HomeMy WebLinkAboutpitkin.eh.246725400585 (1981)Document Layout
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Permit
Application
Log Sheet/Notes & Photos
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Second System on property
Third System etc.
Floor Plans
Please See Building and Land Use Approvals Files for additional information.
i r
•AtPEN#PITKIN
:ENVIRONMENTAL HEALTH CIEPARTMENT
IFDIVID-tlgi. SEWAGE DIOPOS. PER-elT NOJL
TYP3 OF PERMIT:
((Tnat+al rrPetrcetion ( 1fm4rpnncy Jae l )kopa it Wur3, iPi4.loua r --mit !.i ! )"•lta:atic.• �f an eaicanq ev�tem,
Ur inatallation (PfavIOUA v'4rmSt .)
! )Was Permit as a re^.9It of Sato ( )Othorr
ISSUED TO: PATE OF !SME'c-5 p p1
0'Mzr_2- H a ex 110 me Phone 2S- 9 Businers Phflae�—
ares.310^^. Rox 2.8tos — -^-
--
G,1rlr�sfi
Se t;Ze Disposal Sy.ltc::l Work to be performed by O LiNEP-
This permit. vallrl ponrl'fy for promises, location by thw foll)ow�ing lona! dns.:dpt:r.n.µL 4 AS P&J K& �MNt=tf
We fa[E 39r f 1 /f\-eC_t J . MAtLP SUPPLv WE �• AVEPA(It PEACOLATIOO +ATE
TH* IndlvlG.:ai Sewego Disposal Permit is granted with regard to the foliewing cocca�&QF_ u
haabcr off D4dfooms W[cx Garbage Disposals-_]— wixiwashars�_ clothe" Washers
G•.LCU).ATEO NVZ. \GE DAILY WAS':E LOAD �.^y�_—GAun"d.
T::E Nr1TG'.E ;iP THE SYSTEM INCLUM LN'DPr, THIS P%.TiTT;
tt 7act, or 'fry xr. int rmlG�I '`, u�
:ict::c.; of F:ral Jl.p_vLrA8soR0-mv Ra `ci
oa•:'1�•cyC:. (incl u'ar••; OT• nnM. rL enY� U: o%t1�1�4/t
Tar'& Crpacit/y v�./1 Anllen P(1^lmr
Atavrptio0 Area ^..pSCSG_—_ `gears ru•:t ritninxgs
o3T—/aJ(p/oJurAtnac- st
arLet :'aMltlur.! cr spaclficaein:rsr V
SiAS S ::'t'QiitF.Irt, INSPECTIO?i Bf TP> 'r'E:II:CEi '_`32r1Axtd'1 /'
2nca••tzica i )Upon c*aplM.loa cf excavation and pr.ioc to poaseaari of gnvcir ^>fcr^ rnrcr!.•7 n:<.•;butioc
:7.trt of Lbsarp"nn field
n Pr!•.r as Lcckti:l of any cvrpunont t 19therr, 3pec!fyt
Pir¢s --a apacltuariuna or the ]roegGdu sc._oe di -poral Av.tem haves Sr.: [.^v iqv^d Ar.d ere -.r;afactcry. Pct.n'..sigq
I. ._r.:by gr..nte: ..q t:.r. nwnvr o& han agrnc to r^r fern the wo •\ i s✓:. -j tc', aF.vve 1. '1 acm•re-eee -wit I, u.- -t1:Io .•.•, r•• Inei•i.!Ila ;
S_.'a .e '.i :pc a_; •:•ar arsons :� ett"t on tea eat- of lneor. rn mf.l. c!or. to gercral Fr,vtatr.n., act :.. -o c.. 'r :^t �•t c.: F.y<ec=r
th:.s n•t t is suhlcct to tea eQllr+ mno arriational torma sad wndrtiols:
U-ROVF6 FOC. 13SUE B2"i 4'- - _ _ —• iti:ie)G!C�y1 %['�0)i/f%fi2, g -
R"ALUM.PECTION APPIROVAJ.;_ILLAIr AF�� -9'
Thr nlwnve Snd tm ideal ee wegr dlsco:..i sy ak.a ins tai led by aW..N�R._—, _ _ _-_ ,�_
h.H^.. •�.[.ai 4.r Jac by ••Jhrnytnterlve Of Lhc A:�pe.. �'it lr Envlre:.:*un[a`.1�—'��..L`,a .:p Ai. '"�.e �;.•ner nvaWM^.Y 4i
ee_!r�•tGt•a lty tr to Aa of f=tlu.-e cr in,do5wcy of this orwngq daa)•»a: 'y A.cm. `oo:pi^'.• + :.otic Jtay.ng a2 ach4A.
JAT3 lF MIA!. 1SSPn�:I033
� y t'"' = --- __
130 South Selene Street
____.�...._.__�,...._.�__
Ampen, Colorado BIG M
303/925-2020
4HN1?AL PROVISION'S UP AN
TNDT.VIDUAL SE'.ACE DISPOSAI. PEMI'i
This Permit must be retained rn.i 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 ebange in plans or specifications after
the permit has been issued invalidatt•s 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 ~ranted until construction, repair and/or operation have occurred
in conformity •,,ith the cnnditloo., of this permit. This Permit is valid only for td+e inJi•-
vidual sewage dispasal system an6/or equipment speci.fica?ly identified herein.
