HomeMy WebLinkAboutpitkin.eh.246721202006 (1977)Document Layout
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Permit
Application
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Second System on property
Third System etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
PITKIIIN COUNTY HEALTH DEPARTMENT D
PERMIT NUMBER / > /7 9`�/ -L1 RECEIPT NUMBER
Owner Roger & Marjory Samuelson Phone No. 927-3557
Owner's Mailing Address pi 0. Box 267 Snowmass, Colorado 81654
Contractor
Address
System's Contractor's Name Ed Dreager
Phone No.
Address 0044 Hooks Lane, Basalt 927-3431
2 mi northwest of Snowmass, Colo
Legal Description Tract 64, Sec 21, Twnshp 8S Range 86W on Col Highway x{82.
Lot Size 0.459 Acre Type of Building by Use Residential house
Number of Bedrooms Z Type of Water Supply Community Well _
Owner's Signature 000i abate April 27, 1977
PLOT PLAN: ATTACHED AS REQUIRED
#}*******#****!***}***#*}#***#**#*****#*****************#***.**********}#***##****}#****#*
Type of Individual Sewage Disposal System ,Jc P 00 /1,, A!!5!1yK - cJCC-rnL C sr/ /n
Type of Soil or Soil Classification LnaM 7-O 5A1VOI, C- AL167L ANO
Proximal Location of Bedrock
- C1,.ec TCS?Fi-
Pro ximal Location of Ground Water Table 4127-Jf TE-, 11VF0 721-111/1 &
*####********##!!*!#######!!i!!##i#!###**********##***###*****#ii*********i*#*}******#i i#*
Percolation Test Date Minutes Per In h %
Minimum Recommended Absorption System Size %Zy,1,6ELL- IOX/O XS
Minimum Recommended Tank Size 7SO GALLOIVS:
Special Conditions of Issue: NOTICE
P when properly signed for issuance, this application
C be omas 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 "wage disposal permit shall
expire 170 days after its [nuance If construction hes
not been commenced. Any change in plans or specl-
ficetions after the permit hes been issued invalidates
the permit, unless approval is secured from the Health
Officer for such changes.
Approved for Issuance By Date -�j7
I*Is Is
gil*****Date
-7NAL INSPECTION APPROVAL � /Ze/�/
(Drawing of System on Back)
LrNE 12so GAILLonl
+EI 2�1 VCp,, CONL'RCTF
• � �PTic.TAn�
oRy
NousE
s•t:. r. y. I NX a •.4•a •
Date
Bill
Inspection Requested By.
Original Report To Be Sent Tb --5 ti"'e
Copy Of Report To Be Sent To
..- Owner
Parcel ID Number
Legal 114,
Lot -1!194—
Check/Receipt Numger
Building occupied vy, t Age Of Build
Date Septic Tank Last Pumped I�c(1 # Bedrooms_
DEPARV*Nr RH(XEmS: 7
Permit Number Year Issued �� ! No Records gonna
Septic Tank Size ty yl (Sq F�> LeachtFie d ic ate dal r �e
Leach Field Size `t:3
INSPHMCN:
Date Of Inspection Inspector"'�v�
Soil Conditions: Dry Saturated Snow Covered Other
Septic System: Functioning Satisfactorily Not Functioning
Comments:
2-
Water Supply: Public: Name
Private: Well , Spring , Cistern , Surface ,
Other
Well Construction And Location: Approved_
Unapproved Because
Bacteriological Water Test: Lab Number Date -`
Acceptable
Other
007TS:
A.P.E.H.D.:4/87
ASPEN*PITKIN
ENVIRSMENTAL HEALTH OEPAR'7ENT
RBpUEb FOR WRTM AND SEPTIC SYSTEM DZSPE(TICN
USE PERMIT MMICPdr ON
Date Requested
Bill To
Inspection Requested By
Original Report To Be Sent
Copy Of Report To Be Sent '
Property Owner
Check/Receipt Number
Parcel ID Number -
Legal 1/4, _/4, Sec.____1/4,Tom$, R Lfa W;
Lot Block Filing Subdivision
Building Occupied,_ Vacant a Age Of Building I( It-. /N/n
Date Septic Tank Last Pumped w, l I 3/xi
D£PARTMENP Rte:
Permit Number �M 22� —2 Year Issued 5 IQ --71 No Records Found
Septic Tank CapaciT 'ty ' (Gallons) Septic Tank Material L4.&—rt
Leach Field Size(Sq. Ft.) *a-�'? Type �Ak
Date Of Inspection -7 I7. Inspector a - Zyi
Soil Conditions: Dryer_ Saturated Snow Covered4� Other
Septic System: Functioning Satisfactorily Not Functioning
Comments:
Water Supply: Public: Name
Private: Well . , Spring , Cistern , Surface—r
Well Construction And Location:
Unapproved
Bacteriological Water Test: Lab
Other
A.P.E.B.D.:4/87
130 South Galena Street Aspen, Colorado 81611
M
ABC SEPTIC CO.
