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ASPEN&PITKIN
ENVI NMENTAL HEALTH HEPAR ENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.R g O ifs
TYPE OF PERMIT:
i`il Initiel Construction ( )En<rguncy Use ( )Repair Nork,(Pravlous Permit I..) ( )Alteration of an existing syvtem,
i A.
lnatallatlon (Previous Permit / ,)
( just Permit as a result of Sala ( )Othori
ISSUED TO:
Owner :Jogtj i- Holme Phone
Mailing „ ,
DATE OF ISSUE Lf
923- V:1 3 3
1 '77C6
t(2 '77C6 Business Phone
Agent Phone
Mail. ng
Address
Sewage Disposal System Work to be performed by
This permit``''(_Qvalid only for premises location by the following legal dcucription, W/lzAa 7a Asp_ Zoo, �/,yleK
LOT SIZE L11 , d Qe I NATER SUPPLY KZIJArE W,€11. AVERAGE PERCOLATION MTP. lz�.2 NASi
This Individual Sewage Disposal Permit is granted with regard to the following use: r—
^ 9 7 Sftii,l f f dW V/.7FSA9.tJC Z.
Nmalx:r oft Dedreoms e k Lofts = Garbage
7Disposals 1 Dishwashers L Clothes Washers j
CALCULATED AVERAGE DAILY WASTE LOAD 3W� GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PER1,IT:
Typ.± of Tank or Treatment
Units CDP C$b'Te- 'r ANK
Tank Capacity _Gallon
minlmra
ff.thod of Final Disposal,
/�k%a>Rtdtid TRowLed 1
Absorptlog
Arca Square Feet
Minimum
Description (including brand name, If any) of other equipment
or appurtnancess
Other Conditions or Specifications, ZF DQ-Z?624i16L IL U'&{ )Z"-�R" 10 RGgw t4�toalS ` SF+ Se AJCI &04k)
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation ( )Upon completion of excavation and prior to placement of gravel ( )Before enverinq distribution
system of absorption field
(XYrior to backfill of any component ( )Ocher, Specify)
Plans and specifications of the proposed savage disposal system have been reviewed and are considered satisfactory. Permission
is hereby granted to tl,e, owner or his agent to Perform the wrk indicated ahnve in accorJance with the Pltkin County Individual
Srva;e U1spe Sal RC.n:latlons in effect on the date of issue. In addition to general provision. act forth on the reverse herc_oe.
this Permit is subject to the following additional terms and conditions:
APPROVED FOR ISSUE B(title)_&wJLEL,1te,,, LcueaK ANle-c",
The abnvc lna vl' - - •. ___-• _.-____ .____.. _.
has ti -en lnapcct
rec„onsibillty i
DA'
BY
I' ^' s J
130 South Galena Street
omit u.; 0t..
mplain as -built draw1laIttachpJ. naai' I��lc IfaQIC'kll6�Gi �
Nancy MacKenzie
TITLE Aspen/Pitkin Environmental
130 S. Galena
Aspen, Colorado E31611 ?@?6i Ml32CRVl1
• ASPEN&PITKIN •
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL• PERMIT
Name of OWNER De-d6/^J PHONE
Address of OWNER
Name of APPLICANT
CI7
Z4 X16>ZA&9.
PHONE I/
PERMIT TO BEs K Picked Up ( )Mailed to, TYPE OF PERMIT: (IONew Installation ( )Repair
( )Owner ( )Applicant . ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM,
Legal Description
se of Let
TYPE OF STRUCTURE: toSingle Family Dwelling ( )Other, Do you plan any further additions to the
residence? ( )YES 1 )NO
No. of bedrooms 2— No. Of Lofta G No. of Garbage Disposals _� No. of Automatic Dishwashers
No. of Automatic Clothes Washers
WATER SUPPLY: N Private Well, Depth 14� /'!. or ( )Public, Name of System
( )Spring
1 )Stream or Creek
(Septic Tank/Absorption Field nA rp e ( )Composting Toilet ( )Incineration Toilet ( )!found
( )Recycling, potable use ( )Recycling, other use ( )vault Privy ( )Others
Theinitialsite inspection must be arranged with the Aspen/Pitkin Envirommental Health Department (925-2020, 8:30-9:10 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/PITlKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
Application for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above Information
in true and that false information will invalidate the application and any subsequent perrmit.
�i,
Signature of Applicant ��� DATE 3 r /
(This application becomes. invalid 12 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.
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.
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 underr&/1�gned ereby acknowledges receipt of this individual sewage disposal permit pile tion and a rm1it fee In amount
10,
Of 3 �7 V 1 Receipt Number Dace ree Received y - Z.% � 8 ; *-by
Administrative bfflcer
3 130 South Galena Street Aspen, Colorado 131611 303/925-2020
PITKIN COUNTY ENVIRONMENTAL HEALTH
j Field Test Data Sheet on Percolation Test
PROPERTY OWNER S�G� `I" 3A2(�,+ *% C 120-2 PHONE `q Z 77 �
MAILING ADDRESS (-a' &2
LEGAL DESCRIPTION OF PROPERT ITU
Pr Hnly. Q tut.. V DACM 124
LOCATION OF TEST HOLES K-� L'{Q �+
Three (3) test holes required per system
., 10
II
wd
Test Hole Depths (24" minimum)
Diameter of Test Holes 19)
1 1 �
Water remaining after 8 hour soak P 1*" 0 f-
Percolation Rate Each Hole
Average Rate %;L , ��
Comments on soil or site: G - l
yd 5�1+,1\vx•,
wA CCW -e5 et c-
�' f')6 U ZO A-e-0,.�1
Signature
y
Date
L
�� jri:� ��■l�xii��lll!��Ir���11.�•��•'1••l•��'Rt�
� ��p®���
RNIM
Percolation Rate Each Hole
Average Rate %;L , ��
Comments on soil or site: G - l
yd 5�1+,1\vx•,
wA CCW -e5 et c-
�' f')6 U ZO A-e-0,.�1
Signature
y
Date
L
11
�e5t�G2
tTG}
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