HomeMy WebLinkAboutpitkin.eh.264916101018 (1989)ASPEN*PITKIN 0
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PER2dIT NO.
V)-Initial
E OF PERMIT:
Construction ( )Emergency Use ( )Repair Work,(Pievious Permit 1 0 ( )Alterationeof a nlexisting system,
reviousor installation )
( )Use Permit as a result of Sale
ISSUED TO:
Otmer `C
:Mailing
Address
Agen t
Mailing
Address
( )Othor:
--- Home
(p
DATE OF ISSAE
Phone Business Phone
Sewage Disposal System Work to be performed by rr���� /�y[3
This permit valid only for premises location by the following legal descriptions r l.L � Y SiAIjIfeL &mrjej
iAi' S I L E �1 A C46 WINTER SUPPLY AVERAGE PERCOLATION INTI.- j2. Mj�.
This Individual sewage Disposal Permit is granted with regard to the following use: fiE//1M JLi ES�J7C�V�i�
Mraber of: Dedreoms 3 _ Lofts_ Carbagc Disposals_ DishwashersClothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD �i GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PER11IT:
Typ.a of Tank or Treatment Units�l(� A k- Tank. Capacity / U0Callon Minimus
Mct.hod of Final Disposals <�'�1�-�E iD��N�' Absorption Area Square Feet Minimum
De:;crlption (including brand name, if any) of other equipment or eppurtnancess
&14IS6�e Of 7/c)/t/
Other Conditions or Specificationst
STAGES REQUIRING I_JSPECTION BY THE HEALTII DEPARTMENT:
( )Before Excavation (�(�Upon completion of excavation and prior to placement of gtavel Y�teystem offore vabsorpterinj ioi fieldon
(KjPrior to backfill of any component ( )Other, Specifys _ ---
Plansand specifications of the proposed sewage disposal system have been reviewed and are ecnsidered satisfactory. Perninsi.on
is hcrc'.:y grantecl to tl,e owner or his agent to perform the work ir.flicated above in accordance with the Pitkin County Indivi.lual
scwa};c Disposal Re'tulotions in effect on the d:.te of issue. In addition to genera] provisions _.. :or'Pi
or: _,,. !-,ver-ie '!er7ei,
this P.jrmit is suhjeCt to the following additional terms and conditions:
ASpen/Pitkin Environmental
sem, Health Officer
APPROVED FOR ISSUE BY �'��'`^�" (title)_
TLr e:xive intvldual segs
.iao disposal system
aSnstailcd by _ __. — ----
has bx-cn in:pcctec] for use by a rcprescntativc of the Aspen Pit in Lnvironr eta Nea t.. Dep.trt,nent. Tho ..wnor as'taT.o-- sn
zc::;w ns_bility in cost of failure or road uacy of thio sewnyc disposal system. Complete a% -built drawing attached.
DATE OF FINAL INSPECTION
TI'rLE
130. South Galena Street Aspen, Colorado 81611 303/920-5070
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of OWNER Grr,Ac,r�n �� ��;5 �o�� ��� --
PHONE 2,-�5"-135-3
Address of OWNER PC), 4< (022 Ca ra�r
Name of APPLICANT revr, r u i��
O L... � �� r.. ��C(�i PHONE
PERMIT TO BE: ( )Picked Up - (?()Mailed tot TYPE OF PERMIT: {New Installation ( )Repair
0()owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failire
LOCATION OF PROPOSED SYSTEM:
2 C' 1 - , (OLAA r Es q!
Legal Description L k ,/
Lot 7 Z Block Filing 1i Subdivision(, 55 R: �' CDaAT Size of Lot . i� acres
�SkS
Do you plan any further additions to the
TYPE OF STRUCTURE: (()Single Family Welling ( )Others residence? ( )YES ONO
•� No. of Lofts_ No. of Garbage Disposals No. of Automatic Dishwashers
No. of bedrooms ��qq
No, of Automatic Clothes Washers ...1--- p
or Public, Name of System
WATER SUPPLY; ( )Private Well, Depth �c r-,
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDt
(jSeptic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
( )Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Other:
The initial site inspection must be arranged with the Aspen/Pitkin Environmental Health Department (925-2020, 8:30-9:30 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/PITKIN 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
is true and that false information will invalidate the application and any subsequent permit.
DA --E 10 -QC -1 J(cl
Signature of Applicant
(Shia 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.
S. 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 permit application andb a permit fee in the amount
o! S �LL_I Receipt Number Date Fee Received �U y
Administrative officer
A '�( ao()i
13b South Galena Street Aspen, Colorado 81611 303/920-5070
oo_ 00-n171 S
a e
t' k z`
MP 3
W� h
w)U
Iv proPo5c9 o N
J �
1 �
t
0 1
OAC � 0
P �1htl)c
ov obI Lc,+
Lv+ 2 v
No