HomeMy WebLinkAboutpitkin.eh.264320406004 (1975)PERMIT NAER1
-Owner i6( -A ,
Owner's Mailing
Contractor
Address
PITKIN COUNTY HE,<H DEPARTMENT
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Systems Contractor's Name S�
Address k, -
Legal
Legal Description
Lot Size
Number of Bedrooms
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RECEIPT NUMBERkj?,,8;3T
Phone #
Phone #
Type of Building by Use'
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Type of Water SupplyWell
Type of Individual (Sewage Disposal System �C l�t�/���C7�� , L—
Type of Soil or Soil Classification ZOA ���'511JD�n-eQG+ 15
Proximal Location of Bedrock
Proximal Location cif Ground
Owner's Signature
PLOT PLAN:
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�/�`ud Date -..Q,
Percolation Test Data MJAU
per inch
Minimum Recommende4 Absorption System Size d "V71,77
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Minimum RecommendO Tank Size
Perini t a is tion valid one year from ate. Application to be m permit and fin on y
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after lower portio is completed and signed by the Sanitarian. RETAIN THIS FORM AT THE
CONSTRUCITON SITE.(
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Date Sanitarian
rawing of system on back)
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COUNTY
PROGRAM_
LOCATIONr i
REPORTED BY
SERVICE REQUESTED
ACTION REPORT
ACTION BY
SH—M-7t (4-71-50)
COLORADO DEPARTMENT OF HEALTH
REQUEST FOR SERVICE
RECEIVED BY DATE d
NAME �iC' f' 21-227 l l
ADDRESS TELEPHONE
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DISPOSITION
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DATE tiro
t TO BOB NELSON
From: Caroly Hardin
Postmark: Jun 29,90 10:55 AM
Status: Previo sly read
Subject: Forwarded: Phone message from Spencer Pie4ceson
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Comments:
From Carolyn Hardiin:
He's the one I told you about who wants to build anew house on
his property in Bjruch Creek. He wants info on opt ons.I
returned his call, told him you'd get back to.bim ome time next
week.
Message: `
{
From Barbara Schlagen:,x
Phone #: 923-3843
Please call
S.
.6,
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER
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MAILING ADDRESS
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LEGAL DESCRIPTION
OF PROPERTY /t
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S�SDIVISJQAI
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LOCATION OF TEST HOLES
Three (3) test holes
req red per system
Test Hole Depths
24" minimum)
Diameter of Test 11oles
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Water Remaining after
24 hour soak O __
TEST HOLE #1.
TEST IQLE #2
TEST #3
DropT•
Drop Time
DropTime
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Percolation Rate
E Hole
ach
Average Rate
Comments on soil or
site:
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30.00' l�
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