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-2467-27;-)-00-601D
• ASPEN*PITKIN •
ENVIRONMENTAL HEALTH pDEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. / 01
TYPE OF PERMIT:
( )I.1-141 Construction ( )Emergency Use')n Mpeir Mork,(Piavlous Permit 1 .) ( )Alteration of an existing ayatem,
or installation / \ (Previous Permit I .)
( )Use Permit as a result of Sale ( )Othori
ISSUED TO:
DATE OF ISSUE x_14 _ A
Owner LYNN IURPmi, Rome Phonel2�I So �'7iBusiness Phone
Mailinp,.y,�W VJ ✓C_ LL/�S. I /� �Z�%
Addres n j/I A�E� iQE l 11
Phone9z�-- /z/70
Mail.ing
Address
Sewage Disposal System Work to be performed by, AR SEPTIC- L vat c -e L.&A✓AT/AiG
This permitr8-valid only for premises location by the following legal desert pilon(
LOT Siff t1.5ACES I MATER SUPPLY C06 -1-L- , AVEN((G-'E�� PERCOLATION MTF. /A
S
This Individual sewago Dlsposnl Permit is granted with regard to the following usot INGLE rAAIIL'i PES (DENC&
Muubcr oft Dodicoms —L Lofts_ Garbage Disposals 0 Dishwashers_ Clothes Washors
CALCULATED AVEMCE DAILY WASTE LOAD 30-0 GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER TRIS PERMIT:
Type of Tank or Traatanent Units 1 (C l/1TNr--
rrthod of rinal Dispo salt 67X ST/NG !&CEPAGE�ED Absorption
Description (including brand name, if any) of other equipment or appurtnance,t
Tank Capacity 00 _Gallon Htnlmm
Are, -t-ri Os square Feat - - -
Other Conditions or Specificationst -r L[i4%/0/✓ OF �Ef�/ /C �Ar"� / — / 6
R err-- sovtiD Soo C,44LCO/ MEiALL i`�/� T4A')A�:-
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation I )Upon completion of excavation and prior to placement of gravel ( )Before cnvering distribution
system of absorption field
KPrfor to backfill of any component ( )Other, Speclfyi
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
is hereby granted to tine owner or his agent to Pcrfnrm the work indicated above in accordance with the Pitkin County Individu41
scwagc Disposal Rennlacions in effect on the date of issue. In addition to g��e off ral provisions act forth on the reverse hereon,
this Permit 1a subject to VIC following aadditionlall terms and conditlons:t4o E
APPROVED FOR ISSUE BYfle r/J�i(*Y'�- (title)Ly�
Tho above individual se.mga disposal system installed by
has tx•en ln,gwcted for use by n repree cntattve of the As
resiwnsibiltty in cost of failure or inad quacy of this/
DATE
130 South Caelene Street
Complete as -bull[ drawing attached.
Aspen, Colorado 814319
303/525-2020
0
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test--- .r
PROPERTY OWNER
326 PHONE
MAILING ADDRESS 1242 Ad A1-0 J w c \ V
LEGAL DESCRIPTION OF PROPERTY&Of %q `D7 , 8 —eMz,
LOCATION OF TEST HOLES �D� Aim-e� mom- Loal
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 8 hour soak
5(e
6
C5
Percolation
Percolation Rate�Each Hole
Average Rate
Comments on soil or site: 6v _ aq" *4k5 t ?h w'O
8w,i/ � zC)
Signature
M7
�z���-
Date///��
AD
Percolation
Percolation Rate�Each Hole
Average Rate
Comments on soil or site: 6v _ aq" *4k5 t ?h w'O
8w,i/ � zC)
Signature
M7
�z���-
Date///��
d
3
71
13
I
0 0 0
I.
i
L 7-
EXISTING
BCD \
±go,
I q
34'
taop-TH
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SEPTIC TAMC
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• ASPEN*PITKIN •
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER L'/ N1kl PHONE
Address
of OWNER
Name of
APPLICANT 1413c:
c-
PERMIT To BE, ( )Picked Up
I Legal Description
I TYPCOF STRUCTURE,
( )Mailed to,
( )owner ( )APPlieaat .
S l ro --- &. /f0 CCS —
PHONE �'c,2 .r— IV 70
TYPE OF PERMIT, ( )New Installation 0Repair
1 !Emergency Use ( )Alteration NOT due to failure
SQC,I/rrtaS�
Filing Subdivision sire of Int acres
( )Sii,gle /sally Dwelling ( )Other, Do you plan any further additions to the
residence? ( )YES ( )NO
No. of bedrooms No. of Lofts No. of Garbage Disposals No. of Automatic Dishwashers
No. of Automatic Clothes Washers
NATER SUPPLY, ( )Private Well, D
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED,
or ( )Public. Name of System
(.)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
l IRecycling, potable use ( )Recycling, other use ( )Vault Privy ( )Other,
The initial site inspection must be arranged with the Aspen/Pitkin Environmental Health Department 1925-3010, 8:30-9230 a.m.l
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/PITRIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
Application for an individual sewage disp0 1 permit is hereby submitted. The undersigned acknowledges that the above Information
i• true and that [alae 1 sa os vii)) 1 !!date the application and any Subsequent pe it
% i>
Signature of Applicant
-=oft
`�� l DATE
(This appllcatlon comes. invalid It months from the above date.)
NOTE: PLOT PLAN must be filed with this application.
Please locate the following items by measured distances:
1. Property lines and dimensions.
Z. Proposed and existing water wells on subject property and
adjacent property.
1. Domestic water service lines.
4. Proposed and existing buildings, driveways, and other
structures.
5. 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 undersigned hereby acknowledges receipt Of this individual sewage disposal pe rmi/t]appileation and • pe�it !pa in the annunc
O! Pf6jU� Receipt Number Date Fee Arealved ,�r7 �(' ..by FN
Administrative officer
130 South Galena Street Aspen, Colorado 81611 3Q3/825-2020