HomeMy WebLinkAboutpitkin.eh.264322301003_264322301004 (1978)PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 72/0 RECEIPTNUMBER /
Owner
Owner's Mailing Addres "S
Contractor
Address
System'!
Address
Phone No. / 2_S_— 72 1
Phone No
5OX/O� � 'AS1gZ,7_ CO R'M2 /
OMITS �/D �4A� *_'I i L_rsLegal Description
Lot Size Type of Building by Use PUPt-E7X
Number of Bedrooms Type of Water Supply C ENT�R - I)ELL
Z:ZZOwner's Signature Date 62 V
PLOT PLAN: ATTACH&DASjUQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Ahoy LLA
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l/CL
Proximal Location of Bedrock IW -1 IJC //4=�/M//vC-11 / C^- / 171-7/V O p
Proximal Location of Ground Water Table ' �`�T C-
Z2CT60y%Z,0E/2 — 6��7�iL ZZIA ,�/ O /
Percolation Test Date � � / 40, Minutes Per Inch "—
Minimum Recommended Absorption System Size �\�2 �j —T
Minimum Recommended Tank Size a �A LLOAIS -
Special Conditions of Issue: NOTICE
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 for such anges.
Approved for Issuance B Date
pp Y
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FINAL
INSPECTION APPROVAL DFate.
(Drawing of System on Back)
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PITKIN COUNTY ENVIRONMENTAL HEALTH
} Field Test Data Sheet on Percolation Test
PROPERTY OWNER
1.�t/(ati.`' PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF
ROPERTY.
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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
414, q-112
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Time
DropTime
Drop Time
2
%K f
.?
O / W
t`
/G
2
I
Percolation Rate Each Hole
Average Rate 0
Comments on soil or site:
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Signature
M W, A - ,
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Date