HomeMy WebLinkAboutpitkin.eh.264322302007 (1988)ASPEN*PITKIN -
ENVIRONMENTAL HEALTH �EPAR� ..'TENT j „J� 2`- �� - (}�l
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
TYPE OF PERMIT:
Xlnitial Construction ( )Emergency Use
or installation
( )Usa permit as a result of Sale
ISSUED TO:
Owner b L' -J
Mailing
Address L?e)� 7l%'s
( )Repair Work,(Pievious Permit 1 .) ( )Alteration of an existing sysstem,
(Previous Permit t .)
( )Othorr
CIV
DATE OF ISSUE.
Home Phone Business Phone q2 57— 7? L/
1 bi 2--
Agent-2�i - �'LE� Phone
Ma i l.in g
Address
Sewage Disposal System Work to be performed by
This permit valid only for premises location by the following legal description: 0 ) {C'
:B�IV I SI'�� W
Loa SIZE 0 / , WATER SUPPLY C Ci AVERAGE PERCOLATION RATE.
This individual Scwagc Disposal Permit is granted with regard to the following use: C f°1. No os
Nixabcr ofr Dodreoms �� Lofts ` Garbage Disposals_ Clothes Washers -
r"
CALCULATED AVERAGE DAILY WASTE LOAD _�GALLONS.
THE NATURE OF THE SYSTEM INCCLLU'DED UNDER THIS PERMIT:
-- 'A� s� Tank. Capacity C✓' _Gallon Minimum
T•. o£ Tank or Treatment Uni i c�e( F Square Feet Mintrium
PSc d of Final Disposalss e'•r �(T- - Abaorptiop .Area
Description (including brand name# if any) of other equipment or appurtnancess
Other Condition! or Spccificationsl
1 VV`V�
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Dt•fore Excavation ( )Upon completion of excavation and prior to placement of gravel ) y stem ofafore vab orptioerinj n'fin
�!ld
� )prior to backfill 0¢ any component ( lOthec, Specify'
Plass and specifications of the proposed sewage disposal system have born reviewed and are considered satisfactory. perroissi.on
ie hcrchy jranLed to tl:c gwrer or his a9enr to perform the work, indicated above in accordance with the Pitkin County Individual
Sewa,,� Disposal Revnl.ltiorts in effect on the date of issue. In addition to general provisions set forth on the reverse het -20f,
this Permit is subject to the following additional terns and conditions:
Aspen/Pitkin Environmental
Health Officer
APPROVED FOR ISSUE BY (title)
Tho a:xwe individual scua.Ao disposal system in by /_��Z
has been ln::{.ected for use by a representative of the As{:en Pit in invironrn<nta
rec:ponseLili!y in c-' :1e of 'failure or inadequacy of thio s wA.)e ispoaal system.
DATE OF F 'SAL, I/NSSPPECT 'ON
I i T kJC.
lieu t. Department. Tho owner asorumoa a
Complete as -built drawing attached.
TITLE
Aspen/Pitkin Environmental.
_ Health Officer - __
130 South Galena Street Aspen, Colorado B1611. 303/525-2020
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ASPEN*PITKIN
ENVIRL,NMENTAL HEALTH DEPARI TENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER
Address of OWNER
Name of APPLICANT J1.!1LToN /-
PERMMIT TO BE: ( )Picked Up , KMailed tot
I )Owner KApplicant
PROPOSED SYSTEM:
PHONE W-5'1- Z% / 1
PHONE 2 2_ l I
TYPE OF PERMIT: ( New Installation ( )Repair
( rgency Use ( )Alteration NOT due to failure
Legal Description
Lot Block Filing Subdivision Size of Lot acres
TYPE OF STRUCTURE: ( )Single Family Dwelling ( )Other: Do you plan any further j�editions to the
residence? ( )YES Y) NO
r;
No. of bedrooms / � �
_ No. Of Lofts ( ' No. of Garbage Disposals No. of Automatic Dishwashers'
No. of Automatic Clothes washers
WATER SUPPLY: ( )Private well, Depth or Public, Name of System
( )Spring /
( )Stream or Creek
TYPES of INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
MRocycling,
Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incinera
tion Toilet ( )Hound
potable use ( )Recycling, other use ( )Vault Privy ( )Other:
The initial site inspection mist 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.
t . INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
t ;E SYSTEM.
