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HomeMy WebLinkAboutpitkin.eh.273503300044 (1973)PITKIN COUNTYj HEALTH DEPARTMENT PERMIT NUMBER 7 2 v 13,"1 RECEIPT NUMBER Owner Ac Phone Phone # Address '7Z Contractor ��/�� Phone # Address J y Location of system ,(3£L 1 T' 1�/�T/'�/� IM7 Lot size s �% t> �►�"E�S Legal description Z.Or I.1$F C. .3 �i�W°�~'wf� /� �'`�✓�"�'�L'£ y `' F Number of bedrooms Date 6e L to Signature of owner Percolation test data Minimum recommended absorption system size Minimum recommended tank size b Permit application valid one year from date. only after lower portion is completed and si site. N't DRA i Date minutes per inch nn Y� jj_j - cation to e/comme��tini �bToand final ttain this form at the construct CA V 17r -Mf- -be SYSvJ � PC��ArNw6 w� c� . an COLORADO DEPARTMENT OF HEALTH Water Pollution Control Division 4210 East 11th Avenue Denver, Colorado 80220 APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS Applicant (Owner): Mail Address: �i� City: A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: —� �/ 11 1 ,� -, Phone: 2 6 Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable buildings, location of potable water wells, soil percolation test holes, so)] profiles in test holes. 1. Location of Facility: County �� T%�/�J City or Town rel/t% �e_b 4>>ia_Lot Size: Legal Description J y - p?i- -Yh¢%f;�;� 2. Type of area and facility - Number of persons served: Subdivision Motel Restaurant Trailer Court Other: ���f;�'ir t/��'Ei� Cl�rt1 S 3. Source of domestic water: Public (name): Private: Well V' Depth Other Depth to first ground water table/NNW lVe" 4. Is facility within boundaries of City or Sanitation District: If so name: 5. Distance to nearest sewer system: Have negotiations been attempted with owner to connect: If rejected, give reason: 6. Rate of absorption in test holes in minutes per inch of crop 'n water level of r holes have been soaked for 24 hours: 7. Name, address and telephone of person who made soil absorption tests: 8. Name, address and telephone of person responsible for design of the system: 9. Est. bid opening date: Est. Completion Date: %/ %.3 Est. Protect Cost:/V, n© Date: /;"Z4 �-'�"� Signature of Owner TEST HOLE I TEST HOLE II Reading Drop Time Reading Drop Time PERCOLATION TEST RESULTS: HOLE I Minutes per inch 1HOLE II Minutes per inch Average percolation rate• 41 6 Minutes per inch Comments on soil and/or site: Address: Signature: TEST FEE $25.00, payable in Advance