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Please See Building and Land Use Approvals Files for additional information.
2u4S-I�II -O2`Of
ASPEN*PITKIN
ENVIRONMENTAL HKALTH DEPARTMENT
�y
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0. !S `7`05LOE
TYPE OF PERMIT:
( )Initial Construction ( )Emergency UseRapaiv Work,(Pievious Permit l'n6,C tit-. .) I )Alteration of an existing system,
or installation //////`````������ (previous Permit 1 .)
( )Use Permit as a result of Sala ( )Othori
ISSUED TO: i DATE OF ISSUE'.
Owner krbw /,,/�elv Home Phone %2%-, Business Phone
Mailing,
Address A22t&
Agent�t
Mailing
Address
Phone
Sewage Disposal System Work to be performed byE�CHu//�LLE� — ��/I//Gi7AlEt/i//✓G
This permit valid only for premises location by the following legal descriptions 1-07 i'l CJkCH
LOS SIZE �//(./C,C WATER SUPPLY—'�aPd)IUjSIi71J (J cu_ • AVERAGE PERCOLATION
This Individual Sewage Disposal Permit is granted with regard to the following use "Z'IIJGLE/-Am 11—•
NwAer oft Bedrooms _3 Lofts Cartage Disposals
�_� Dishwasherss
_L Clothes Washor�_.
CALCULATED AVERAGE DAILY WASTE LOAD "-j-( � GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Typo of Tank or Treatment Units VvAckATED -TE'r 1/ANK Tank.Capacity_Gallon MSnlmaa �r. j�l jj /dA..,
]m_thod of final Dlspo3als5ff-P'4i;r-R Absorptloo Area Square rest Mintmua
Description (Including brand namee It any) of other equipment or• appurtnaneess
.Other Conditions or Spcelfleationes
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: -
I )Before Excavation ( )Upon completion of excavation and prior to p)apement of gravel( Before covering dlct-jt.utlon
ystem of absorption fir_ld
lylPrJor to backfill of any component I )Ocher, Specityt AJ/p N E
Plans and specifications of the pro Posed sewage disposal system have been reviewed and are considered satisfactory. Permission
is hereby granted to thr, owner or his agent to perform the work indicated above in accordance with the Pitkin County Individual
Srwa a Disposal Reanlations in effect on the date of issue. in addition to q,eq/craI provisions act forth on the reverse her•Iof,
this Permit is auhjcet to the following additional kerma and conditionat Ntq/V� ;
APPROVED FOR ISSUE BY"A_rgjZ (title )lLLQ1_
r
The above individual scua•)o disposal system Installed by IYI FWtN�INC.
has bccn ln:rpccted for use by a representative of the Aspen I•tt to Envuonml•a to Nealth Department. The ownur assumes a
reo)wnsiblltLy in case of failure or inadequacy of this sewagu disposal system. Complete as-bv Llt drawing attachod.
DATE OPIN�#L INSPEC IO
BY: !1� TITLErI 'i ; ric .
13 Souti4 CPalena Street Aspen, Colorado 91691 303/925-2020
GENERAL PROVISIONS OF AN
INDIVIDUAL SEWAGE DISPOSAL PERMIT
This Permit must be retained and made available for inspection at the above location upon
request.
This Permit shall not be transferred without approval of the issuing agency.
This Permit shall expire 120 days after its issuance if construction has not commenced and
a valid building permit has not been obtained. Any change in plans or specifications after
the permit has been issued invalidates the permit, unless approval is secured from the
Health Officer for such changes.
This Permit is temporary until final approval is granted by the issuing agency in writing.
Final approval cannot be granted until construction, repair and/or operation have occurred
in conformity with the conditions of this permit. This Permit is valid only for the indi-
vidual sewage disposal system and/or equipment specifically identified herein.
Before issuing final approval of this Permit, the issuing agency reserves the right to
impose conditional terms and conditions required to meet its applicable regulations on a
continuing basis. Monitoring and testing requirements may also be imposed. The issuing
officer shall be notified not less than 24 hours prior to backfilling or closing up the
work which would prevent inspection of components installed in places otherwise inaccessible
following such backfilling or closure.
This Permit may be revoked or suspended by the issuing agency for reasons set forth in the
regulations of said agency or of the State Board of Health, as applicable, including failure
to meet any term or condition imposed thereon during temporary approval or upon final approval.
