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Please See Building and Land Use Approvals Files for additional information.
•ASPEN*PITKIN
.•
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ENVIRONMENTAL HEALTH D 7 ,TM --
INDIVIDUAL SL:7Af;E DISPOSAL PF -.1' : NO. I ��
TYPE OF PERMIT:
'p In(tlal Construction : )Emergency 'Jae I ::tupalr vork.(Pievious permit i .) ( )Alteration of an exist(ng system.
\or installation irrevlous Permit t .)
( )Use Permit as • result of Sale : )Othor+
ISSUED ATOS: /
DATE OF ISSUE
Owner /V/i� �1 �''Cny p-�
Ha me Phone ii S% - 8tlsiness PhoneMailing
—
Ahi:lress 31R �MJOC-)Lti7Avc
Agent
*failing
Address
TU P -
Sewage Disposal System Work to be performed
Phone /23-7b32– I
This permit valid only for premises location by the follovinq legal description[/VL /V/VL /7 ULC LU ( O J /- 7 ✓ t'v
jc 52 /�e,P-�. t4ftFl- r
LOT SIZE vATY0. SUPPLY AVERAGE PERCOLATSGN MTF. C� } L
This Individual Sevagu Disposal Permit Ss granted with regard to the following "sae JAiV Lt rt of L y F�( DL`/✓�
]malsor of[ Dcdteoms 2 Lotts L? Garbage Disposaalls� Dishwashers Clothes vavhors
CALCULATED AVERAGE DAILY WASTE LOAD '3 ; `/ GALLONS. _
THE NATURE OF THESYSTEM
I?CLUJ�Ic[D��7NDER THIS P Fu7LT:
Type of Tank or Treatment U its Srr ' e TrT" - K
:tathei of final Disposal[ �CppC Q Absorptloa
_.IescrLption Ilncclfludlnq brand name. if any) of other equipment or appurtnances[
.Other Conditions or Speciflcationst
1
Tank Caparc�itty�_ ✓ `� —Galion MLnir—
Ates Tit'SCJ �1-5-p RFXc feet Hinlnum
STAGES REQUIRING INSPECTION BY i E HEALTH DEPARTMENT:
I )Before Excavation 1 )Upon completion of excavation and prior to pl,Cement of gravel Before covering distrlhvt`on
system of abso[ptem: :_..
/{Prior to beckflll of any component ( )Other, Specify+ �i6 &l L
Plans and specifications of the proposed sewage disposal system have been reviewed and Are considered satisfactory, Pe[n!s son
is Pcrcby granted to tb,i owrer or his anent is pnrfhrm the wet indicated above in aecar"rec with thr. pitk:n County :rdivl:val
Sevagc Dinpesal Rc•h:lacions in ctfc:c on tAc date of in+ue. In addition t geicral provL&,ana act forte on the reaerse hctcot,
this remit is awhiect to the following additional teras and condieto:a: IV 0/jr
T/
APPROVED FOR ISSUE BY L (title) �lti - 1 •
Tne shove in.tividual ovale disposal sy+:em inacall ed by �S/E/y it %�L�'�/ Lt//f'i e•+�N U
has be-,, I-:pecced lar van by a rrtp[rsentatvvo cf theTepee Pitt[n !nvi ron.+�ntarllra p••r t�ncnt. T. uwnut a'hie,•oa at
rvcPonsc L'illty in case of lai:uro or inaU -quacl of thcr uewana "caporal aystem. Com.pleta as -wilt :raving attacnud,
DATE OF FINAL/ JSPE IOi7_ 3
14 BY: f TITLE���
130 South O�a Street Aspen, Colorado B1611 303/925-2020 -
GENEPAL PaOVISIONS OF AN
INDIVIDUAL SEWAGE DISPOSAL PERMIT
This iermit must be retained and 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 vslid Luildi.ng permit has not been obtained. Any change in plans or specifications after
the permit has been issued invalidates the permit, unless approval is secured from the
Health Officer for such changes.
This V&nnit is temporary until final approval is granted by the issuing agency in writing.
Final approval cannot be granted until construction, repair anal/or operation have occurred
in confo-rmity with the conditions of this permit. This Permit is valid only for the indi-
vidoal sewage disposal system and/or equipment specifically identified herein.
