HomeMy WebLinkAboutpitkin.eh.264916102007 (1979)PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER
Owner 11-15' �� ��� S
Owner's Mailing Address
Contractor _S t ZT
Address
System's
Address
Legal De
--60
RECEIPT NUMBER — ' `_;—
Phone No.
Phone No.
/A
Lot Size ��) /ir 12 C Type of Building by Use )e �_s
Number of Bedrooms ype of Water Supply
Owner's Signature ` 6C, Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal Systema�Tnz
Type of Soil or Soil Classification &4X Z"MIl
Proximal Location of Bedrock ( ',.erl 7H,4AI 17
Proximal Location of Ground Water Table .E THAN /7 )rT`
Percolation Test Date Minutes Per Inch
so Tr oloc- Aleo�ti •��il/
Minimum Recommende AbbsF tign Lysogee�m S1 J 8�!
W )'f'N 3 FT DF ��A �� ��LIS�L S
Minimum Recommended Tank Size
Special Conditions of Issue: IvoTlce
p When properly signed for issuance, this application
/i /0�� becomes your permit. Application valid one year from
Ydate. 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 changes.
Approved for Issuance By
Date
FINAL INSPECTION APPROVAL Date �����✓
(Drawing of System on Back)
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
3L
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Ti e
37 L -
Drop Time
Drop Time
S13
-70 11
S
q4 S
g '8 �l
Ir % 0
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
z �.
Signature
Date' �!
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No" 32332
County Treasurer's Office, Pitkin County, Colo.
` „ 11miurb of
Account of
Credit
Aspen, Colo., J l _ r�e 1977�—'
-� 710 -7 �/
boIIRd -, ,(a/�
THE C. F. HOECKEI CO., DENVER
Fund.
3
Treasurer
Deputy