Each and every condition of this Permit is a material part hereof and is not severable. Any
challenge to, or appeal of, a condition hereof shall constitute a rejection of the entire
permit and upon such occurrence this Permit shall be deemed denied ab initio.
This Permit is issued and accepted with the understanding that a fee in the amount of
$ , plus cents for each mile traveled by a designated inspector from
the principal office of the issuing agency to the location of the system and return, may
be charged for each of no more than two annual effluent samples routinely collected and
tested from subject system as deemed necessary by the issuing agency to monitor said
system for compliance with the Provisions of Article 10, Title 25, C.R.S. 1973, as amended,
and the rules and regulations which implement said Article; and that a like fee may be
charged for each such sampling taken in conjunction with the determination of compliance
of subject system with a cease and desist order issued pursuant to C.R.S. 1973, Section
25-10-107(1)(k).
The issuance of this Permit does not imply compliance with other state or local regulatory
or building requirements, nor shall it act to certify that the subject system will operate
in compliance with applicable state and local regulations adopted pursuant to Article 10
of Title 25, C.R.S. 1973, as amended, except for the purposes of establishing final approval
of an installed system for issuance of a local occupancy permit pursuant to C.R.S. 1973,
25-10-111(2).
APPLICANT'S SIGNATURE
a
ASPEN*PITKIN 0
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICF.MN F02 tiN INllI' ::'?J: L S::' -.A7:. DISPL)S[_L• PERMIT
Wawe o£ 0[:tl2ER ��/j�%(//� �Q�� --- _ PHONE �%�7, i7S�
Address of OWNER 03P1' /71QPL E D� .. �RRBO/YDAI�- ra &92'6
6
Plane of APPLICAN,r�'/ ?�//� Tf�/P-� � _ _ PHONE A72 7—
P£Rk IT TO PE+ ( )PL cYrd Ilp rJd pallei t]: T I; Or PF.RNIT• ( )NCY' I^�talttion WRepair
Or.,er ( )APPlicart i )L'mergeac/ Use ,( IAltereticn NOT Lue to failures
Jl!ASION 0; V1ID7OSED SYSTEM, '
Legal L'oscr;pticn
',oi_—�.� ri 1.'.ng_gond)-•f n'un fik"U, e Of Lot _ acres
—:-.L O single racily Dwelling ( )Others__ Do voo plan any further r.dditions to the
• -•�_ -- ata idente7 ( )YES K) NO
No. of t+ed:oosna_ _ Na. n[ iofta�— No. liL OarLage ofd,»a.,le _� _ _ tic. of Automatic Dishvashers
Ra. of Auto..a Lia Clothes Mashers f` ____
Q,TER SUPPLY! ( )private well, Depth Or NPublsc, ::zukkc C: S+aiem (
( )Spring //�_
( )Streasa or Creek
iYPEs or INDIVIDOAL SEWAO£ DISPOSAL SYSTEM P60i_J_SED+
06 Septic Tank/Absorption fieid ( !Aeration ;lanl/,,b20rptinn i'ie.sd ( )Cempoating Toilet f )lneineratfon Toilet ( Wound
( )Recycling, potable use ( )Recycling, ether us. ( )Vault Privy ( jG>'•.e:s_`
the lnitfal site inspection mus* he arr:.nc-c' vi*h + krper./Pitkin Environment.: li�_Ic . Oenrrl::mn! (9t5 -3C70, 8!70•9:30 a.r..i
tefere a permit can be i9rtad. TQC in'1 :•L^Cly. relay: G1 spOp._ per -.AL must Y< -esuei L,-;nre a b•Jilding permit cdn be nbt..ITed.
TIN..AL I11511::CTION APPROVAL KiET DE Lf*;:.1 VY ^ft ASFY:%/f ITX:N ENVIR:,UKUi'IhI. NE"TH L•COART. ZNT PRT_Lk TO 4ACXFIL'.ING ANY PORTIO.•:
CT TU: S:STEh.
*p'rlicatio„ for an Individual Zp"Pce dfeMaal pcsmlt ie horeby nubmittcd. The L. 2_rJL::.eL acxnowledgea that the shove intcrretion
il true and that fango loft ill Sn ij}Yda•e tho r.::p}Station are. any s�]tege: nt //pi�e roti.
