HomeMy WebLinkAboutpitkin.eh.264327100002 (1986) (Barn).x 03-27/-00 —00 -
ASPEN o0PITKIN
002ASPEN*PITKIN ._ �
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. A106
TYPE OF PERMIT:
( Initial Construction ( )Emergency Use ( )Repair Work,(Pievious Permit
er installation
( )Use Permit as a result of Sale ( )Others
ISSUED TO:
DATE OF
.) ( )Alteration of an existing system,
(Previous Permit t )
ISSUE "_
Owner G,tlifly ��!�//+��eA�_ Rome Phone .20r,J�--i-F—Business
Mailing
Address '
Agen t_t
Mailing
Address
U
0
b 17--
Phone
Phone
Sewage Disposal System Work to be performed by Un-; A-—,, 1
This permitvalidonly for premises location by tho following log/al deecriptions�7/�-l7C IAI .2 7— 1 ,D—nf1 S p
LOT SIZE it F'1C..K� , WATER SUPPLY �'�G�0%V/S'1OA/ AVERAr.r PERCO�LAT,I/ON RATE.LUS%//yt�
This Individual Sewage Disposal Permit is granted with regard to the following usermd
i
Nur.iber oft Dodicoms fs' Lofts ' Carbage Disposals Dishwashers Clothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD "% Z L.cJ GALLONS. - .
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Type of Tank or Treatment Units Tank Capacity �_ _Callon minimum
PSethod of Final Disposals�8r!�y �/�,rT� ,✓C Absorptiop Area 270 square Feet minimum
Description (including brand name, if any) of other equipment or appurtnancess
�1nlie
- -
Other Condition! or Specifications$ '
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: '
t )Before Excavation ( )Upon completion of excavation and prior to placement of gravel a, system ofBefore vering absorpcionrfield n
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 Individual
Sewa;e Disposal Revulations 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 terms and conditions:
>C
APPROVED FOR ISSUE BY
ctitle
The above individual sevago disposal system installed by
has been 1n:1peth
ctcd for use by a representative of e Aspen Pit in Envlronmcnta
re::ponsibiltty in case of failure or inadequacy ofthis, sews. disposal system.
DATE Or INAL INSPECTION 11
Reajtt Department. The uwnur asaumes a
Complete as -built drawing attached.
f
TITLE$ (�#2�t.•
'130CSou Galena 9traat Aspen, Colorado 81611
303/925-2020
ASPEN*PITKIN -
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER C $ S PHONE
Address of OWNER �(�� /rlck�ai.J �=�� -�
Name of APPLICANT S fA �P PHONE c/ 2. O y
PERMIT TO BE: Picked Up ( )Mailed to: . TYPE OF PERMIT: VJNew Installation ( )Repair
`C ( fowner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure
IACATION OF PROPOSED SYSTEM:
Legal Description
Subdivision Size of Lot acres
Lot Block Filing
TYPE OF STRUCTURE: ( )Single Family Dwelling ( )Other: _ //��yw /�f - Do you plan any further additions to the
residence? ( )YES ( )NO
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 �( (, f Lo R ,C e- - S P to- / w
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAC£ DISPOSAL SYSTEM PROPOSEDs
-O( 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 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.
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 disposal permit is hereby submitted. The undersigned acknowledges that the above information
Is true and that false infocN+ation will invalidate the application and any subsequent permit.
Signature of Applicant 7 DATE
(T s 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.
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 his in ividual sewage disposal perms ap licntion and a permit„A i�t the amour.
Of $ /00•d1- , Receipt Number r _, Date Fee Received /� by
Administrativo Officer
130 South Galena Street Aspen, Colorado 81611 303/925-202o