HomeMy WebLinkAboutpitkin.eh.272929203001 (1978)03
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER () RECEIPT NUMBER /
Owner r` �S� Phone No. l'6 g',2 7
Owner's Mailing Address ���_✓�--
Contractor Phone No
Address
System's Contractor's Name
Address
Legal Description F °� 40,57e-kl l lJ 'co 4e4z S
Lot Size &ae. Type of Building by Use I&
7 s
11
Number of Bedrooms Type of Water Supply
Owner's Signature Date
PLOT PLAN: ATTACHED AS REQUIRED
Type of Individual Sewage Disposal System
Type of Soil or Soil Classification
Proximal Location of Bedrock >
Proximal Location of Ground Water Table -> V
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Percolation Test Date 9—,2Y:294 V�� — 7 ++ I&S— Minutes Per Inch —
Minimum Recommended Absorption System Size
Minimum Recommended Tank Size Z000���`�
Special Conditions of Issue:
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NOTICE
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
notbeen commenced. Any change in plans or speci-
fications after the permit has been issued invalidates
the permit, unless appro-1 i. ---1 from rhw Health
Officer for such changes
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Approved for Issuance By4t, Date �+
FINAL INSPECTION APPROVAL e —2 -3
(Drawing of System on Back)
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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
o
TEST HOLE No.1 TEST HOLE No. 2 TEST HOLE No. 3
: L I 31L -
Drop Time Drop Time Drop Time
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Percolation Rate Each Hole `r
Average Rate
Comments on soil or site: ? /
Signature
Date
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER `�� PHONE
MAILING ADDRESS
LEGAL DESCRIPTIOI
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
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
q7 L
Dro Time
17L-
Drop Time
47 �--
Drop Time
-7
D
Z ��--
5
r r,
Percolation Rate Each Hole
Average Rate
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Comments on soil or site:
j.0 al,� 2, r e*, `cam,
Signature i]..VVL1 j !_
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Date �`