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ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PER11IT 140.
TYPE: OF PERPIIT:��n1Am6eA-
( )Initial Construction ( materguncy Use 17J Repair Nork,(Pievious Permit 1 1�'I�J Ty ,) ( )Alteration of an existing system,
or installation X _ (Previous Permit 1 q
( )Use Permit as s result of Said ( )Other,
ISSUED TO:
DATE OF ISSUE II -Z7-9 C)
Ownerj%16MA.S 4-I Q.(.(X6Z (�(�SI't.t/I I Home Phone gly3-Z ( O� Business Phone 9ZS- �-WZO
Mailing, ,ff
Address �.0 �0X�Y LA✓(JOV1G�a�l� i.0 ���Pz 3
Ma il,in g
Address
Sewage Disposal System Work to be performed
W11 -AN
Ir[cct"iq in SE'/J,Sw l4 s �4,
This permit valid only for premises location by the following legal description: T Sr 5 fz F.CVV
Llyr Sitli I a.c,vZ NATER SUPPLY 19V-IVak WZII AVERAGE PERCOLATION RATE.
This Individual Sewage Disposnl Permit is granted with regard to the following use: 6iraLe t'Q-Y1'l.lW
Nv.[bcr oft Dodreoms 3 Lofts Garbage'! Disposals_0 Dishwashers_ Clothes Washers I _
CALCULATED AVERAGE DAILY WASTE LOAD 4 s0 GALLONS.
THE NATURE OF THE SYSTE`1 INCLUDED UNTTDER THIS PIMNIT:
Ty?a of Tank or Treatment Unit: Septi C TO�-2vj� �L C�xd 5+i Vlg Tank Capacity �60 _Gallon Hinio,un
r!:tMd if Final oiapoaals P'65ol',��X
1 0n d Absorptioa Area square Feat Hinlnum
Ocsorlption (including brand name, if ^any) of other equipment or nppurtnaneess
2e co m vvte vIQ i r) .5 u u 0 a �i vevter Uaa U'C_ (so 4-1�-
Vr � I F � YG�c
Other Culdltios or eppcifieations: "
Pro � � / t 6tfiil-P.r' ,5t* �atk,5 YVi c l5f �je l vtR .
Scgsltw( 5l,ould �o� �x ivlsfzuCed in 1G�e eisGz�t�
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTPIENT:
( )Upon completion of excavation and prior to placement of gravel j>dBefore covering distribution
system of absorption field
k -w Ltd �i d ro ,y I 6X used
du1 vLway .
( )Before Excavation
(p Prior to backfill of any component ( )Other, Specify.
Plans/,,and specifications of the proposed srwaec disposal system have born reviewed and are ennsidered satisfactory. Pe coin .f on
in btroby granted to tl^ owrrr or his lorn.. to r�rforn the uork iwiltatrd ahnve in accorda..,,ce with thl: PLt::in irunri :rolivi.luaL
Snua; Disposal Ro•mlat.ons 1n effect on the d,to of issue. In addition to general pcavrsinns arc :arth on the rtverse L•et!ri,
this P.•rmit is ouble_t to the follcv Lnq ..Jxtronal tercu and conditlona:
Aspen/Pitkin Environmental
Health Officer
APPROVED FOR ISSUE BY ' A— (title)___.._
I930 Suu.n toalann Street. Aspen, Colorado ti 1639 303/900-6070
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Aspen/Pitkin Environmental
Aspen/Pitkin
Health Officer
I930 Suu.n toalann Street. Aspen, Colorado ti 1639 303/900-6070
AA
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IN
150 bail���
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4"c Tank.
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ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE 61SPOSAL-PERMIT
Legal Description
Filing SWAM
S t 'Q u W , a lP ,
C4) 1 11I
of Lot / +area
TYPE OF S'i-RUCTUREt ( 'Single Family Dwelling ( )Other, Do you plan any further aq!tItions to the
residence? ( )YES (rso
No. of bedrooms_ No. of LOfts No. of Garbage Disposals — y4 No. of Automatic Dishwashers
No. of Automatic Clothes Rashers /
WATER SUPPLY: d)P/rivate well, Depth or ( )Public, Name of System
( )Spring
( )stream or Creek -
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDt
C.)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )MOund
( )Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Othert
The initial site inspection must be arranged with the Aspen/Pitkin Environmental Health Department (925-2020, 8:30-9:70 a.m.)
before a permit can be issued. The Individual sewage disposal permit must be issued before a building permit can be obtained.
FINAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITAIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
AppIlcation for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information
Is true and that Calw 1 itlon will lnJvs�)idat he applies/t�Ylon nd.,any subsequent permit.
signature of Applicant s�r1�F� ` /�('/�Tj/ DATE_
(This applicatioh becoxs. invalid 13 months from the above date .l
NOTE: PLOT PLAN must be filed with this application.