Before issuing iina.l approval of rM s Permit, rale issuing agen^y reserves the right_ CO
impose conditional terms and ccnditions required _n 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 inours prior to backfilling or closing up the
work whirh would prevent inspection of components installed in places otherwise inaccessible
followi_-ug such backfilling or closure.
This Permit may be revoked or suspended by the issuing agency 'or reasons set fortl, in the
regulations of said agency or of the State Board of Health, as applicable, -including failure
to meet any term or tradition 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 herecf 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 issuink 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 regulatiuns a-bich implement said Article; and that a like fee may be
charged for each such samplinS 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 s
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 chat the subject system will operate
in compliance with applicable strte and local. regulations adopted pursuant to Article 10
of Title 25, C.R.S. 1973, as aaended, except for the purposes of establishing final approval
of an installed system for iseuanae cf a local occupancy permit pursuant to C.R.S. 1973,
25-10-11.1(2).
APPLICANTS SIGNATURE
I
•APENIa1TKIN •
aMENVIRONMENTAL HEALTH DEPARTMENT
APPLICATIONN FOR AN INDIVIDUAL S_WACE DISPOSAL- PERMIT
�1
Name of OWNER PHONE
Address of OWNER— eO
'_ e-= of APPLICANT 0QyV. ¢— PHONE
6 P1nMtT Tr_ _DES (Picked Up • ( )Nailed tot . TYPE OF PERMITt New Inatallatlon ( )Repair
( )Omar ( )Applicant _ Ir ,)rmorgency use ( ))Alteration NOT dos to Iallua
_ vxATlon OF PROFOsrn sysTEYt 1�11
Ltgal Dcs.rlpaA/
oa �� , 5� R (
tut Lt -
Block riling suiil
re of Lot
TYPE OF STPUCTUREt (X Slagle Family Dwelling ( )OthertDo you plan any further addlticna to the
residence? ( )YES ( )NO
So. of bedroemsI_ No. of Lofts No. of Garbagi Jispoaals I No. of Autoamtie Dishwashers
No. of Automatic Clothes Wasters
N.11_F_A sOPPUT(Private Nall, Depth
spring
)Scream or Creek
,VPr.S OF INDTVIDI)AG SEW,,, -.E 31S'.OSAL SYS1..14 PROPOSEDt
or ( Imblia, Name of Sytt-m
PO Septic Tank/Adsorption Field ( )Aeration. Plane/Absorption Field ( )Comxsting Toilet ( )Ineinoraticn Tailot ( IMok,nd
( )Recycling, potable use i )Ra-yclin;, other ute ( 1Vault Privy ( )others__!_
TL: i:.iti:.: sits inspection moat t+.: a<: anu3 v: h Uie AaperdPitkin Ervirermmntal Health Ocoartmeat (975-20r0, i-34-9110 a.m.)
per:Ai: ce.1 bn issued. diaponal parmit muse to Ssaued bofo.e c building permt.. can be obtained.
FItA:. 1145,•ECTION NPRCVAL MUST bi. Q:'J`_'M ry T:E ASPEN/P1TX1N ENJIRONMENTAL 11EAL.TH 0EPARTi!=Rr PRIOR TO OACAFi LLING A.rr POSTION
OF S.X Sri rEM.
Auplaetttor. for an 1-.d4vidual sn�ag1 dtavaai o rmlt la htc+ subAittod, The undersigns{ acknowledge* that the above informatirn
to t,.P and that fals.t iri/er�T+/�j'i- ) v. i ate the ap tion end any subsequ.�nt permit. QQ
r.nn•'..-e or A('F/t^zrt � OAO DAT' I
(Thi_ apPlivaticn bC^Aeta. invalid 12 manila Prem the aWu�+, date.)
NOTE: PLOT PLAN saist be filed with this application.
:•lease locate the £o Llowing items by measured d'_stancesr
1. Property lir._s and di.neasions.
2. Propo5sv, and existing water wells on subjert property ani
adjecent prover -y.
3. D::c.cs`ic witzr s+:rvice lines.
A. Proo.,Ecd and e-i.stino buildings, dr-iVP'ays, and other
rtvuc=cres.
3. Streq"s, lakes, ponds, irsi^atiaa ditches, and other w:,.ter
co•.:cscs.
6, FrcroRea and existing i1:,Jlvr.dual sewage systems on subject
Vracerty.
SUBMIT REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF !NSTALLATION IS TO
VE CHANGED FROM ORIGIN-'iL PLAN.
The underatgnad hereby Wknnwl-dgto re.alpr of •h 4 inti Vidmtl aew,ae disposal "nit applicntlon and n porn a eoa e. !P2 nm,unt
eE I S sfo _ Aecelpt Nv:riur ��7 %.3 ., pate rt" deceived
Mala L.:.ro ti:v Off l car
3
130 SoutFa Galena Street Aspen, Colorado 81611 303/925-2020
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