATIONS, LAB -MICRO 106 (Rev. 3-79) 100M UNSUITABLE ❑ FOR TEST RESULTS MEMBRANE FILTER w DIRECT s o VERIFIEDADJUST U COLIFORM/ 100 ML COUNT* i\ ) LAURYL SULFATE BROTH 24 3 I" \ W 48 2 I I- BGB COLIFORM / 1D0 ML 0 M PN RESULTS GREATER THAN ONE COLIFORM PER 100 ML INDICATES w NON-COMPLIANCE WITH MINIMUM o 0 DRINKING WATER STANDARDS. 8� PESMAW 2376, • I /F s - CrTA L Ua L! MW � 2(M MQW O 25 GO 10 50 N.840 t2` 43” W. 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