HomeMy WebLinkAboutpitkin.eh.264328202005 (1991)[ a ��13- Aga-oa-oos
`r+ ASPEN*PITKIN ®
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT 140.
TYPE OF PERMIT:
( )Initial Construction ( )Etnergancy Use
or installation
( )Use Permit as a result of Sale
ISSUED TO:
( )Repair work,(Pcevious Permit 1 .) K111teration of an e�g,# ytem,,
revious Permit 1
( )others
Owner j JUC K I "l Home Phone
Mail-ing r> bi(2
Address 77 ) iXOV-MK_ '
Agen t_L
Mailing
Address
4
C- e Disposal System Work to be performed by
DATE OF ISSUE.
4•nU�:"'L Phone
Phoned
'/'0 0417 ( C
`f,�
This permit valid only for premises location by the following legal descriptions to + ri-IA
LOT SIZE /1� , WATER SUPPLY�ILr�L �1Y)� Y�/T_�++;�• 1t R"GE,PERCoy O LTF 'X(5I/Vr 3��1/L
This Individual Sewage Dispos 1 Permit is granted with regard to the following uses
Nutaber oft Bedrooms � Lofts fJ Garbage Disposalsr_ j Dishwashers, ) Clothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD O{/ GALLONS.
THE NATURE OF THE SYSTEM INCL
aype of Tank or Treatment Units l
d
et.hod of Final Disposal s'a-a - — s
UNDER THIS PERMIT:
ascription (including brand name, if any) of other equipmer
Di cllmk, ivo/J (3^_,X '7o bf d A•j i
Tank. Capacity (2 Callon Minimum
Absorption .Axe& -' Square Feet Minimum
s
t or appurtnaneass Nom"
4F%
)ther Co ditions or Specifications �� %�
i/Lf/- /L TSA i �� ��F'7 I�r'�
go? L)1 .
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation { )Upon completion of excavation and prior to placement of gravelefore covering tistrion icid n
(}Prior to backfill of any component ( )other, Specifyt
Plans and specifications of the proposed sewage disposal system have been reviewed and are ecnsidcred satisfactory. Permission
ix hereby granted to tb(, owner or his agent to p-.rformthe work indicated above in accordance with the Pitkin County Individual
Sewa,e Disposal Revelations in effect on the date of issue. In addition to general provisions set forth on the reverse Ler,oi,
this Permit is subject to the following additional terms and conditions.
title
APPROVED FOR ISSUE BY
/
The• above in4ividunl ac'.+a•Ao disposal system installed byC/ L-
in has ix cn in:pcctcd for use by a representative of the Ass:en ctn Envl ronr�•nta
reoponsibility in case of failure or inad��uacy of thi>u ycwa,Ae ddispoual system.
DATE OF F N INSPECT ON
BY:
Hca t.. D.pirt,ntnt, Th,! ownor aseumoa a
Complete as -built drawing attached.
TITLE
130 Soutti Galena Street Aspen, Colorado 81611
303/920-5070
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER Chuck Mayer PHONE 923-2611
Address of OWNER 0857 Brushcreek Rd , Snowmass Golordado
Mame of APPLICANT Kevin MacLeod PHONE 925-5590
PERMIT TO BE: ()OPicked Up { )Mailed tot TYPE OF PERMIT: ( )New Installation { )Repair
( )Owner ( )Applicant l )Emergency use (X)Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM:
(qt w 1 Block 1 filing 1 Subdivision Brushcreek Vi l l jW. of Lot 2.0 acres
rYPE"OF STRUCTURE: ()OSingle Family Dwelling ( )Others Do you plan ail further additions to the
residence? 09 YES ( )NO
No. of bedrooms 4- No. of Lofts No. of Garbage Disposals 1 No: of Automatic Dishwashers
No. of Automatic Clothes washers 1
Brushcreek Village Water
WATER SUPPLY: ( )Private Well, Depth or (X)Public, Name of System 1S r1C
( )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 BACKFILLING ANY PORTION
OF THE SYSTEM.
Application for an individual sewage disposal permit is horeb submitted. The undersigned acknowledges that the above information
is true and that false information will invali a the app i d any subsequent iL.
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.
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 undersi�gnCp�� hereby acknowledges receipt of is individual sewage disposal permit application and a per:gLJe e n the amount
of Sf 5 ("i `" _, Receipt Number 6== Date Fee Receivedy r . • by /
Administrative officer
FjLon-
930 South Galena Street Aspen, Colorado 81611 303/920-5070