Application for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information
is true and that false informations will invalidate the application and any subsequent permit.
�ar,
Signature of Applicant _
Q-Lt.e.t , A.!� DATE I—/ t/— Sl
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.
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 undersiggPd hereby acknowledges receipt of this individual sewage disposal permit Application and a per
in the amount
Th_ 7_� - , Receipt Number , Date Fee Received -by
Administrativo officer
130 South Galena Street Aspen, Colorado 81611 303/9252020
506 East Main Street
Aspen, Colorado 81611
303/1925-5973
BU NG PERMIT APPLICATION
ASPEN*PITKIN
REGIONAL BUILDING DEPARTMENT
Jurisdiction
t
General
Construction
Permit
NO. 9055
Applicant to complete numbereo spaces Drily.
JOB ADDRESS
,.y
�.
TRACT OR SUBDIVISION
RSULLOT
(LI SZ
NO.BLOCK
tA
MA.ILL ADDRESS
OWNER
.�. l
7 i / .. ^II
L
MAILADORESS
CONTRACTOR
PHONE
LICENSE NO.
4. tT .oma
ARCHITECT OR DESIGNER MAIL ADD RE
PHONE
LICENSE NO.
ENGINEER MAIL ADDRESS
PHONE
LICENSE NO.
6.
USE OF BUILDING
7.
6 Class of work: /EW ❑ ADDITION 47 ❑ ALTERATION rl REPAIR ❑ MOVE ❑ WRECK
g, Change of use from
Change of use to
zz
00 oIa
00
�
�7
ll
l OValuation of work: $ jd
11, REMARKS:
A
APPLICATION ACCEPTED
PLANS CHECKED
APPROVED FOR ISSUANCE
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BY
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DATE
DATE
DATE
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NOTICE
SEPARATE PERMITS ARE REQUIREDFOR ELECTRICAL, PLUMBING,
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ASPEN46PITKIN
ENVIRONJA-ENTAL HEALTH DLPARTMENT
Legal decription:
Name of Owner:
Address:
Name of Agent:
FIELD TEST DATA SHEET
'GO V7 toAA;C-�+
(# & st: / p.o. box)
�46(gLe�;g-
!5 & 0 AK12-
(city) (state) (zip)
Water Supply: Public Utility_ Subdivision Y, Private Well
Lot Area: Distance to Nearest Surfa e Water ft.
Dates Observations Made: Soil Borings: by lerl�j
Percolation Tests:
kX by &EA]
SOIL BORING TESTS
xx
TO GROUND -.'E-, IEEI
7 E . I
U. . C A
TOTAL DEPT.
F E I 1
CHARACTER Of SOIL INIT,R IN FEET
0 . It - VED
KST..AI1O RIC.
B-1
/
—Cc H IR HOLE
IST CY VE
NTE. V—
I N MINUTES
L
P-1
-
B-2
A
--:H
Z:
PERCOLATION TESTS
Average Rate: -// minutes/inch
Plan "7
of he site on the back
�, c�
Date Signature
kT,
VN -#V 114GLOIIIAN
ASPEN/PITKIN
SANITARIAN
130 S. GALENA
A:- F IN, CO 8 16 11
CHARACTER
NOW., ".IE.
YES' TIM E
DROP IN RATER LEVEL, INCHES —VIES
TO TO1 I
,EST
NUM SCR
DEPT.
INCHES
Or SOIL
THICKNESS IN INCHES
—Cc H IR HOLE
IST CY VE
NTE. V—
I N MINUTES
11C.— —Y I. LAST
LAST PERIOD LAST PERIOD 0 100 ONE.IN C.K
P-1
A
P-2
P-3
P-4
.:l
NOK 9 S9 NX 9Q JCR 99
A1 NR 9 A A9 A N� At 39 J9 3�
fK 1N Al 9
V7K 39
3C At S9 rX1 NIL K2 ��11
Average Rate: -// minutes/inch
Plan "7
of he site on the back
�, c�
Date Signature
kT,
VN -#V 114GLOIIIAN
ASPEN/PITKIN
SANITARIAN
130 S. GALENA
A:- F IN, CO 8 16 11
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