Please locate the following items by measured distances:
1. Property lines and dimensions.
2. Proposed and existing water wells on subject property and
adjacent property.
3. Domestic water service lines.
4. Proposed and existing buildings, driveways, and other
structures.
S. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and existing individual sewage systems on subject
property.
SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.
The 3Mdersignad hereby acknowledges receipt Of thio individual sewage disposal permit application and a�`fee in the amount
of S � 0CIO Receipt Number ,- °! %21_ Data Fee Received i r�-b%f
Admini•tr+tivo OCLlccr
3
130 South Galena Street Aspen, Colorado 81611
31013/9215-2020
PHONE
Name of OWNER
Address of OWNER P/, �51�! 4:Z�/Y)-13
Name of APPLICANT
PHONE
PERMIT TO BE, ( )Picked Up (s�1/13ailed tot
TYPE OF PERMIT: p(1 New Installation (
/;
)Repair _
(✓lawnsr ( )Applicant
)Emergency Use (
)Alteration NOT due to !allure
Legal Description
Filing SWAM
S t 'Q u W , a lP ,
C4) 1 11I
of Lot / +area
TYPE OF S'i-RUCTUREt ( 'Single Family Dwelling ( )Other, Do you plan any further aq!tItions to the
residence? ( )YES (rso
No. of bedrooms_ No. of LOfts No. of Garbage Disposals — y4 No. of Automatic Dishwashers
No. of Automatic Clothes Rashers /
WATER SUPPLY: d)P/rivate well, Depth or ( )Public, Name of System
( )Spring
( )stream or Creek -
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDt
C.)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )MOund
( )Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Othert
The initial site inspection must be arranged with the Aspen/Pitkin Environmental Health Department (925-2020, 8:30-9:70 a.m.)
before a permit can be issued. The Individual sewage disposal permit must be issued before a building permit can be obtained.
FINAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITAIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
AppIlcation for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information
Is true and that Calw 1 itlon will lnJvs�)idat he applies/t�Ylon nd.,any subsequent permit.
signature of Applicant s�r1�F� ` /�('/�Tj/ DATE_
(This applicatioh becoxs. invalid 13 months from the above date .l
NOTE: PLOT PLAN must be filed with this application.
Please locate the following items by measured distances:
1. Property lines and dimensions.
2. Proposed and existing water wells on subject property and
adjacent property.
3. Domestic water service lines.
4. Proposed and existing buildings, driveways, and other
structures.
S. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and existing individual sewage systems on subject
property.
SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.
The 3Mdersignad hereby acknowledges receipt Of thio individual sewage disposal permit application and a�`fee in the amount
of S � 0CIO Receipt Number ,- °! %21_ Data Fee Received i r�-b%f
Admini•tr+tivo OCLlccr
3
130 South Galena Street Aspen, Colorado 81611
31013/9215-2020
r r ♦ P ,'�. " •n T, e,t 7 \ir r.. r.rnAT HEALTH
IT,.: rp
• PI':L1',� COil:::F D�P:.i�":•;.i:! Or :.t./�R�7.,tr.:Srt.n., ...tL.H
Box. V Asp!2n City ?fall
Aspen, Colorado .
925-2020
PERMIT "
System Location-�A�.��� / —
Contractor -
1. Construction approv>"ll:
' T 8 � R•88 Gt1•
Plans and location are hereby'approve3.
Perc. rate_ inches in1e minutes= sq. 'feet of
absorption area per bedroom.
X 16,5 sq. feet_'q. feet minimum require
m-nt.
equirement. I Suggest P �< 1=„O
Date rY--��fl- ��—a Inspector
2.' Final approval of system:
No sys.ell shall be deemed to be in compliance tirith the
$ev,ao •• 'Disposal Lads until the asse lEQ� SJRtE l isaJ?rGVe�
Urlor t0 COVeriri7 any ;Dart.
$'t serptic tank cleanout .�,ith gas seal
\71 ?roper materlals and assembly
f
Date /L /I�//�__ Inspector
' Retain With^...1_ V :4COr''I$ al CO: :. I i:Ci'.G'.' illy.
If et any time i.:: r. permit must hr c
repairs made irurcd�: mac_;/.
:Pr
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t
CAS T .O/V.O
FO.E �fi.,� Ca.;VYE.e cJF ,
Norte -
i/DC/,SE O/�/E:'NS/ONS' Ail/O G�^�G'F/T/ON /ti:
AT/On/ P�ViO�G' BY DsyvEr� .