HomeMy WebLinkAboutpitkin.eh.264326304001 (1989)V3-aG3 - C, 00
r - ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0. 5
TYPE OF PERMIT:
)Initial Construction ( )Emergency Use ( )Repair Work,(Pievious Permit ! ) ( )Alteration of an existing system,
or installation (Previous Permit ! )
( )Use Permit as a result of Sale ( )Other: /
ISSUED TO: DATE OF ISSUE
A ;
0lcner2jokoHAYA� Home Phone
Mailing � d : J / Address I �(L�APE-Al.
Agen t--�
Ma i l.in g
Address
Business Phone
Phone 012-0 OZ
Sewage Disposal System Work to be performed by
Thin permit valoid only for premises location by the following le(l�,?I descriptions b �0J
LO'I S I 45-
C�'ES WATER SUPPLYStAe +�tef)csCS91,91 l/rS%O/AVERAc;E PERCOLATION RATE �
This Individual Sewaye Disposal Permit is granted with regard to the following use: (II�L � �L%f� � PrA)Ci�
N,xabcr of: Dodreoms Lofts [�' Garbage Disposals_ / Dishwashers �� Clothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD ( , GALLONS.
THE '_ATUi:E OF THE SYSTEM INCLUDED UNDER THIS PER1IT:
Typ•:! of Tar.k or Treatment Units �/� /A � �O Sank Capacity '�� _Callon Minimua
Method of Final Disposaiz 6C Y,T Absorptiop AreaSquare Feet Mininum
Ocscrlption (including brand name, if any) of other equipment or appurtnaneeat
I Tom, &70 SQ FT E, -A2 H; %�� 16 �X 1012-�DEE�
Other Conditions or Specificationat ��� �C J�G� � � �/ 1,cc 7/0AJ %W6�
1-7—
D AJ &V6eSC
STAGES REQUIRING I_1SPECTION BY THE HEALTH DEPAR'TNENT: /A�['
I )11•forc Excavation Upon completion of excavation and prior to placement of gravel i/11Before covering distribution
/' `System of absorption field
( )Prior to backfill of any component ( )Other, Specify:
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
iw hcrcl.y granted to tl:c owner or his agent to porform the work indicated above in accordance with the Pitkin County Indiviinal
Sewa;o.Disposal Re•mlations in effect on the date of issue. In addition to genera) provisions set forth on the reverse hereof,
this Permit is subject to the following additional terms and c ndit ons:
v _ //� r - - Aspen/Pitkin Environmental
hPPROVED FOR ISSUE BYl_ �ie (title) Health Officer
Th(- a!•avc ir..iividual ncwa•)o disposal ay+tea SnsWllcd by_���li
i ijas b,cn in.;pccted for use by a represcntativc ref the Aspen,%"i-iitr,in Lnv:ronil-•nta Rcalt-�cp-+rtm:=nt. Th. ,,not a3•iur^'0s ATl
• rc::;,ons:biltty in ease of failure or inad qu f t iu sew.nle dispoual sy-item. Completo as -built draving attached.
r
DATE 01' FINAL. Ir '' '7:: 'TI N _
. Aspen/Pitkin Environmental
BY , T' LF _Health officer
�`(
130 South Galena Street Aspen, Colorado 81611 30/920-5070
-µ ASPEN*PITKIN
ENVI NMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER Mo{zt' AIJ M68 4AYE551 PHONE 220
Address of OWNER Q(o?0 JO/�l�r�OlJ �R-
Name of APPLICANT iPA1W_d4 �Tt/C�L't�Y PHONE 770 'P30 Z
PERMIT TO BEs (')Picked Up ( )Mailed tot TYPE OF PERMIT: (.1 ew Installation ( )Repair
( )owner (L?lkpplicant ( )Emergency Use ( )Alteration NOT due to failure
IACATION OF PROPOSED SYSTEM: T y
Legal Description L-61. Z-67 67 ��/Q fy �A�p
Lot P+-�% Block Tiling Subdivision ✓/Klin D1 D Size of Lot acres
TYPE'OF STRUCTURE: (P-9ingle Family Dwelling ( )Other:
Do you plan any further nd ions to the
residence? ( )YES ( O
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 (r)Publie, Name of Systemrl�J ,
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: .
(wreptic 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, 9:30-9:30 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.
Application for an individual sewage.disposa pe mit is hereby submitted. The undersigned acknowledges that the above information
Is true and that false in o will v id to the application and any subsequent permit. 9
Signature of Applicant DATE
(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.
<. 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 rtni fee n thq amount
/ /�
Of $ •Z , , Receipt Number L' U�� J l , Date Fee Received / Z7 �� L I , .byl �l%�a�t� �L .(�'
Administrative officer
130 South Galena Street Aspen, Colorado 81611 303/920-5070