HomeMy WebLinkAboutpitkin.eh.264527100001 (1975)PERMIT NUMBER_
Owner
Owner's Mailing
Contractor
Address /
ess
1
Svstems Contractor's Name
Address
Legal L
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PITKIN COUNTY HEALTH DEPARTMENT
RECEIPT NUMBER
Phone #
Phor;e #
Lot Size
52>D . f- A
Type
of
Building by Use o -/ ;IV e�
Number of
Bedrooms
Type
of
Water Supply
Type of Individual Sewage Disposal System /, 10mi — Gc 1
Type of Soil or Soil ClassificationAit/n G�/�/4✓CL
Proximal Location of Bedrock /1/o -r D, 7eizmlzVE1p % o /
Proximal Location of Ground Watet Table
Owner's Signature
PLOT PLAN:
Percolation Test Data —1-2— _Minutes
Minimum Recommended Absorption
Date
inch
Minimum 4ecommended Tank Size /J (J LT/TL-1-P_ If
10
YrmItMpplication
Pvalid one year from Date. Application to become ermit and final only
the Sanitarian. RETAIN THIS FORM AT THE
after lower portion is completed and signed by
CONSTRUCITON SITE.
Date � cj 75 Sanitarian
( awing of system on back)
PAR14 Ail D
SEUrID FLOOR Dw6cuW6
UNIT
_J��oaEu
10
3.5"
Np Cm"ETE
C,. TAM K
FENcg LINE
e
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WATER- LINE
APPRo)UmATc
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER ® S PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST MOLES
Three (3) test holes required per system /
k,f
Test Hole Depths (24" minimum) 7 p
Diameter of Test Holes
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Water Remaining after 24 hour soak
7 •pin
'O
D Time
Drop Time1 ••
Im
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IVA,
Percolation Rate Each Hole
Average Rate /f
Comments on soil or site:
w ni�t J.A�
SIG11ATURE
DATE 9//9/�7s