HomeMy WebLinkAboutpitkin.eh.264503201002 (1979)Oi
PITKIN COUNTY HEALTH DEPARTMENT PERMOT NUMBER `�05� RECEIPT NUMBEReA~
Owner / L �������1 �� C � Phone No. �4_2 7 ` � C;1� S
Owner's Mailing Address & 3 Z /4s -S 2 /4 EY
Contractor 1 G--� ���T �G -rA h) 2 Phone No.
Address /+UG /� �, CA, �� ��� �-
System's Contractor's N
Address
Legal Description LOQ 3 CA191-FOL W0003 C),91210316A)
Lot Size Type of Building by Use /qQ S Z -
Number of Bedrooms — Type of Water Supply
Owner's Signature Date
PLOT PLAN: ATTA HED AS REQUIRED
Type of Individual Sewage Disposal System �U I " - AMM M0
Type of Soil or Soil Classification /t -Ti LOr1.�n
Proximal Location of Bedrock �iCEA"rE� -7—/f,4AJ S F -F.
Proximal Location of Ground Water Table t!5�112,15NWt A
Percolation Test Date �o / aMinutes Per Inch —
Minimum Recommended Absorption System Size 1�0 �Q ET
Minimum Recommended Tank Size �X/ST/NG /200 11 JET "AEieATEIJ P�IMFAT PIAgJT
Special Conditions of Issue: When NOTICENOTICEproperly 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
• _ expiredays after its issuance If construction has
not been
commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
he permit, unless approval is secured from the Health
• Officer for such changes.
• 40
Appro ed for Issu a By Date 72
FINAL INSPECTION APPROVAL
14W/ / Date
(Drawing of System on Back)
2 -gTw-Y
Douse
36)
I2510-GAt,AJ taPCu►NO" tokZETC
CAOWUACTV SCPrjF TAN< CONE pu
+CNAWP- Wrri+ y2�
PUMP
• �s
rN
PITKIN COUNTY ENVIRONMENTAL HEALTH
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 8 hour soak
v
v
26 " 3e 28 f
TEST HOLE No.1TEST
a —
Drop Time
HOLE No. 2
Drop Time
TEST HOLE No. 3
3`.
Drop Time
� 1 I
3
N`10
Percolation Rate Each Hole
Average Rate O
Comments on soil or site:
Signature
Date —?/W /74?