HomeMy WebLinkAboutpitkin.eh.264929102006 (1976)i
76028
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER
71)
Owner, ` _ /5 %mc- i< ,,p t,
Owner's Mailing Address 4ny' /` / `---P f 4ZO Al'
Contractor-erf�
Address
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RECEIPT NUMBER -20'767
Phone No.
J
Phone No. / 252 2
System's Contractor's Name'
Address 4 1 L /25-
Legal Description
Lot Size -f C Type of Building by Use
muti5s iLa_/iCE
Number of Bedrooms Type of Water Supply
Owner's Signature ,211,r
�,_, D Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification 7) 5141VD Y ��i I�Z-- 722 g /
Proximal Location of Bedrock *07—
Proximal
Location of Ground Water Table
C17
Percolation Test Date Minutes Per 712,
2
X 12
Minimum Recommended Absorption System Size
o T a
Minimum Recommended Tank Size /Ono CA L -LOA) C
Special Conditions of IssuejJWhen properly signed
NOTICE
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
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
e
FINAL INSPECTION APPROVAL ate r
(Drawing of System on Back)
T,
PITKIN COUNTY ENVIRONMENTAL HEALTH
FieldTestData Sheet on Percolation Test
PROPERTY OWNER /"�iI/DC,G� - l /rP��UErP PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLESZpGG9C'k YV 01�C-7 /—d /
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 24 hour soak
0
11
,..1(1
q //
13 t1
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Time
Drop Time
Drop Time
11
1
z' s
'z
7 E50
1194, o
6
I L2- 5j
'3
t 5:2-7
7 52
i -
Percolation Rate Each Hole
Average Rate 5
Comments on soil or site: RG D SAN p '� LOAM
Signature
Date 2-�7