Signature of ;.pplicant .,- r4&/DATE
(This apolieation bvcomer. invelid 27 mo -t%. _roc t::� aLove data.)
NOTE: PLOT PLAN must Le filed with this r:.nplication_.
Blease locate the following iteas by meaeured distances:
1. -Property lines and Ui9ension9.
2. Pr�,rlosed and existing water wells en subject property an.l
adjacent property. -
S. Domestic '.nater service lines. -
!. I•roposed and exisr.ing buildings, driveways, and cthcr
EI1—tures.
5. Streams, lakes, ponds, irrigation ditc as, and ocher water
courses.
6. Pro'+osed and existing individual sewage syst_ns on s:,Lject
property.
SUMMIT A REVISED PLOT PLIU.'' PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED rROl ORIGINAL PT-i0l.'
The undersigned hereby acknowledges receipt of thi n[lividun.l sewage dispoa:.l penait application and a per it a in the amount
of S ��Q -°- o , Receipt M=bar '3� (G oate fee P.ccalved ' 1 %- r , .by k� -.
AdminLat:ativo Of Llrcr
130 South Galena Street Ampaha Colorsdo 81011
303/925-2020
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER �w •� PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY T
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
i j /
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•
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Dro
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Percolation Rate Each Hole
Average Rate
Comments
Comments on soil or site: �!
Signature
Date
Owner
Address
PITKIN COUNTY HEALTH DEPARTMENT
PERMIT NUMBER 7, o 1) 6 0 RECEIPT NUMBER t(p p J (, _
Phone
Contractor / ��/y�� _ Phone
Address
Location of system �Q���A �,�, Lot Size
Legal description
Date 4- A�j/ �3 _ Siganture of owner
Percolation test data Ajz IOC a Q, minutes per inch
Minimum recommended absorption system size / Y y ? 6
Minimum recommended tank size / =Z..J
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 construction site.
DRAWING OF SYSTEM
1- o
f0 VS f5.
as'
—Fi;ld
Date �� ��� % ? Sanitarian
Me
-UitORADO DEPARTMENT OF HEAC
nater Pollution Control Di Sion
4210 East 11th Avenue
Denver, Colorado 80220
APPLICATION FOR APPROVAL OF LOCATION FOR SEPTIC TANK SYSTEMS
Applicant (Owner):
Mail Address:
City:
A. INFORMATION REGARDING PROJECT SUBMITTED FOR REVIEW: -
Phone:
Attach separate sheets or report showing entire area with respect to surrounding
areas, topography of area, habitable buildings, location of potable water wells,
soil percolation test holes, soil profiles in test holes.
1. location of Facility; County , t If./v City or Town
Legal Description , /� �O _�� T rC? Lot Size:
2. Type of area and facility - Number of persons served:
Subdivision Motel Restaurant Trailer Court , "f
Other:
3. Source of domestic water: Public (name):
Private: Well _ Depth _ Other _ Depth to first ground water table
4. Is facility within boundaries of City or Sanitation District:
If so name:
S: Distance to nearest sewer system:
Have negotiations been attempted with owner to connect:
If rejected, give reason:
6. Rate of absorption in test holes in minutes per inch of drop in water level after
holes have been soaked for 24 hours:
7. Name, address and telephone of person who made soil absorption tests:
8. Name, address and telephone of person responsible for design of the system:
9. Est. bid opening date: _ Est. Completion Date: Est. Project Cost:
Date:
Signature of Owner
- iGNF,TURES FOR LOCAL GOV0fENT OFFICIALS: The undersigna®have reviewed the.
proposal for the location of the above-described septic tank system and
RECOMMEND APPROVAL or DISAPPROVAL in the space provided below:
DATE APPROVAL DISAPPROVAL
/- /--7
Signature or Local'Hea Health Department
9 P
Signature for Mayor or City Manager
Signature for County Commissioners
Comments :
Signature and Title
Note: The applicant must obtain the comments and signature of at least one of the above.
C. FOLLOWING FOR STATE HEALTH DEPARTMENT USE: Recommendations of the District Engineer
D. ACTION BY THE COLORADO WATER POLLUTION CONTROL COMMISSION:
dWp-10 (Rev. 5-70-100)