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HomeMy WebLinkAboutpitkin.eh.264328201005 (1989)�6 ASPEN#PITKIN ENVIRONMENTAL HEALTH DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. XPE OF PERMIT: nitial Construction ( )Emergency Use ( )Repair Nork,(Pisvious Permit / .) ( )Alteration of an existing system, or installation (Previous Permit 1 .) ( )Use Permit as a result of Sale ( )Othors ISSUED TO: DATE OF ISSUE•. OtmerPANLHome Phone L- Y(O Business Phone Address ©. D�-x0 €Al �L4 D Agent U lff Phone Mailing Address Sewage Disposal System Work to be performed by 1 9UdK2— {/,`'f�!This permit valid only for premises )oeation by tho following legal descriptiontIz /0 /111 1 V D LOT S'lte WATER SUPPLY AVERAGE PERCOLATION RATE. Q AIQ This Individual Sewage Disposal Pernit is granted with regard to the following uses � D n657 T Nur.%b0'r of: Dodreoms 3 Lofts © Garbage Disposals Dishwashers �� Clothes Washors CALCULATED AVERAGE DAILY WASTE LOAD �.�(� GALLONS. THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT: Type of Tank or Treatment Units&r 10-_ ( " N < Mathnd of Final Disposal:���>n e 16� �C�� Absorptlop Deacription (including. brand name, if any) of other equipment or appurtnaneess Other Conditions or Specificationss Tank -Capacity / Callon Minimum Area .1 %e) Square Feat Minimum STAGES REQUIRING INSPECTION BY THE HEALTH DEPAWrTIENT: { )Refore Excavation(Upon completion of excavation and prior to pla0ement of gravel a Before covering distribution aystesa of absorption field �)?rior to backfill of any component ( )Other, Specifyr _ Plates and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Pernissi.on lual in hereby grjnted to tho owner or his at to perforn the work indicated above in a::cordancc with the Pitkin Co,;nty Indivi, Scwa;.� Disposal Re•ntlations in effc•.t on the date of issue. In addition to general provision" _cc .`ort; on _lw reverse hct xi, this P.rrmit is suhject to the following additional terns and conditions: Aspen/Pitkin Environmental Health Officer APPROVED FOR ISSUE BY (title)_ ____ The a rive individual ae /a.)o disposal system installed by __ has teen in!jpcctcd i' for use by a representative of the Ass:cn itkin Lnviron:nnta Health r1cp.%rtmeTe er nr.. hown73rI WDA rc_ponsibility in case of failure or inad,,-quacy ofthio sewage: ofd sal system. Complete at -built drawing attached. D."ATE OF FIN IriSPI CTIO;i Aspen/Pitkin Environmental BY : 91t Health Officer TITLE 13M South Galena Street Aspen, Colorado 61611 303/920-5070 y� ASPEN40PITKIN t1 ENVIRONMENTAL HEALTH DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT Name of OWNER c. �l � s r,� Z-� ss � `'PC.- PHONE 5� GSA i Address of OWNER Name of APPLICANT SG "� r' PHONE ' PF.R.MIT TO B£: Picked Up ( )Nailed tot TYPE OF PERMIT: ,New Installation ( )Repair ( )Owner �pplicant _ 1 )Emergency Use ( )Alteration NOT due to failure LOCATION OF PROPOSED SYSTENt s ,��, /J/�j (/% Legal Description Z, . -I /0 : dJ /O o el / / /� J r " - �� - - //G2 J Lot Block Filing Subdivision Size of Lot 3 acres TYPE OF STRUCTURE: Single Family Dwelling ( )Other: Do you plan any furthe 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 MATER SUPPLY: ( )Private Well, Depth orX)Publie, Name of System ( )Spring ( )Stream or Creek TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDt - 'Septic 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. 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 BACKFIL:.ING ANY PORTION OF THE SYSTEM. Application for an individua se g sal ermit is hereby submitted. .The undersigned acknowledges that the above information is true and that false info m ti o i v (date the application and any subsequent permit., % Signature of Applicant DATE /O (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. 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 a lieation and a permit fee in the amount of S Receipt Number , Date Fee Received by E 1 /1 Administrative Officer 130 South Galena Street Aspen, Colorado 81611 303/920-5070 vc� GaRAG i' l Doo - �,'A Long 00PV CL I op Re 0 SfK ,J ULC! -r-^ `\ J s 7o 14- � i 11i • Sf // / 1