P.O. Box 129
CARBONDALE, CO 81623
925.1470 963-3829
SOLD 8V
DATE / as'(Fe
N
REB1 �� ^
CA H COO CHA OE ON ACCT./
-y�yo
CC
8///
RECEIVED OY
5- 1002 ` 1ank`You
All claims and reWrned goods MUST be accompanied by dds bill.
d
LL
- 14�65r4 B.I.
BUILDING INSPECTION DEPARTMENT
[:]CITY QWSPEN -COUNTY OF PITKINF}, DORADO
ADDRESS
Hy 82 West
PLUMBING OR
DOMESTIC APPL.
OF 108
PERMIT
WHEN SIGNED AND VALIDATED BY BUILDING INSPECTION DEPARTMENT THIS PERMIT AUTHORIZES THE WORK DESCRIBED BELOW.
Septic Tank
CLASS OF WORK: NEW %) ADDITION ❑ ALTERATION ❑ REPAIR [3 MOVE ❑ WRECK ❑
OWNER
NAME Roger Samuelson ADDRESS O• Box 7 PHONE
cc
LICENSE LICENSE
0
NAME (AS LICENSED) CLASS NUMBER
V
Imo-
ADDRESS PHONE
Z
O
SUPERVISOR
V
FOR THIS JOB NAME DATE CERTIFIED
PLUMBING
DOMESTIC APPLIANCES
FLOOR BSMT. 1 2 2 6 S 6
7 B OTHERS
NO. OF
UNITS
DESCRIPTION OF WORK
AUTO. WASHER
BATH TUB
AUTOMATIC WASHER
DRINK. FOUNTAIN
DISH WASHER
DISH WASHER
• Well
WATER SOFTENER
FLOOR DRAIN
GARB. DISPOSAL
OTHER- -
GREASE TRAP Ditches.
W t
REMARKS
SAND TRAP
Septic Tank 8x8x6-
SEWER-SANITARY
Cinderblock
SEWER -STORM
SHOWER
Dry well bxbx6
SINK
♦�
SLOP SINK
UNDERGROUND
SPRINKLER SYS.
�A 30
URINAL
7 � c
WASH BOWL
AGENCY
AUTHORIZED'
BY
DATE
ZONING
WASH TUB
WATER CLOSET
WATER
DISTRIB. SYST.
PUBLIC HEALTH
C'
Septic Talik
WELL
STATE
ENGINEER
r
OTHER
TOTAL "%TURES
BY FLOORS
VALUATION
TOTAL FIXTURES
ON JOB
OF WORK
NOTES TO APPLICANT:
FOR INSPECTIONS OR INFORMATION CALL 925-7776
PLAN
TOTAL FEE
THE VALUATION OF EACH OF THE ABOVE UNITS SHALL BE INCLUDED IN THE VALUATION OF WORK.
FILED T P
FOR ALL WORK DONE UNDER THIS PERMIT THE PERMITTEE ACCEPTS FULL RESPONSIBILITY FOR
DOUBLE
CHECK ❑
COMPLIANCE WITH THE TECHNICAL PLUMBING CODE REGULATIONS, PUBLIC HEALTH DEPAI TMENT,
STATE OF COLORADO, CITY OF ASPEN ORDINANCES, AND ALL OTHER COUNTY RESOLUTIONS,
lo•oo
CITY ORDINANCES, STATE LAWS, WHICHEVER APPLIES.
FEE ❑
CASH
NE WORING DY IN AVACE.
P ERMITRE UBJECTC TO REVOC ATION REUID 114SPETIONS SHALL 01 RE USP NSION FORKV OLATTIION OF DANYJ LAWS GOVERNING SAME.
BUILDING INSPECTION DEPARTMENT
A FINAL INSPECTION SHALL BEB ORE OCCUPANCY IS PERMITTED.
SIGNATURE
OF
APPLICANT _ 41"
DATE
TE
THIS FORM IS A PENT ONLY
WHEN VALIDATED HERE
DATE I PERMIT NO. I LICENSE 4I REGENTS CLASS I AMOUNT
7/11/67 C-89 I SEPTIC, TANK
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