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HomeMy WebLinkAboutpitkin.eh.272909200018 (1978)/© -27 p PITKIN COUNTY HEALTH DEPARTMENT PERMIT NUMBER �0©�3 RECEIPT NUMBER Owner CS (%CPhone No. Owner's Mailing Address ,Z` dJ9Y24,Z11U44Z Z33 Contractor N/q Phone No. Address /.5�.3/�!//�/f / L_33 System's Contractor's Name �r�cz- //mGye­-s Address ! Legal Description CT/D�t� lD�' Lot Size ±2- fie' �S Type of Building by Use �,�A49�/dam/mays/SEN Number of Bedrooms Owner's Signature 3 PLOT PLAN: ATTACHED AS REQUIRED Type of Water Supply 6EL L_ Date '7Z311-753 Type of Individual Sewage Disposal System S� r/C��� Type of Soil or Soil Classificati Proximal Location of Bedrock Proximal Location of Ground Water Table Percolation Test Date 3 v Minutes Per Inch Minimum Recommended Absorption System Size 41-1-2619 I_Y20 2 L Minimum Recommended Tank Size AA90 6Xuolf,19 NOTICE Special Conditions of Issue: when properly signed 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 fo such ch gas. Approved for Issuance By Date FINAL INSPECTION APPROVAL Date (Drawing of System on Back) 0 lS� WELL P ConIcRET�• fzi�lGs 12' DEEP $ELOu1 ►�UtT) 4 PPkOXiMA-rLCY -6 7Z 5 Ap It I c TANK �oRrH PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER C --i �^Q PHONE MAILING ADDRESS LEGAL DESCRIPTION OF PROPERTY LOCATION OF TEST HOLES Three (3) test holes required per system f! Test Hole Depths (24" minimum) Diameter of Test Holes Water remaining after 8 hour soak TEST HOLE No.1 TEST HOLE No. 2 TEST HOLE No. 3 Droa & I Time Drop Time Drop Time D ?" Percolation Rate Each Hole Average Rate Comments on s it r site: - Signature Date/