HomeMy WebLinkAboutpitkin.eh.264322110004 (1987)` . • � . ,. - EAG
ASPEN*PITKIN
ENV I NMENTAL HEALTH HEPAR r MENT
INDIVIDUAL SEWAGE DISPOSAL PE1U-1IT NO.
TYPE OF PERMIT:
Initial Construction ( )Emergency Use ( )Repair Work,(Pcevious Permit I .) ( )Alteration of an existing system,
(\\or installation (Previous Permit i )
( )use Permit as a result of Sale ( )Other:
ISSUED TO: DATE OF ISSUE.
OImer /iyitleL) AVDE20
.u�V67A) Home Phone Business Phone5-
ddre ng X C:�� I E'EN � ��10
Address
Agent_
address
0
Phone
Sewage Disposal System Work to be performed by�� ALIE kJAMS
This permit valid only for premises location by tho following legal jdt§cr1ption-&,- 4 Hi%�S—fi
LOT SItE�_ f Cc) , WATER SUPPLYcj AVERAGE PERCOLATION RATE.
• r1
This Individual Sewage Disposal Permi* is granted with regard to .the following use: C r��„E
Nuxabcr of: nodicoms `7` Lofts a . Garbage Disposals_ Dishwashers I Clothes Washers _.
CALCULATED AVERAGE DAILY WASTE LOAD 00 GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PER14IT:
Type ts£ Tank or Treatment Uf 7 .:
nits'3CC TA — Tank Capacity ' ) 11_, Callon Minin,u:a
Mct.hod of Final Disposal: A6� o A) 1t/C Nom' Absorptiop Area % Square feat Minimum
Description (including brand name, if any) of other equipment or appurtnancest
n1o��
Other Condition) or Specificationat
4df -
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation ( )Upon completion of excavation and prior to p%agement of gravel(JQ IIefore covering distribution
`system of absorption f:":ld
(Prior to backfill of any component ( )Other, Specify:
Plaos and specifications of the proposed sewage disposal systemn have been reviewed and ara ecnsidcred satisfactory. Pernissi.on
i:, hcrehy granted to the owner or his a.;ent to perform the work indicated above in accordance with the Pitkin County lndivi ual
Sewa•;e Disposal RQ-7ltlations in effect on the d.xte of issue. In addition to general provisions set forth or, the reverse her-ZoC,
this Permit is subject to the following additional terms and conditions:
c
APPROVED FOR ISSUE BY r __ (title)
�
Th<• P..%ve individual sci.rago disposal system installed by PM6U(�A __
ii�ss bucn in:p,ccted for uve by a representative of the Agpenn 11xi in Lnviron;>,•nta Hca. t Dcp7%r,r.,IIt._ TT17! wn,; ar.��u.�na ars
re::{:ons:bilxty in case of failure or inadequacy of th u sew qU disposal system. Complete a: -Lunt drawing attachod.
DATEZO-'''A
TITLE
130' South Galena Street Aspen, Colorado 81611
&-4; 25-2020
��/� ower) ate. ow.�„ (
• ASPEN*PITKIN
ENVIF•40NMENTAL HEALTH DEPAFI`{MENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name o f OWNS R14 ',-A GI id D 5 C PHONE
Address of OWNER?
Name of APPLICANT -13t:3, Y,4e-2% `4oyb6-5- PHONE
PERMIT TO BE: cked Up )Mailed to: TYPE OF PERMIT: VNew Installation ( )Repair
)Cvner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM:
egal Description%0
L'%C % 7.E �Ti9� �s✓�"/J Lfs .j (Qp /c-/� ��.� 5" �" /Qe .
Lot Block Filing Subdivision Size of Lot acres
TYPE OF STRUCTURE: ingle Family Dwelling ( )Other: Do you plan any further additions to the
IKresidence? ( )YES O
No. of bedrooms ? No. of Lofts No, of Garbage Disposals 11No. of Automatic Dishwashers 1
No. of Automatic Clothes Washers
WATER SUPPLY: ( )Private Well, Depth
C f5pring
( )Stream or Creek
or ( )Public, Name of System 0-T7V,?e- C S
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
eptic 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.
t Application for an individual ewage disposal p mit is hereby submitted. The undersigned acknowledges that the above information
is true and that false inf tion will inval to application and any subsequent pe it.
{. fr� �� DATE P An
Signature of Applican
(This application becomes. invalid 12 mo hs 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.
{. 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.
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 and a permit fee in the amount
of S o2 , Receipt Number , Date Fee Received ____� •bY �/4
Administrativo officer
13A South Galena Street Aspen, Colorado 81611 303/925=2020
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I PAP, 141 IJG
I"r'�N
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
FIELD TEST DATA SHEET
Legal decription:
Name of Owner:
Address:
Name of Agent:
P)
Water Supply: Public Utility Subdivision <- Private Well
Lot Area: Q C,4eJ—_,5 Dist nce to Nearest Surface Water ./� ft.
I&A4,1�0� 1>1 14 _ o
Dates Observations Made: Soil Borings: 7 by iC r
Percolation Tests: y AFFAI
SOIL BORING TESTS
000 o o 9999ogm
o 9 9 990
9 A go o o o goom 99 1
99 M A 999999 9 o A 99 Moo go o A A o Moo 9 99. o
.[NC
TET
TOTAL O[/TM
DEPTH TO GROUND WATER, •[[T
-
}v MVM•[.
P[[T
DROP IN WATER LEVEL, INCHES
TEST TIME
TO TO
MINUTES
TO PALL
CHARACTER Of SOIL WITH TMIC AN [/\ IN /[[T
Q{
THICKNESS IN INCHES
O/![RV[O
ESTIMATED NIGH
tiff
o B-1
>"
f<
NE B-2:
N1 11 o o o o
PERCOLATION TESTS
Average Rate r7 minutes/inch
Plan-ofite on the back
Date 7;;
Signature
BIOS NELSON
ASPEN/PITKIN
SANITARIAN
130 S. GALENA
ASPEN, CO 816 1 1
k'
C.... CTC. O/ SOIL
*4 *SIRS � WATER
DROP IN WATER LEVEL, INCHES
TEST TIME
TO TO
MINUTES
TO PALL
TEST
NUM/EK
DEPT.
INCHES
THICKNESS IN INCHES
SINCE NO IN NOLC
IST WET OVERNIGHT
N TERVAL SECOND NC.T LAST
N MINUTE LAST PERIOD LAST PERIOD PERIOD
ONE IN CN
P-1
2-1
P-3
y
P-4
0.
Average Rate r7 minutes/inch
Plan-ofite on the back
Date 7;;
Signature
BIOS NELSON
ASPEN/PITKIN
SANITARIAN
130 S. GALENA
ASPEN, CO 816 1 1
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