HomeMy WebLinkAboutpitkin.eh.264322203001 (1976)1 Ze -?6f-
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PITKIN COUNTY HEALTH DEPARTMENT �_ J-4�
76074 RECEIPT NUMBER
PERMIT NUMBER
Owner %,1
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Owner's Mailing Address
ContractorPhone No.
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Address
System's Contractor's Name
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AddressA Ni -3
Legal Description
Type of Building by Use ` �C
Lot Size L�1
Number of Bedrooms Type
f Water Supply
Owner's Signature f J
PLOT PLAN: ATTACHED AS REQUIRED
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Type of Individual Sewage Disposal System
Type of Soil or Soil Classification'
Proximal Location of Bedrock
Proximal Location of Ground Water Table
es Per Inch
Percolation Test Date Minutes
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Minimum Recommended Absorption System Size
Minimum Recommended Tank Size
NOTICE
Special Conditions Qf 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
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 fors h than es./,,
Approved for Issuance ByDate
FINAL INSPECTION APPROVAL
Date
(Drawing of System on Back)
Section
FILE REFERENCE:
INDIVIDUAL OR
ESTABLISHMENT:
ADDRESS:
NARRATIVE:
COLORADO DEPARTMENT OF HEALTI.
DIVISION OF ENGINEERING AND SANITATION
A C T I V I T Y _RE P O R T
Private Sewage Disposal
W/J Ranch
Units 6 and 7
Code 12
County 49
I received a complaint from Helen Hines concerning the
discharge of sewage on the surface of the ground at the last unit
west on the upper bench. Investigation with the manager, George
Koch, revealed that an effluent line had separated at a joint and
was ponding directly below. Verbal notice was given to make repairs
and notify this office when completed. Koch said that he would
contact Frank Hodges immediately to do the work.
LETTER TO FOLLOW: ( ) OTHER RECOMMENDATIONS:
DATE:
ES: 7 (Rev. 6-70-100)
19 76
REPRESENTATIVE:
PI1 KIN COUNTY ENVIRONMENTAL HEATH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER��� 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 24 hour soak
0
TEST HOLE Noll
TEST HOLE No. 2
TEST HOLE No. 3
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Drop / Time
Drop Time
Drop Time
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Percolation Rate Each Hole
Average Rate
Comments on soil or site:
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Date
Signature e
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