HomeMy WebLinkAboutpitkin.eh.264321304004 (1990)ASPEN&PITKIN a /� j 3 _ a 13_ N- (bq
ENVIRONMENTAL HEALTH OEPARTIVENT T
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. � L x 4(d
TY E OF PERMIT:
)Initial construction (',)Emergency Use
or installation
( )Use Permit as a result of Sale
ISSUED TO:
Owner
Mailing
Address /
Agent C;) WALTLCS 1 -
Mailing
Address
( )Repair Work,(Pievious Permit f .) t )Alteration of an existing system,
(Previous (Permit ;f •)
( )Othors
DATE OF ISSUE
Home Phone92 =72/&_Busine_ss,Phone� 0
Phone 9 -5 2g'7
81L,02
:;ewage Disposal System Work to be performed by DOV-,V /��� /��•��
11 &gLjtv&ie ons for premises location by the following legal descriptions c. IQUS f
LJT S I2E NATER SUPPLY !S�UBD/ (/1SiO4 DtSiZC'i : AVERAGE PERCOLATION RATF. II"ILH
This Individual Sewage Di poral Permit is granted with regard to the following use: eAJQ-LC-&MILA LMIDL 12-6—
Nwaber ofs Dodreoms Loft 5C Garbage, Disposals_/ Dishwashers^�^ Clothes Washers _
CALCULATED AVERAGE DAILY WASTE LOAD Z� GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Type of Tank or Treatment Units�me- //Wk n Tank Capac y _Callon Hlnimua
method of Final Disposals �f11-7-4MIe.5WO B�O(6,��1EW4bsorptiop Area Square Feat Hinirrum
Description (including brand name, if any) of other equipment or appurtnancest
DbS1AJ6 AJ-0/God-&AGZv�tl . �c�s��e�
Other Condition! or Sp ifications
/n ,8E /FIs-7fiG�cD i9C'CDD� ('r Lflil/#' �J�tl/� S�'EC'/F�G9%/d,✓s
�,a /�1� i`;(IC'/NEE,es ��•i7 �O /O 9�
Sit X146 -o" P �)e a 6C
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation( Opon completion of excavation and prior to placement of gravel Before
-ystem coveringof distribution
Prior to backfill of any component l )Other, Specifys
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
Srwa,;c Disposal Revulations in effect on the d.,te of issue. In addition to general provisions sett forth or, the reveree hereo[,
this Permit is suhject to the following additional terms and conditions:
AWe(i,/Pitkin Environmental
(title)
Health Officer
APPROVED FOR ISSUE BY (--
The a` ave ln.iividual mc-10dispoNal system Installed by t//"�/""''�__ —rt
i,ns i�.•cn tn.:{•:meted for use .. !c?c rscn;.,C:vo .-" the i.'iy.�i', _!-.a _:.::ci....'�u:.
rv:.;>onsc�iltty in tae•: of fa'iiure or inadequac/ of tet aCW." c dig{<��1 uyztcm. Co mete �s-Guilt drawinq etischod.
1�,;TE O' FI*.,ij �r.;ni: . T t,l `� � 0
- -_" Aspen/Pitkin Environmental
EI• � _.�_�.__ -------_--------- TI'SLE`-------Health Officer
_----- -----
130 South Galena Street Aspcn, Colorado SIG11 303/820-5070
*0 ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN
INDIVIDUAL SEWAGE
DISPOSAL•PERMIT
�
PHONE
Name of OWNER
Address of OWNER 72
��'�
C U��//
Mame of APPLICANT
�d GtiR,tTcn5 G'V41_rc� s ���s� C-1 PHONE '1.e15-- zks' 1
'ER.ytT TO 9E: ( )Picked Up ''(e mailed tos TYPE OF PERMIT: (k)Nev Installation ( )Repair
9Owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure
xy,ATION OF PROPOSED SYSTEMS
ti fV
,egal Description
of
Block wi riling Subdivl
( )Others Do you plan any further additions to the
residence? ( )YES ( )NO
;R 0S/1 Size of Lot _acres
'YPE OF STRUCTURE: K)SingleFamily Dwelling
No: of Automatic Dishwashers
to. of bedrooms
.3' No. of Letts No. of Garbage Disposals / /
jo. of Automatic Clothes Washers 1
mTER_SUPPLYS ( )Private Well. Depth
or (NJPublic. Name of System
( )Spring
( )Stream or Creek
YPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDt '.
