HomeMy WebLinkAboutpitkin.eh.264316401012 (1985)ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0. ,?���"���
TYPE OF PERMIT:
( )Initial Construction ( )Emergency Use
or Installation
( )Use Permit as a result of Sale
ISSUED TO:
(wller
0'.
Mailing,
Address
Agent /
( )Repair Work,(Pievious Permit 1 .)Xrevious lteration of an exi%.�ty/,i� .tem,
Permit 1
( )Other:
a ` sr -
DATE OF ISSUE ( ,
Home Phoneq2,J'3C P Business Phone
Phone
Mail.ing
Address
Sewage Disposal System Work to be performed b y_ga,�iThis permit valid only for premises location by the following legal dots iptions )—tr r-I'C as
LOT St r WATER SUPPLY :� ( 0AbM "�101���, AVERAGE PERCOLATION TF.
This Individual Sewage Disposal Permit is granted with regard to the following use:
Niraber of: Dodreoms _� Lofts Garbage Disposals Dishwashers L Clothes Washers _.
CALCULATED AVERAGE DAILY WASTE LOAD p�0 GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Aype of Tank or Treatment Units 1
t'v-thod of Final Disposals F;.0 C Absorption
Description including brand name, if any) of other equipment or appurtnancess
i
Other Conditions or Specifications$
Tank. Capa ty. ® ` ,Callon Minim=
Area Square Feet Minimum
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
dst
( )Refore Excavation ( )Upon completion of excavation and prior to placement of gravel Aystem, offorevering absorptionrfield ution
Prior to backfill of any component ( lother, Specify: _
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
is hereby granted to the owner or his agent to perform the work indicated above in accordance with the Pitkin County Individual
Sewa;e Disposal Revulations in effect on the date of issue. In addition tq ge ^
eL�1 provisions set forth on the reverse heroY,
this Permit is subject to the following additional terns and conditions:
APPROVED FOR ISSUE By 4LZ (title)
The above individual sewago disposal system installed by
hes been ln:.pcctcd for use by a representative of the Aspen 1'it in Lnvironrr,,:ntal Health Departrnant. The uwnur anaumos a
recl�onsibiltty in case of failure or inadequacy of chi sewag dispo 1 system. Complete as -built drawing attached.
DATE OF N ° IN' T
Ey: ` TITLE
130 South alena Street Aspen, Colorado B'16'11 303/525-2020
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL• PERMIT
PHONE
Name of OWNER (�^�. �7�//ice✓� �l�//G�� 7 ;
Address of OWNER, � fid) /R�GzL%9'
Name of APPLICANT PHONE
P£RtT TO BE: ( )Picked Up ( )Mailed tot TYPE OF PERMIT: ( )New Installation ( )Repair
( )-Owner ( )Applicant . ( )Emergency Use S?OiH teration NOT due to failure
I,(yL•ATION OF PROPOSED SYSTEMt
Legal Description
Lot Block Filing Subdivision Size of Lot acres
TYPE OF STRUCTURE:()Single Family Dwelling ( )Other: Do you plan an further additions to the
residence? (X)YES ( )NO
No. of bedrooms ✓ No, of Loftsl^ _ No. oL Garbage Disposals_ No. of Automatic Dishwashers
.._
Ko, of Automatic Clothes Washers
WATER SUPPLY: (/' Private Well, Depth — Or ( )Public, Name of System
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAnE DISPOSAL SYSTEM PROPOSF.D1
(.)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
( )Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Others
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 wil validate the application and any subsequent permit.
Signature of Applicant L-�' ' DATE
(This applicatio becomes. invalid 12 months from the above date.)
NOTE: PLOT FLAN 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 applicaatiio'n` and a perm t fee n the amount
of 3--,�n . Receipt Number , Date Fee Received �3d !� Y
Rdministrativo Officer
130 South' Galena Street Aspen, Colorado 81611 .303/925-202.0
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Per7ion Test
PROPERTY OWNER Tell 1? PHONE
r
MAILING ADDRESS
k
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
TEST HOLE No.1 TEST HOLE No. 2 TEST HOLE No. 3
Droo i 1 L Time Drop Time Drop Time
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
Signature
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A parcel of land being located in Section 16;
oo'
Township 9 South; Fange 85 West of the 6th Principal
Sag
Meridian. Said parcel is more fully described as
follows: beginning at. a point wherce the North 1/4
coiner of said Section 16 bears n12°43'08"W, 2894.88
feet; thence S21*01'E, 76.20 feet; thence S59°04'W,
4%
310 fee, more or less to the bank of the Roaring
3�
Fork River; thence Northerly 75 feet more or less
along the bank of the koaring Fork. River; thence
N59^04'E, 320 feet more or less to the point of
/
beginning.
I. Harold W. Johnson, a registered surveyor in the state of
Colorado do hereby certify that on the 15th day of July 1985
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