HomeMy WebLinkAboutpitkin.eh.264504200003 (1976)PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 76664 RECEIPT NUMBER
Owner ���� `� Vv �� Phone No.
Owner's Mailing Addre X1"/N I T
Contractor
v Phone No.
Address
System's Contractor's Name
Address
7 91
Legal Description t 2t.0 ��
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Lot Size 21 &6
e)F 6
Type of Building by Use 5, � hS/2- /'-I -
Number of Bedrooms Type of Water Supply
Owner's Signature Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System �� �4�r`�K r � E�/9C'E 959
Type of Soil or Soil Classification ��-AY ! OAV A.N�
Proximal Location of Bedrock
Proximal Location of Ground Water Table ,V4O� �� ��� 64�r,4Tc� 77111AJ F FC—C7
Percolation Test Date ( Minutes Per Inch �d
Minimum Recommended Absorption System Size (// �x ,sx f
_ r
Minimum Recommended Tank Size 7J0 Cs14LZzA/S — Z__W0_
Special Conditions of Issue: rvo
When properly signed forr iss ssuance, this application
becomes your permit. Application valid one year fromi) PUMpvo 86///J'TALLED 7-G
/ date. If an individual sewage disposal permit is issued
for property onwhich 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 ch changes.
Approved for Issuance By Date
FINAL INSPECTION APPROVAL G ate
(Drawing of System on Back)
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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 24 hour soak
TEST HOLETEST
L No. 2
TEST HOLE No. 3
/7
Drop Time
Drop TiWe
Drop Time
-3or
D
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n
Percolation Rate Each Hole
Average Rate 27
Comments on soil or site:
Signature
rl,
Date