(()Septic Tank/Absorption Field ( )Aeration plant/Absorption Field ( )Composting Toilet )Othez)IncinQratlon Toilet ( )Mound
(*)Recycling, potable use ( )Recycling, other use
( )vault Privy
permit can be obtained.
;he�initlal site inspection must be arianged with the Aspen/Pitkin'£nvironmental Ilcalth Department (925-2020, 8:30-9:30 a.;n.
>he'ln a permit can be issued. The individual sewage disposal permit must be issued before a building p
RONMENTAL HEALTH DEPARTMENT PRIOR TO DACKFILLINC ANY PORTION
'1NAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVI
X THE SYSTEM.
application for an individual se "a a disposal permit is hereby submitted. The undersigned acknowledges that the above information
I's true and that false SnfortJlat willralldat the application and any subsequent permit.
'
signature of Applicant
t 71 r� DATE �C1
(This application becomes. invalid 2 monttu Szem 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.
Z• proposed and existing water wells on subject property and
adjacent property.
Domestic watet service lines.
4. Proposed and existing buildings, driveways, and other
structures.
5. Streams, lakes, ponds, irrigation ditches, and other water
courses.,
6. Proposed and existing individual sewage systems on subject
property.
N IS TO
SUBMIT A REVISED PLOT -PLAN PRIOR TO CONSTRUCTION IF INSTALLATIO
BE CHANGED FROM ORIGINAL
seb acknowledges receipt of this individual sewage disposal 4rmit Ppl cation and a permit fa 1 the amount
The undersign q(��R Y , Date Fee Received by
of i Z Si� G w , Receipt Number Administrative Officer
Aspen, Colorado 81611 303/925=2020
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#SPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
FIELD TEST DATA SHEET
Legal decription: 4l`
Name of owner:
Address: z 7 / r71(i. U�� y,(- /7 1 _W
s p.o. box) (c'ty) i (state)
Name of Agent: ---
Water Supply: Public Utility Subdivision Private Well
Lot Area 2 Distance to Nearest Surface Water r—a,. ft.
Dates Ob ervations Made: Soil Borings: 2-451AP by
Percolation Tests: by
SOIL BORING TESTS
TEST
NG NUM[[N
SR
DE•TN TO iROVNO NAT[A, /[[T
TOTAL o[•TN
FEET OlICNVCO [ITIMAT[O NIiN
CHARACTER OI 60IL VYITN THICKNESS IN /[CT
B-1
-Z2--.
of S FY
C� 44 X C,Pi 0//Ve %d
TEST C'IMC
DROP IN MATCH LEVEL. INCHES
MIN VT[S
TO FALL
SECOND TO
> 5EE Cj/E.tJ
TEST DEPTH
UMBER INCHES
TNICRr IN
SI'CCNO IN MOL[
IST MCT OVAM IGNTN
NT[AVAI
MINUTES
LAST PERIOD
PERCOLATION TESTS
Average Rate: -,2(jminutes/inch
Plan of he site on the back
Date Signature
BOB NELSON
A5rEN/P1TKJN
SANiTARiAN
130 S. GALENA
A�Pt:N, CO 81611
CHARACTER OI SOIL
Mg1A! TIAT[A
TEST C'IMC
DROP IN MATCH LEVEL. INCHES
MIN VT[S
TO FALL
SECOND TO
TO
TEST DEPTH
UMBER INCHES
TNICRr IN
SI'CCNO IN MOL[
IST MCT OVAM IGNTN
NT[AVAI
MINUTES
LAST PERIOD
MOST
LAST PERIOD
LAST
PERIOD
ONE INCH
P-1 1&
12�/
/
/L�
"'
P-2
C1
7
7
P-3
20
�„
?'/
Yu
/ f
/ 0
37—
Average Rate: -,2(jminutes/inch
Plan of he site on the back
Date Signature
BOB NELSON
A5rEN/P1TKJN
SANiTARiAN
130 S. GALENA
A�Pt:N, CO 81611
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