HomeMy WebLinkAboutpitkin.eh.246734400019 (1986)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.
2Y&7— 3H-ooa/y
•ASPEN*PITKIN •
ENVIRONMENTAL HEALTH � MTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO
TYPE OF PERMIT:
I,
( )Initial construction ( )Emergency UseRopalr Mork, (Pcevlous Permit 1 ,'� �(✓ .) ( )Alteration of an existing aY+tem,
or installation (Previous Zarmc 1 .)
( )Use Permit as a result of Sale - ( )Othor+
ISSUED TO: n �( DATE OF ISSUE
Owner.'LGPd/. AwVI i lA�. HAu2ar —Home Phone / BBusiness Phone
Mailing
I' /EL(�QF�(� (V ! a1
Address I /
Agent IOFt /G/nikC Phone9�7—��%(O
Mailing ^ ��
Address
Sewage Disposal System Work to be performed
/� —� p �(� `` Cps''
This permit valid only for premises location by tho following legal domeriptions Ail act.— ISI ra,-, e) e,.71 JX s w
l �1
LOT StIE �2 /IC,E'C MATER SUPPLY L%1-ICUNT /DArI ��G[,[, AVERACE PERCOLATION RATE
This Individual Sewage Disposal Permit is granted with regard to the following us*, Stk�LC/!� /1M 1 Y Ch IDEua ..
Nu+.+ber of+ Dodreoms 2-- Lofts_L Cartage Disposals__ Dishwashers C.�� Clothes Mashors
CALCULATED AVERAGE DAILY WASTE SHAD ) CALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT: 7
i
rpe of Tank or Treatment Unit: )C���N k— Tank Capacity (7- C' _Callon Minimum
;shod of Final Disposal, SEEP�JE��E l'3.ED Absorptlop Area e.' Square Feat minimum
iptlon (including brand names It any) of other equipment or appurtnancea:
No�E
Other Condition! or Specificationst
6�jr
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
1 )Before Excavation ( )Upon completion of excavation and prior Lo Placement of gravol �fore covering distribution
stem of absorption field
Wi PT for to backfill of any component ( )Other, Specify, _
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
is hereby granted to thowner or his agent to perform the work indicated above In accordance with the Pitkin County Individual
Sewage Uispesal Rc•mlations in effect on the date of issue. In addition to general provisions set forth on the reverse hereof,
this Permit is sublet¢ to the following additional terms and condit4nss
APPROVED FOR ISSUE BY ` �� (title) l
The above indtvldual scvago disposal system Installed by
has b.•en Innlr c[cd fur use by a representative ran<ntacive o[ the Asp.* an Cnvtronmrn to jjealth neP,rtmenc. The uwnur aseumos a
ll
rvaponsiblliLy in case of [allure or Inad<quacy of thi acwAr disposal system. Comple[o as -built drawing attached.
rr _ DATE
�t LJ BY.�
9/daJ ct
130 Soutl
v/yV TITLE �L-'(
Aspen, Colorado 81611 303/925-2020
F—
e
0 0
ASPEN#PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of OWN
Address of
PHONE ') ? 7—e 6?
Name of APPLICANT �/ p zn��L ed���HONE 92 %-327(p
PERMIT TO BE: ( )Picked Up (X Mailed tot
( )Owner NAppllcant
I
Legal Description
F1
TYPE OF PERMIT: V)New Installation ( )Repair
( )Emergency use ( )Alteration NOT due to failure
Subdivlslon
Sire of Lot
acres
TYPE OF STRUCTURE: 01 Single Family Dwelling ( )Others Do you plan any further addlticns to the
+/�� resldence2 ( )YES ( )NO
No. of bedrooms_ No, of Lofts No. of Garbage Disposals No. of Automatic Dishwashers l/
No. of Autonatic Clothes Washers /
WATER SUPPLY: (>QPrivate Well, Depth or ( )Public, Name of System
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSFD:
(.)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
( IRocyCling, Potable use ( )Recycling. other use ( )Vault Privy ( )Other
The initial site inspection must be arranged with the Aspen/Pitkin Environmental Noalth Department (925-2020, 8!30-9:30
before a permit can be Issued. The individual sewage disposal permit must to Issued before a building permit can be obtained.
FIMAL INSPECTION APPROVAL MUST SE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PoRT:ON
OF THE SYSTEM.
Application for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above inforsution
Is true and that false (1 forma/tion will invalidate the application and any subsequent permit.
Signature of Applicant DATE
(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 CONSTIRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.
The undersigned hereby acknowledges receipt oC C 1• individual sewage disposal perml a'pp�l/ea tion and a permit/Cee In the amount
of 3_1/)L)� Receipt Number �c� Date Fee Received V-2 —t.by
Administrative Officer
130 South Galena Street Aspen, Colorado 81611
303/925-2020
•
•
40
A•n / Pitkin Environmental Health Department
Contact Log Sheet
Name:
ParcelID#: Address: 3 z Z
Date Person Spoken To Comments / Action to be Taken Initials Time
% _-r - / ,
y
ASPEN*PITKIN 0
ENVIRONMENTAL HEALTH DEPARTMENT
FIELD TEST DATA SHEET
Legal decription: 7K OZ JL/ -9—Y6
Name of Ow
Address:
Name of Agent: JOF we/Abaj S
Water Supply: Public Utility_ Subdivision_ Private Well
Lot Area: ± 1zA Distance to Nearest Surfa e/ Water ft.
Dates Observations Made: Soil Borings: /0 is 9y by �Q
Percolation Tests: p byl
SOIL BORING TESTS
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Average Rate: �20 minutes/inch
Plan of the site on the back
Date Zs Signature
kX NELSON
ASPEN/PITKIN
SANITARIAN
130 S. GALENA
ASPEN, CO 81611
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