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HomeMy WebLinkAboutpitkin.eh.264320406015 (1987)vhs-2oy-o(-ot6- `.bi f ASPEN*PITKIN ENVIRC)NMENTAL HEALTH DEPART ENT ILNDIVIDUAL SEWAGE DISPOSAL PERI -IIT NO.970&3 TYPE OF PERMIT: ( Inttiai Construction ( )Emcrgency Use ( )Repair Work,(Pcevioua Permit I .) ( )Alteration of an existing system, or installation (Previous Permit I ) ( Use Permit as a result of Sale ( )Othors ISSUED T0: DATE OF ISSUE D Ownerr(J��(i�E� Home Phone Business Phone al -in g . O. 3G l �E/�i. LTJ O) � 12- Address 1 Agent) Mailing !address Sewage Disposal System Work to be performed by Phone This permit valid only for premises location by the following legal doucriptionsj&7—S % _L� �Gr• IAT SI2F. 32 ACOFS WATER SUPPLY %VA%f 1,deaAVERAGE PERCOLATION RTTF.20 This Individual Sewage Disposnl Permit is granted with regard to the following usa;' Number oft Dedreomsy— Lofts_ Garbage Disposal., Dishwashers Clothes Washers CALCULATLO AVERAGE DAILY WASTE LOAD 7S GALLONS. I THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERiiIT: Typ.. of Tank or Treatment. /�U11ni�_ts C&_ / j��N9 Tank Capacit eve _Callon Minimu:a Mctfod of Final Dispo3all \GEpd/�� T�E�� �s Absorptiop Area � Square Feat Hin.lmum Description (including brand name, if any) of other equipment or,appurtnancess LOW WA 7-64 1)SE% o I ICT: (2/2- GAtGo v Ft!/SN) IrO ,BE/NSM44t-D- rther Conditions or Specifications: ONE STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: ( )flefOrC Excavation ( )Upon completion of excavation and prior to placement of gravelefore coverin•q distribution X.Byste:n of absorptio,l (i..ld APrior to backfill of any component ( ]Other, Specifyt Plans and specifications of the proposed sewage disposal system have been reviewed And are considered satisfactory. Pecr. isston i r hcrchy qra::te(1 to th,o owner or h13 a,ent to p•-�rtnrm the work indicated above in accordance with the Pltk.in C,,,unty Indivi:lual Sc-•.:a;c Dispesat Re•1:31-itions in effect on the d:,te of issue. In addition to general provisinna Oct fort` on _hc !-.verse LerzoP, this P,-rmit .ie s0'icct to the following additional terms and conditions: APPROVED FOR ISSUE BY `��(title)` I d The aixive individual ac•aa,io disposal aystcm installed by has been in:a,cc[cd for use by a representativc cf the Asl:cn I'it in Lnvlronm,—ntaal He�a th )v truntnt. Tho .)wnor aaau.:.os arl rccponeibility in Casa of failure or inad -quacy of thi acw.i,a disposal qy-Stem. Completu ax -built drawing attached. DATE Wi�3outh INSPEC IQ � v_// BY: TITLCJ�2 c 1lena Street Aspen, Colorado 81611 303/925-2020 ,rr. ASPEN*PITKIN ENVIFtUNMENTAL HEALTH DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT TYPE of STRUCTURE: KSingle Family Dwelling ( )Others Do you plan any further additions to the residence? ( )YES Pd NO No. of bedrooms 2- 3 No. of Lofts No. of Garbage Disposals © No. of Automatic Dishwashers No. of Automatic Clothes Washers WATER SUPPLY: Private well, Depth 5 } or ( )Public, Name of System ( )Spring ( )Stream or Creek TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (%yseptie 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 individua se d pos permit is hereby submitted. The undersigned acknowledges that the above information is true and that false in f mc. 1 i alidate the application and any subsequent permit. Signature of Applicant DATE dc'l /&I (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. 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 FR0M ORIGINAL PLAN. The undersigned hereby acknowledges receipt of this individual sewage disposal permit ppl ation and a permit feel in the amount o! S % , Receipt Number , Dace Fee Received ZL6 by Administrative Officer 130 South Galena Street Aspen, Colorado 81611 303/525-2020 PHONE Name of OWNER Address of OWNER 100./ o,X Z/ Name of APPLICANT PHONE PERMIT TO BE: ( )Picked Up - Kmailed toe TYPE OF PERMIT: New Installation ( )Repair (",owner ( )Applicant ( )Emergency use ( )Alteration NOT due to failure LOCATION OF PROPOSED SYSTEM: /S _ �oi �� �" % wl Pe• / Z Legal Description CJ �� r Lot Block_ filing Subdivision Size of Lot _j- ? acres TYPE of STRUCTURE: KSingle Family Dwelling ( )Others Do you plan any further additions to the residence? ( )YES Pd NO No. of bedrooms 2- 3 No. of Lofts No. of Garbage Disposals © No. of Automatic Dishwashers No. of Automatic Clothes Washers WATER SUPPLY: Private well, Depth 5 } or ( )Public, Name of System ( )Spring ( )Stream or Creek TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (%yseptie 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 individua se d pos permit is hereby submitted. The undersigned acknowledges that the above information is true and that false in f mc. 1 i alidate the application and any subsequent permit. Signature of Applicant DATE dc'l /&I (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. 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 FR0M ORIGINAL PLAN. The undersigned hereby acknowledges receipt of this individual sewage disposal permit ppl ation and a permit feel in the amount o! S % , Receipt Number , Dace Fee Received ZL6 by Administrative Officer 130 South Galena Street Aspen, Colorado 81611 303/525-2020 we f � i Cov��oc,�r -Tv Lev-val. S16� �i ito 40 Cuero , �e ep 3 'Za''r >o� �� C._o s, ock `7, �Yu.s�A- C',reeL J kke-^-. CnU-IA , Co. L I NES /N SPACE SYDNEY LINCICOML (L.S. /4111) BX CO-ORACO 81623 30 3832