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HomeMy WebLinkAboutpitkin.eh.264502200004 (1985)57 Q2� —00-061(ASPEN*PITKIN ENVIRONMENTAL HEALTH DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. SAO TYPE OF PERMIT: ( )Initial Construction ( )Emergency UseKAepair Work,(Previoua Permit 1�.) ( )Alteration of an existing ayatem, or installation / (Previous Permit i ) ( )Uae Permit as a result of Sale ( )Othort ISSLED TO: DATE OF ISSUE. O OwnerP Home Phone ` 3r Business Phone Mailing Address Poo. Cu:it,SS Agent Phone / j(CAV'�+1Tjl _L-si k'j �Lt� Phone -13421 D Mailing j� Address -2315- �Iou.WS O�eK ROAD Sewage Disposal System Work to be performed by BIC146sT 1JIJS'i'+EG -,T 7 /, v Z � n This permit valid only for premises location by tho following legal descriptionyM e -r l/y gg, fV(. LOT StZE p 733 �iCQFS . WATER SUPPLY AVERAGE PERCOLATION RATE This Individual Sewage Disposal Permit is granted with regard to the following use: St�GLE fIM%!y a ESlq�ve� Nurabor oft Dodreoms Lofts Garbage Disposals_ Q Dishwashers ^:_ Clothes Washers CALCULATED AVERAGE DAILY WASTE LOAD !4-70 GALLONS. THE . NATUP.E OF THE SYSTEM INCLUDED UNDER THIS PERPiIT: Typ.: of Tank or Treatment Units � I MK- Tank. Capacity Gallon Minlmua Mc- thod of Final Gisposalr j j/ -, L,SE: &-X] S%T-/wr A T- . Absorptiop. Area Square Feat Minimum Description (including brand name, if any) of other equipment or.appurtnancess Other Condition! or Specificationst STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: ' ( )Before Excavation ( )Upon completion of excavation and prior to placement of gravel ( )Before covering distribution system of absorption field Prior to backfill of any component ( iOther, Specifyt __ _ Plans and specifications of the proposed sewage disposal system have been reviewed andare considered satisfactory. Pernission i:r hcreby granted to tl,e owner or his agent to p•^rform the work indicated above in accorda,cc with the Pitkin County Indivi3lial Sewa,c Disposal Revelations in effect on the date of issue. In addition to general provisions act forth on the rovcrse hetcoe, this Permit is subject to the following additional trras and conditions: APPROVED FOR ISSUE BY __ (title) Tho ah%ve individual %e-wago disposal system Installed by -f���" (✓/�\.:� has b.�en I- I for use by a representative (.f the p, 'it 1 a Unvl rOn!'q-uta re:lwnsibiltty in case of failure or inadequacy of //t��htu se -l') diaposal ay -.stem. DATE 0 FINAL INSPE( ION (d ZQ Ilcalth Dcparun6nt. Th.! I)Wnur aSrl W'a3 a Complete az-built drawing attachod. TITLL 30 'South Galena Street Aspen, Colorado 81611 30 /925-2020 n E . ASPEN*PITKIN ENVIRONMENTAL HEALTH . DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT Name 'o f OWNER k\'" G V" 1 ti f: ) \"%,s A S Address of OWNER %'-k 14- lg� - - PHONE J Name of APPLICANT \4`+'t,ys--T 1 �� 1PHONE PERMIT TO BE: _VAPicked Up ( )Mailed to, TYPE OF PERMIT: ( )New Installation )Repair ( )Owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure LOCATION OF PROPOSED SYSTEM: Legal Description i Lot i Block Filing Subdivision Size of Lot acres TYPE OF STRUCTURE: (`)Single Family Dwelling ( )Other: Do you plan any further additions to the residence? ( )YES (,)6 NO No, of bedrooms No. of Lofts (" No. of Garbage Disposals _ No. of Automatic Dishwashers ir) No. of Automatic Clothes Washers I WATER SUPPLY: ~ ()Private Well, Depth ty 'J �7 , or ( )Public, Name of System ( )Spring ( )Stream or Creek TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSF.Di ()(Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound ( )Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Other: Theinitial site inspection must be arranged with the Aspen/Pitkin Environmental Health Department 1925-2020. 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 INSrECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION OF THE SYSTEM. Application for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information is true and that false information will invalid to the application and any subsequent permit. Signature of Applicant .Jl_. DATE t/A- (TAis application becomes. invalid 12 wont s 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 wager 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 permi fee iqltha amount of S�/��- , Receipt Number , Date Fee Received �D Ji��g� ,.by� Administrative Officer 130 South Galena Street Aspen, Colorado 81611 .303/925-2020 IeDW4ETCAL AMD 12'To ISS 1�1 vorPT-M) N N )F6`XeAUA-TjW oflmAn&q's A, 4L SVWaa Ouddr SLALI" -C 1 �_5©'