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Please See Building and Land Use Approvals Files for additional information.
E
ASPEN*PITKIN .• .
ENVIF IRNMENTAL HEALTH D TMENT
INDIVIDUAL SEWAGE DIS?OSAL PERMIT 210.
TYPE OF PERMIT:
f )Inttial Conntruction I )Cmerganey UnaRopair Work,IPievlous P!rmit ) ��� .) ( )Alt-rarion of an existing ryataa,
or lnctallatlon //) (Pre Pioun Purmit 1
1 )Use Permit as a result of Sa:e I )Other, ,, �7 p
ISSUED TO: DATE OF ISSUE (� 22'83
Owner GcaeGE As Aooe Phenp-923-1103 Business Phone _
g
ddress P. P o. Box .36 UJoeoy 61"TKa 00 R/ (0
Addres___
Agent Lrgirisl, FivGNES e 2hcne2`3--
Ma:14r.g
ddtass
Sewage Disposal System Work to be performed byLaEL NU614F75
This permit valid only for prcmises location by t%� following legal dOveripaion,4:;& it, T4 A O Sw
Lor SIZE ;L20AQRe5 WATER SUPPLY /,4LL 1'IEMr..CC _PPEE.R,r/I/
CO`LATICH RAT9 A /�
�j
:his Individual Sevaga Dlspo-nl Permit is ar.i,"d with regord to Vic follcw.ng use, Vpe {,jt_Y / ES Q06,JC r .
Mu.,ber of, D•dreoma 0 Lott- I :arbage Disp�000ssaal�ls�� D Dishwashers �� Clothes Nasnors
CALCULATED AVERAGE DAILY WASTE LOAD &0 GALLONS.
THE \ATCc.E 01 THE SYSTEM INCLL^ED UNDER THIS PERM17;
pe of Tank at TreaiL ent UnLttS1F / iC-. AAjk_
thud of rinal Disposal, SffnAGF SBCAbsorpticp
escr:ption (including brand if :. ny) of other equlpaont or appuctnancas,
Tank Cap.city�__Callon Mtnimm
Asea XQO Sgoaru Feet Nlnim,_s
Other Corditiens or Spw ficaticner
SEEPAGE Lk -0 1/37- Agf SO FT. •Pen/ 14,*GflrloA% DIM" N A-40
G,eoM wE�_ �Tt� TA11K 1t105sBE So rr' u4ECL
STAGES REQUIRING II.SPECTION BY THE HEALTH DEPARTMENT:
/00 F -r
1 )Before Excavation ( )Upon completion of excavation and prior to pInCemert of gravely�l Before en�e rl nq discrlhutlnn
\system of absorption Itold
1 )Prior to backfill of any component ( )Other. Spacify,
Plans and specifications of the p.-opaaed sewage disposal system have bean revtere'_ and are cennl•Icrcd satisfactory. PermineAon
in hereby granted to the owner 3 t.ts agent to n„rfnrm tUa work indieatrd al»ve in .... rdanee with the Pitkin County In•I: vi.:•ml
Sevagc Disposal. Rwu,lationa in ._,fust on the date of isa ue. I at!It,on tO gen ral provis tons act for on ti,a revcras ha[aoi,
this Permit is auhject to the (allowing additional terms and conditional
APPROVED FOR ISSUE BY f (title)
The above Individual savant, disposal system Installed by Will
has becir ln.q+retod tur use by n repr"entat:ve cf the Aspec Pit[in'_ovi[or.a�nCa II: SIC OC"rament. Th.. "Inur a++awa .71
reopansibllity in ,a” of (ailuro o: tn'e•huacy of thea acwaqu diaposai eyatcm. Complato as -built drawing attached,
DATE0'D INAL iNSr't.CTIO
OF -
BY: /e TITLE'
r�1330 South Galena, Street Aspen, Colorado 81611 303/925-2020
�l �J
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GENERAL PROVISIONS OF AN
INDIVIDLILL SEWACE DISPOSAL PE-IMIT
This Permit 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 valid building permit has not been obtained. Any change in pians or specifications after
the permit has been issued invalidates 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 granted until constriction, repair and/or operation have occurred
in conformity with the conditions of this permit. This Permit is valid only for the indi-
vidual sewage disposal system and/or equipment specifically identified herein.
Before issuing final approval of this Permit, the issuing agency reserves the right to
impose conditional terms and conditions required to 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 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.
This Permit may be revoked or susoended by the issuing agency for reasons set forth in the
regulations of said ag.ncy 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 even 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 acceptei 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 issuing 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 regulations which implement said Article; and that a like fee may be
charged 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 'or 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).
