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HomeMy WebLinkAboutpitkin.eh.264929102034 (1975)i; .0 G K �t � �t �z 3 © 0 a PITKIN COUNTY HEALTH DEPARTMENT I Q r -I PERMIT NUMBER • `J N Owner R 0 � ._ r T `S Owner's Mailing Address Z504 ) �✓ S'y&r O `� Contractor Address Systems Contractor's Name IAddress elm ILI I C Legal Description a / 4 Lot Size 1 mr A.C- Number of Bedrooms�b V, nem RECEIPT NUMBER [ 6 Phone # 's Sri Phone # %-i r 3 Q!h2 r d Type of Building by Use Q + Type of Water Supply Type of Individual Sewage Disposal System, Type of Soil or Soil Classification /Y'42 mi=l Gl ra(-- )c, Proximal Proximal Location of Bedrock Proximal Location of Ground Water Table%% i5 Owner's Signature PLOT PLAN: Percolation Test Data Minutes er inch Minimum Recommended Absorption System Size-- j +�/ Of 4?2 Min' um ecommended Tank Size U a dr�7 Pe it application valid one year from Date. Application to become permit #nd final on: after lower portion is completed and signed by the Sanitarian. RETAIN THIS FORM AT THE CONSTRUCITON SITE. Date Sanitarian (Drawing of system on back) PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER .Se- w 2 L PHONE MAILING ADDRESS .S69 3 Q `� d �Q— i LEGAL DESCRIPTION OF PROPERTY E 9 i LOCATION OF TEST HOLES C r S/ 1 ✓'e r �i S Three (3) test holes required per system Test Hole Depths (24" minimum) i Diameter of Test Holes 1211 ell Water Remaining after 24 hour soak TEST HOLE #1 TEST HOLE #2 TEST HOLE #3 Drop Time Drop Time Prop Time fp; /'o; 36 3-3 0/3 of 5 ��g� Di 7 Z '767 16' o - a � 2 /i • � n Rate Each Hole Percolation * Average Rate �)o O ]� z Comments on soil or site. SIGPlATUBE DATE ■ AN^ PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER C0.6 PHONE MAILING ADDRESS LEGAL DESCRIPTIC 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 HOLE 111 TEST HOLE #2 TEST HOLE #3 Dron Time Drop Time Drop Time Percolation Rate Each Hole Average Rate a NAME OF RESPONSIBLE PARTY RUNNING TEST SIG11ATURE PHONE PHONE