HomeMy WebLinkAboutpitkin.eh.264326402010 (1984)ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
•INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. �,�Da
TYPE OF PERMIT:
( )Initial Construction ( )Emergency Usa rnair Work,(Pievious Permit t .) alteration of an exis ng tem,
or installation Previous Permit 1
( )Use Permit as a result of Sale ( )Others
ISSUED TO: DATE OF ISSUE . Z
Owner U) A76ZYM Glia Q6 FJ Home Phone 2a--A74—Business Phone
- r --R
Mailing // 1 '
Address A/6 USTOA1 r
Agent �19CAIC JC (/)A/�72'e011 i /,oA) Phone 2-1 7 �
Address l73 eue_.l amok �-Dr
Sewage Disposal System Work to be performed
This permit valid only for
for premises location by the following legal descriptions /,AZ- ''-/,
LO'I S I t E 2. ` 1 A k , WATER SUPPLYST& e W r , AVERAr:E PERCOLATION RATE
This Individual Sewage Disposal Permit is granted with regard to the following use:
Ntrabcr of Dodreoms _ Lofts Garbage Disposals_- Dishwashers Clothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD 66-f) � GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Type of Tank or Treatment Unitt'f3C—PT-J(r�AJ,;r-- /� Tank. Capacity 2— , — Callon Minim=
r1rthod of Final Disposals XiS7 �N � f3�GE '80) Absorptiod Area ` Square Feet Minimum
Description (including brand name, if any) of other equipment or appurtnancest
Other Condition! or Specificationet
P 'C �'/ % rtt / < o�� ��FTi4C
� o i�,�it��`Tf�jE�t/'��'���Ti��tl�
SIF �E RE UIR NG IISPECTION BY THE REA TH DEPA�TrIENT:
( )Defore Excavation ( )Upon completion of excavation and prior to p'aCement of gravel ( )Before covering dist.r1fution
system of absorption field
Prior to backfill of any component ( )Other, Specifys _
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 ual
Sewa,e Disposal Requlations in effect on the date of issue. In addition to general provisions set forth on the reverse hereof,
this Permit is subject to the following additional terns and conditions:
4
APPROVED FOR ISSUE BY (title) CsL C:�tlLCi4c.t+�..�
l
The above iniividunl sevago disposal system installed by �����%%tr'%s' C V/(y�1C
has tx•cn ln::pccted (or use by a representative of the Aspenen i'it in Envsronr�nw .ilea t. Deparuncnt• TFc owner asoumos Ali
reoponsibility in case of failure or inadequacy of this acwage disposal system. Complete as -built drawing attached.
DATE OF FINAL INSPECTI N�'1�'� '
BY: tG TITLE_ l + , .
130 South balena Street Aspen, Colorado 81611 303/925-2020
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of OWNER ` "�'��fi PHONE
Address of OWNER A(
Name of APPLICANT � (�B I �I PHONE
PERMIT TO BE: ( )Picked Up ( )Mailed tot TYPE OF PERMIT: ( )New Installation ( ))Repair
( jowner ( )Applicant ( )Emergency Use Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM:
Legal Description
Lot Block Filing Subdivision r�r_L✓�.+ Size of Lot acres
����////
TYPE OF STRUCTURE: 1 Veingle Family Dwelling ( )Others re you plan any further additions to the
,II sidenceT ( )YES ( )NO
% /
No. of bedrooms No. of Loffts No. of Garbage Disposals No: of Automatic Dishwashers
No. of Automatic Clothes washers _/
WATER SUPPLYs ( )Private Well. Depth or ( )Public, Name of System �ti i` -
(ki5pring
�(
)Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(.)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Mound
(')Recycling, potable use ( )Recycling, other use ( )Vault Privy ( )Others
The initial site inspection must be arranged with the Aspen/Pitkin Envirorunental 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 BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
Application for an indi�inf
dual s�rwa dis al perm is hereby submitted. The undersigned acknowledges that the above information
is true and that false do 'will oval da the application and any subsequent permit.
-�
DATE
Signature of Applicant i.ti�
(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."
She undie/rsiq�e� hereby acknowledges receipt of this individual sewage disposal permit application and a permit fee in the amount
of $ ! Cte)0 ((II—�f _, Receipt Number *Date Fee Received 1/ aby
Administrativo Officer
C' K 775 O
130 South Galena Street Aspen, ,Colorado 81611 303/S25-2020
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