Before issuing final approval of this Permit, the issuing agency reserves the right to
i..,posa conditional terms and conditions required to meet its applicable regulations on a
co:tinuiug basis. Monitoring and testing requirements may also be imposed. The issuing
officer shall be notified not less than 24 hours prior to backfilling or closing up the
work which would prevent inspection of components installed in places otherwise inaccessible
following such backfilling or closure.
rnis 2erni.t may be revoked or suspended by the issuing agency for reasons set forth in the
t
regulations of said agency or of the State Board of Health, as applicable, including failure
to meet any term or condition 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 hereof 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
S , plus rents 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 uubject system as deemed necessary by the issuing agency to monitor said
system for compliance with the Provisions of Article 10, Title 25, C.R.S. 1973, as amended,
aad tae rules and regulations which implement said Article; and that a like fee may be
cnarged for each such sampling 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
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 that the subject system will operate
in compliance with applicable state and local regulations adopted pursuant to Article 10
of Title 25, C.R.S. 1973, as amended, except for the purposes of establishing final approval
of an installed system for issuance of a local occupancy permit pursuant to C.R.S. 1973,
25-10-111(2).
n APPLICANT'S SIGNATURE
09
0SPEN*PITKIN •
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FCR A:) INDIVIDUAL SEWAGE DISPOSAL• PERMIT
Name or-
Address
fAddress
OWNER Mr. 'Woody Block 338 Ilincoln Ave. Palo, Alto PHONE (415) 571-5160
Calif. 943`1
of OWNER See above
Name of APPLICANT Christopher Morse Box 920 Nspen PHONE 991—AF,17
PEAMTT TO DE, ( )Picked Up - t<)N.tilod toxo TYPE OF PERMIT: ("Mev Installation ( )Repair
( )Owner a )Applicant . 1 )Emarsenry Use ( Uitecatlon :10T duo to fail..a
I Legal Description
I Lot_ .--
!Ypr Or STRUTCRa:
NE; NE} S.ec. 20 TBS. -RB3W 6th P.M
:Sling Subdivision size of Lot 4S.''2 acre•
]RASingic :'amily Dwe111nq l )Other, _ Do You plan any further��sadditione to the
sesldence7 ! )YES {')N0
vz. of tvdrocma ? No. of Lofts No. of Garbage Disposals 1 No. of Automatic Olshwashets
ao. Of Automatic Clothes Washers 1
WATER SUPPLY: 1 lPrivate well, Depth P anriinQ or 1 lrubllc, Name of System
( )Spring
1 lstrcem or Creek
TTPi'9 Or Imury,yOAL sE- ArF DisposAL SYSTEM PROPOSE7,
f+SSeptic Tank/Absorption Field ( )Aeration Plast/Absorption field
f )Recyclinq, potable use ( )Recycling, other use
( )Composting Toilet ( )Incineration Toi.et ( )MO,ind
( )Vault Privy ( :Other:
Tne 'initial site lnapeetien tact be arranges! with on- Ascen/Pitkin Cnvlronmenca: Health Department 1925-2610. 3:]0-9:19
kefore a pern-t can Lo 1.,"dd. TG_ individual swage disposal permit must be issued before a building permit an oc octai:.od.
FINAL INSPECT!:N AF? -OPAL MJZT 9E GIVEN BY TH: ASPEN/PITE_N ENVIRONMENTAL HEALTH DEPARTRENT PRIOR TO DACSFILL:%G ANY POAt1UN
DE THE SYSTEM.
App:Station lo- art Sadly/dual sewage die per t is herehy submitted. The ung ed saknowledgea that the above In Corina cion
is true and chat Ca:id inform sort will v ids Sha application and any subeq•�gnt craft./
Signature of Applicant DATEIL
Signature
/ (This application becomes. irvaa 23 on tba Prem "a above dace.)
NCTE: PLOT PLAN must be filed with this application.
please locate the following Stems by measured distances:
1. property lines and dinenEions.
2. Proposed and existing water wells on subject pr:perty and
adjacent property.
1. Domestic water service lines.
i. Prcpcsed and e::isting buildings, driveways, and other
stru--tures.
S. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and existinq individual sewsgz systems on subject
property.
SUBMIT A DEVISED PLC`" PLAN PRIOR TO rONSTRUCTION IF INSTALLATION 'iS TO
BE CHANGED FROM ORIGINAL PLAN.
The undersigned hereby aeknowtedgea rete 1pc of his lndlv:Cua1 se•+ale dlapoeal permit kation and a p ��c lee in Cho amn•:nt
Receipt Number %� Da to Tec Rtcoived __-�' / by
adminlstra Uvp oLClcpr
C� /f)0
130 South Galena Street Aspen, Colorado B1611 303/925-2020
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER 04'A F✓ 4- PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 8 hour soak
0
TEST HOLE No.1 TEST HOLE No. 2
TEST HOLE No. 3
DropTime Drop25
Time
Drop
L,
Time
11 /
S'
A VV O 7
;
0 c /
Sx
'I1,732 -
L
a /. L 9
3/
7 qZ
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
Signature
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