APPLICANT'S SIGNATURE
d
— - — -----------1
ASPEN40PITKIN •
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INGIV?DUAL SEWAGE DISPOSA PEW1I.1'
Halve of OWNER� / L/t� ( PHONE �3—X103
Address of OhTNLP. '( 4 3% 1�(ib v %1456 �KS1Z- 34�f- Olb
Maria of APPLICANT
W
P!:_LT'ro !Lr: ( IPickal: rp •tailed tot
(hoer ( )APPllcant ,
EAC11r3017 or YRDMSED SYS -no
rryc( -P7-m-.1-44
PHONE 96)3- 2103
TYPr or PEN T, ( )Nov Installation yQ.lepais
1 )flnrrgency Ose ( IJUtsratirn NOT dua to fa slur..
Set IL-ISIS-AeTS(A)
-rilin9 Subdivision Sire of Lot
^.'nt'OF S'r. :TUFEt uSin•.lo family Halling ( ]others_^_
or tads Dame_ �. J� Ne, of lofts Nc. v: Carbage Dispceals _
'n, e( FYt Gm!c)n CJoth::n tAa. era
Do yon r•an eny further .:ddiVAthe__
resldercry ( )YES ( INC AIK Cy eltw
No: of Autoaatie Dle:ivaahtrs
`.Tck SUPPII, d:ivato Nall, tepth_UNor ( 1P.D:1-, Same o: System
or 1:rtek
-",FS OF TNn•J1^06t SE.Na:j F. n1SPOSA4 SYSTSK PPOPO':ED,
K•otic Find ( )Atr.tic.i Pl.nt/ALa-rption ritld ( )Comyorting Toilat ( )Incinc:atfon To;let ( )Hound
cYelLkg, pocabla cr- ( )RecYV:ing, oCict usr ( )Ta ,.t Privy 1 )Other:_.,
1..d_icl -r.
--Tr
_ .�...aat ]e i.;cd with tr.c Aapenl Pitkin £nvironmontcl Health DCF•rtment (i25-2020, 0:7 m
0-9170 a..)
,•
..crc a Fc.!tcan L- 7be II,-6vidvnl sewagt dirncs+l peratt must be iSSw•d before a building permit ccn rr obtained.
INSI•i.Cyl ON AFFRG:nIHE 11Y T4: AsPr(VrI:AIIf LNviroNY.EdTAL UALTH wCPARTKENT PRIOi. TO EACKM 3NG ANY PORTION
Cl' We SYSTFdi.
f.•hl [o: cion lw .r !-di•5 a• ! +v o dte'o. 1 Fermit is hyµµkX submitted. Th- undersigned acknowledges chat the above infornat:o„
a tree -Ad tha: (Bi Ce in 1 .a vii♦ In u L',a aJ�`YJ rr SIon :od any svb.cgc/m.t porrmit.
f).gxeucc of Avel:..,.nt - DAT
(This n?PlientJ cn becomes. invalid 12 month, fron the above date.) !
l:31'E: PLCT L.": must be piled w1t:.h this application.
Pl^^_sa locatc the fcllawiny items by measarcd distances:
1. P>:-,ptrty lin-s and dimensions.
a. f•ropc,a•d and existirt_ water w�l.ls cl: subjact property and
adljhrcAt ;toperty.
.', DomesLic water service lines. '
E. !•rcpased and existing buildi�lgs, driveways, and other
S. StreAms, lakes, ponds, irrigation Fitches, and other water
ccarses.
C. Proposed and existing individual sewage systems on subject
property.
I
SUBMIT A PFVISSD PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO
BE CHANGED FROM ORIGINAL PLAN.'
The undenl htrnby acknowledges receipt of t 1 'ndlvldual sevege disposal Permit a pli on and r por t ea in the Amount
U. 1 /sQ r keciipt Number_, Date res F,aceivtd ,.by
AAmirAs,trativo O(ficYr
130 South Galena Street Aspeh, Colorado 816M 303/926-20201
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PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
PROPERTY OWNER a PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF
Three (3) test holes required per system
Test Hole Depth's (24" minimum)
Diameter of Test Holes
35,E
r
511�/ v
Water !ema8 ursoak
/t4 47/0,7 b
4D r, wi C Oc N_
Fsjj��
TEST HOLE No. 3
L -
Drop
• ..
• . .
yTime
_:,i��
Lr�s► - .-
��IY/[fir _� �
�
a
NMI
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
Signature
Date ��/