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HomeMy WebLinkAboutpitkin.eh.264326302002 (1991)ASPEN#PITKIN �? (o 4.3_ X63-Ua-cba ENVIRONMENTAL HEALTH DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. "I I J J TYPE OF PERMIT: ( )Initial Construction ( )Emergency Use XRepair Work,(Pievious Permit 1 .) ( )Alteration of an existing system, or installation (Previous Permit 1 ) ( )Use Permit as a result of Sale ( )Other: ISSUED TO: DATE OF ISSUE �!/ Ocaner� Mailing Address Home Phone Business Phone d -D Agent C��tIA�/ �` &AIS �/'(!�'-1/UN PhoneMaiUd aims AdMdress EV, K 72J, F/61 2— Sewage Disposal System Work to be performed by This permit valid only for premises location by tho following legal descriptions J3a"U LO'r SIZE T /qL l°" 11A 36 " ld d , WATER SUPPLY E� / y��� AVERAGE PERCOLATION R11TFnn f3Trd to SW&Lf-�IM�iY KESiDC_td�l-E_ This Individual Sewage Disposal Permit is granted with regard to the following use: P Nur.:ber oft Dodrooms Lofts 0 Garbage DispLooFals_ _ Dishwashers_ I .^ Clothes Washers --�—_. CALCULATED AVERAGE DAILY WASTE LOAD -S © GALLONS. THE NATUP.E OF THE SYSTEM INCLUDED /yUNDER ArTHIS PER1�fIT: rpe of Tank or Treatment Units i 1 �� �iv1� �-^ /w l Tank. Capacity / VGallon Minimum :shod of Final Disposals Absorptiop . Area P� [�i square Feet minimum zacription (including brand name, if any) of other equipment or appurtnaneess �DM C :then Conditions or Specificationst Ai 100 STAGES REQUIRING I dSPECTION BY THE HEALTH DEFAKIMEN-1: ( )Before ExcavationUpon completion of excavation and prior to placement of gravel system c o v e rti Before i n g distribution n Prior to backfill of any component ( )Other, specify: _ .AbAjk!5 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 Indivi;ival Scwa a Disposal Rcvulations in effect on the date of issue. In addition to ,y general provisions set forth on the reverse hercof, this Permit is subject to the following additional terns and conditions: A) //A Aspen/Pitkin Environmental APPROVED FOR ISSUE BY / (title) Health Officer Tho ahove in:iividual sc�rago disposal system installed by 1!5U& � -- hes bxcn in::pectcd fur use by a represcntativc Cf the Aspen i'it in unv►ronr_�nta Healt.. a ­;u+— �Q!3 a renponsibility in cese of failure or inadequacy of this ewag disposal system. Complete as -bull[ driving attached. DATE OF FINAL i 'P CT ON Aspen/Pitkin Environmental gY • TITLE � Health Officer 130 South Galena Street Aspen, Colorado 81611 303/S20-6070 ASPEN*PITKIN ENVIRONMENTAL HEALTH DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT Name of OWNER (._-4ghletr PHONE 4?c�-5749CO Address of OWNER Co 06�n 2Z Name of APPLICA14T h' PHONE q,25-- 086 PERMIT T TO BE: K Picked Up " LOCATION OF PROPOSED SYSTEMS ( )Mailed to: • TYPE OF PERMIT: ( )New Installation Repair ( towner ( )Applicant . 1 )Emergency Use ( )Alteration NOT due to failure Legal Description n Got J6 l? Block riling Subdivision � w`b'DOC Size of Lot acres rYPE'OF STRUCTURE: (kfSingle Family Dwelling ( )Other: Do you plan any further additions to the residence? ( )YES ( )NO to. of bedrooms_ No. at' Lofts No. of Garbage Disposals No: of Automatic Dishwashers _ to. of Automatic Clothes Washers S ^ MATER SUPPLY: ( )Private Well, Depth or Public, Name of Systemy✓ �/ ( )Spring ( )Stream or Creek TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED, NSeptic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound i )Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Other: The'initial site inspection must be arranged with the Aspen/PitkinEnvironmental 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 HE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION OF THE SYSTEM. Application for an individual se age di posal ermit is hereby submitted. The undersigned acknowledges that the above information Is true and that false info a w inv a the application and any subsequent pe i Signature of Applicant DATE (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. 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 undersigned hereby acknowledges receipt of this individual sewage disposal permit application and a it fee in a amount o! i P3(—, / e,6 . Receipt Number l , Date Fee Received ^+ j : by Administra vo officer 130 South Galena Street Aspen, Colorado 81611 303/950-6070 PITKIN COUNTY HEALTH DEPARTMENT PERMIT NUMBER _�%0 `•'::)-- Owner Owner's Mailing Addres ,I • "1 Contractor Address System's Contractor' ame Address � TAT RECEIPT NUMBER6P Phone No. %'g_f_— / Y 7 a Legal Description & / -' "_,- I i v-�_ L.v v v I, - Lot Lot Size —t,lZ� F-5 Type of Building by Use/7�lNG�� i�MtZy 1PEjtU KI—k— of Q.Arnnmc � Tvnp of Wntpr Ciinnly ✓%AlIeLO&OV -_)y9 sGM PLOT PLAN: ATTACHED AS REQUIRED Type of Individual Sewage Dispo� Type of Soil or Soil Classification Proximal Location of Bedrock Proximal Location of Ground Water Table Percolation Test Date © Minutes Per Inch Minimum Recommended Absorption System Size Minimum Recommended Tank Size S ecial Gitions of Issue: NOTICE p When properly signed for issuance, this application _ �5-:5— , becomes your permit. Application valid one year from AECv'41q&MO aco /0 n �/ V � date. If an individual sewage disposal permit is issued for property on which no building permit has been issued, the individual sewage disposal permit shall expire 120 days after its issuance if construction has not been commenced. Any change in plans or speci- fications after the permit has been issued invalidates the permit, unless approval is secured from the Health Officer for suc `changes. Approved for Issuance By Date FINAL INSPECTION APPROVAL Date (Drawing of System on Back) PITKIN COUNTY ENVIRONMENTAL HEALTH Fiend Test Data Sheet on Percolation Test PROPERTY OWNER �q '. �t�t,-�2 PHONE MAILING ADDRESS _ LEGAL DESCRIPTION OF PROPERTY LOCATION OF TEST HOLES Three (3) test holes required per system Test Hole Depths (24" minimum) Diameter of Test Holes Water remaining after 8 hour soak 0 TEST HOLE No.1 TEST HOLE No. 2 TEST HOLE No. 3 6�,I Drop Time Drop Time Drop Time -70'/,/,, Zq 7'N ,v Percolation Rate Each ole Average Rate AD Comment on soil or sit Signature Date ?11,�4 g