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HomeMy WebLinkAboutpitkin.eh.272904300004 (1973)Owner A Address Contractor Address x a �aq -0,13- coo -001 • PITKIN COUNTY HEALTH DEPARTMENT ;FM MV� PERMIT NUMBER7�_ RECEIPT NUMBER Phone i# Phone # ��,� —2,3 'V �/ 6&e � _ 5'41(, QQ ,QlI Location of system c�/�©O �,�";©. �00�7 /�� Lot size 5, 3. Legal description /(� �8 w — Sze, 4 /VP W SW � Number of bedrooms Signature of owner Date Percolation test data "'— minutes per inch Minimum recommended absorption system size /0 So �� ( ,9 %►' 2 % l S'EL-�q� r Minimum recommended tank size 570 94UOAI �; — %© tIMPAR l ME-AITS Permit application valid one year from date. Application to become permit and final only after lower portion is completed and signed. Retain this form at the cotr c ion site. 9 7 � l e P- YS , iVCk- 10/ . ioeo 6W-1.oA � f-f4t1SF G'AM DRAWING OF SYSTEM MNE- Me O PITKIN COUNTY ENVIRONI.IENTAL.HEALTH - A Field Test Data Sheet on Percolation Test PROPERTY OWNER G ( n7 -� f � � � ll S PHONE MAILING ADDRESS it ��`-G e [ L 4.* x'16,23 LEGAL DESCRIPTION OF PROPERTY` R 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 #1 TEST HOLE #2 TEST HOLE #3 i Drop.Time Drop Time Dro-p, Time v �, 7 i 91 3:.Z--- j7Z 2 >/ / --- 0Z ' l . l �; f L -- 1� 01/ Yeo Percolation Rate Each Hole o reed ► .� Average Rate t �• / / Comments on soil or site: X / 1 SIGNATURE DATE C � . PITKIN COUNTY ENVIROUMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER Elm m -JZ Q �/C/ PHONE �� 3 MAILING kDRESSC,6- D611 dGLC �. �cslCTr��C, dl �� 7� `�4 2 6 LSAT- S r�yVr LEGAL DESCRIPTION OF PROP'_:113TY T, ID S , K S{' c I1% � LOCATION OF TEST HOLES Three (3) test holes required per system R Test Bole Depths (24" minimum) 76 Diameter of Test Holes fZ Water Remaining after 24 hour soak � '36,, 30 12 TEST HOLE #1 TEST HOLE f#2 TEST HOLE #3 Drop,Time Drop Time Dro-n Time U 6 64a, i 2 YS .7 b 'lye !.� 3 1V v © r / Percolation Rate Each Hole Average Rate Comments on soil or site: 71 Ys a r Q- rl Q , % 1 �z S SIGI;A'iOE DATE o �� • 4 0 r � COLORADO DEPARTMENT OF HEALTH COUNTY/ REQUEST FOR SERVICE PROGRAM RECEIVED BY n J DATE _ LOCATION/�� NAME REPORTED BY e"eii" !j22rIC j ADDRESS 1 311 �wTELEPHONE SERVICE REQUESTED 6 A' -7;;vk s D,4'y ACTION REPORT ACTION BY DISPOSITION DATE SH -M-71 (4-71-50)