HomeMy WebLinkAboutpitkin.eh.264322303001 (1987) (Orig Barn)26y3-225 -00 -00&
ASPEN40PITKIN SjJ aka Q- p
ENVIRONMENTAL HEALTH DEPART-iMENT f.&\ c ll (cy1s as -9 -8 sij
����222-QI-067
INDIVIDUAL SEWAGE DISPOSAL PER2IIT NO.
TYPE OF PERMIT:
( initial Construction ( )Emergency Use ( )Repair work, Oinvious Permit 1 .) ( )Alteration of an existing system,
installation
( )USe Permit as a result of Sale ( )Others
ISSUED TO:
O,,-ner�AIL14 r�tHome Phone
Address C• V►/SP��J t��11 �l �D'
(Previous Permit ( )
DATE OF ISSUE. /'�z
Business Phone
Agent om / t' Phone
Mailing
Address
Sewage Disposal System Work to be performed by
This permit valid only for premises )o cation by the following legal descriptions SZ -g. 2 �r�%9 ,S —1(/ - OJT .\
LO,r SELF. 1 �}MAUZES , WATER SUPPLY �Ey{,� AVERAGE PERCOLATION RATE. 3O M. 015_
This Individual Sewage Disposal Permit is ��EE �rP�ivi(T T2�j5
I po granted with regard to the following use:
Nut.,l>cr of: Bedreoms 6) Lofts_ L! Carbage Disposals_ 10 Dishwashers Clothes Slashers V'
CALCULATED AVERAGE DAILY WASTE LOAD S. t_ 0 GALLONS.
THE NATURE OF THE SYSTEM IN_CLUUD/FFDUjN�DER THIS P_EFMIT: �7
TTr,t:k or Treatment Units Tank Capacity (�lJ Callon MInimu:a
I".ethod of Final Disposals � C��t1 C LV_7 Absorption Area 2t Square Feet Minimum
D.scrlption (including brand name, if any) of other equipment or appurtnancess
NouF
Oth--r Conditions or Specificationss
�c) � �e-
STAGES REQUIRING I_JSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation (Upon completion of excavation and prior Lo p1neement of gravel ( )Before covering distribution
\ System of ab:orptioes fi..ld
(R)Prior to backfill of any component ( )Other, Specifys
?laws and specifications of the proposed sewage disposal system have barn reviewed and are considered satisfactory. Pecnis::S.on
i.� hereby granted to tLr owrer or his agenr to perform the work indicated above in a4cordance with the Pitkin County lodivi val
Srwa•;., Disposal Revulations in effect on the d.,te of issue. In addition to general provisions set fort; or, the reverse her�oi,
this P..rrnit i:, sut.ject to the following additional terms and conditions:
APPROVED FOR ISSUE BY _" (title)
T1•,o t`:wive in1ividual xe•.rago disposal system installed by DM EP __Z r /
has h.,cn In::,,.c;tcd for use by a representative ct the A9S:.:: i'ttirn '_'nvirc,n;-•.�,ta Hoa Dcp•.run�,nt. Tho uwnor+r�:ru.':•ca aTi
re sansability in ccs of failure or inadequacy of than sews a dlspoYll uya'cXR7
Ccmpletc ss-buill drawing attached.
DATE 0 ' z
I, INSPECT 021 AND 6 ��
"� TITL'
1 O' South Galena Street Aspen, Colorado 81611 3033/19.25-2020
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ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER 9- NC -h PHONE q1 $ - 71. , _
Address of OWNER O L3 7C y Z46 �S�^—�! C� � 5-11�'�Z
Name of APPLICANT /�, #I %M �� � �Y. PHONE Iq L
PERMIT TO BE: ( )Picked Up ( )Mailed toe TYPE OF PERMIT: ( )New Installation ( )Repair
( )Owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEMt
Legal Description 1 %-
Lot Block Filing Subdivision Size of Lot -+ -=< k-' acres
TYPE OF STRUCTURE: ( )Single Family Dwelling jOthert PARI) Do you plan any further additions to the
residence? ( )YES ( )NO
No. of bedrooms No. of Lofts (�� No. of Garbage Disposals No. of Automatic Dishwashers
No. of Automatic Clothes Washers 0
WATER SUPPLY: ( !Private well, Depth Ox Public, Name of System
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDs
Septic 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..n.)
t e a permit can be issued. The individual sewage disposal permit must be issued before a building permit can be obtained.
FInnL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
3a
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.
Signature of Applicant iA ' DATE 2,0'/
( is application becomes. -invalid 15 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 and a permit fee in the amount
c"'� Date Fee Received �/ , 'by t ry
OL S fC , Receipt Number Administrativo officer
130' South Galena Street Aspen, Colorado 81611 303/S25-2020