HomeMy WebLinkAboutpitkin.eh.26433430001 (1999)Aspen/Pitkin Environmental Health Department
Permit for an Individual Sewage Disposal System
130 S. Galena St. Aspen, Colorado 81611
Phone 970-920-5070 / FAX 970-920-5074
Permit # 99078 Parcel ID # 2643-343-00-001
Type of permit New( ) Repair( ) Addition to House( X )
Name of Owner Luigi & Elizabeth Giordani
Street Address 1038 Owl Creek Rd
Property legal description
Size of lot .5 acres
Water source private well
# of bedrooms in house
Caretaker unit
# of bedrooms in caretaker unit
Total square footage of the house
2600
# of offices, lofts & similar sized rooms in house (2 future remodel)
Total square footage of the caretaker unit
# of offices; lofts & similar sized rooms in caretaker unit
Designed for what # rooms (list) FOUR TOTAL 2 existing + 2 in future addition.
Permit information
Designed by Jerome Gamba
Mailing Address
Perc rate 20
Septic tank capacity
PO Box 1458, Glenwood S
Profile hole depth 17'
1750 minimum
CO 81602
_ Depth to groundwater or bedrock +17'
Absorption area 1252
Comments
Septic permit approved per compliance with the engineer design and specifications dated with engineer's
stamp 9/21/99 on Sheet 1 and 9/16/99 on Sheet 2. Any changes must be approved by this department and the
design engineer prior to them being made.
Design is for two -1,000 gallon concrete septic tanks (the first tank does not have a baffle) followed by a 1,000
gallon concrete pumping chamber. The effluent is pumped up to a drywell that shall be 19' wide by 19' wide by 12'
deep. The 12 foot depth is the distance measured below the horizontal inlet pipe.
Minimum horizontal distances between components of the system and physical features shall conform to the Pitkin
County ISDS regulations. The ditch must be lined were the setback does not conform to the required 50 foot
setback between the septic tank and the ditch. This department does not endorse any brand of products.
Permit approved by: Date: /F -z 3 9
Plans and specifications of the proposed individual sewage disposal system have been reviewed and are considered
satisfactory. Permission is hereby granted to the owner or the agent to perforin the work indicated in accordance with the Pitkin
County ISDS Regulation in effect at the time of issue. This permit becomes invalid 6 months from the date that the permit was
issued unless system construction has commenced or an extension has been approved in writing by the Department.
As -built drawings must be included with this permit before the final approval will be issued.
Installer: inv'T- - . j
Final inspection approval Date: 0
i
0/6 I y 11 A, - A,--"
ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATI . FOR INDIVIDUAL SEWAGE DISPC L SYSTEM
130 S. Galena St., Aspen Colorado 81611
Phone 970-920-5070/Fax 970-920-5039
----------------------------
Name of OWNER n 1
Owner's Mailing Address
Business Phone: qA) - -7V - / Home Phone:
Primary Contact Person (all communication regarding this permit will go through this person)
Name
Company / U
Contact Mailing Address
Business Phone : q4
hu A
L v r.
59CCell Phone.
S
uJD& SIP C o 1 d
Fax: 9¢-S - 11/0
Parcel ID # (available from assessor's office) / _ 3 - 3
at 920-5160 or at www.aspen.com/assessor/ J lv �%
Street address of property -10 3 F 0 f & �" S CO
Legal Description: Lot :0 ,BTock`1 u'�1 4434 ,Filing Subdivision rl,Ia
Size of lot: 1/ 2- acres. Type of proposed structure: wlh � Size of bldg. envelope:
Total square feet of house 617 DD # of bedrooms in house
151)
# of offices, lofts & similar sized rooms in house
Caretaker Unit: Attached ( ) Detached ( ) Total area(sq. ft.) of caretaker unit N 1 III
u ;_ --+'L-, ,nit # of offices, lofts and similar size rooms of caretaker unit
Permit is for: New Home ( ) Repair due to failure ( ) Remodel/Addition (✓) Emergency use ( )
Water: Private well ( ) Spring ( ) Stream ( ) Community/Public Water System ( )
If community system: Name of
The fee for a ISDS application is $330 for a permit that takes 6 hours or less for the department to approve. If approval takes
longer than 6 hours, a rate of $55 per hour will be charged. The maximum fee is 51000. The basic fee of $330 is due at the time
of application. The remainder, if any, will be due in two stages: first, at the time of issuance of the ISDS permit: second, before
final approval of the ISDS permit.
Application for an individual sewage disposal system is hereby submitted. I hereby certify that the above information is true and
accurate and that I have provided true and accurate information on locations of all existing and proposed wells, contour
intervals, buildings, property lines, ditches, slopes, waterlines, springs, suction or irrigation lines, drinking water cisterns, drain
tiles, irrigation ditches, lakes, water courses, streams, floodplains, dry gulches, and existing septic systems. I hereby certify
of
that any such features not shown on attached site map are not present. Issuance of the permit does not imply the app
any other permit required for construction pursuant to Pitkin County codes. No construction may be undertaken until all
approvals and permits have been obtained.
The Aspen/Pitkin Environmental Health Department, Pitkin County and employees of these agencies will be held harmless
should the individual sewage disposal systerjjfaA or malfunction. The permit to construct is issued on information submitted by
the applicant or his/her representatives. er assumes full responsibility in case of failure of the system.
Date
Signature of applicant
Received b Receipt # 311/Date
y ,iE If I
ASPEN/PIN ENVIRONMENTAL HEALTH*-eEPARTMENT
SEPTIC SYSTEM APPLICATION CHECKLIST
NOTE: SEPTIC PERMIT APPLICATIONS CANNOT BE ACCEPTED UNTIL ALL OF THE
INFORMATION BELOW IS INCLUDED.
The soils test and system design must be done by a Registered Professional Engineer. You
should plan to meet with the RPE at your site to discuss where the soils tests should be done
to meet all of the County regulations and where you want to put your house. The RPE will be
your contact for issues you want to discuss about your system's size and location. The RPE
should check each box to indicate the following have been submitted before the application
can be accepted.
Completed application form
�w Engineer design by a RPE registered in the state of Colorado.
Site map showing locations of, or stating that the following do not exist: all existing
and proposed wells within setback distances (including on surrounding properties),
contour intervals, all proposed and existing buildings, property lines, ditches, slopes
of greater than 15%, water lines, sprinkler systems, springs, suction (irrigation) lines,
drinking water cisterns, drain tiles, irrigation ditches, lakes, ponds, water courses,
streams, floodplains, floodways, dry gulches, or existing septic systems. This must
include all such features on neighboring properties within setbacks.
Complete building floor plans. Floor plans should be 11x17.
Proof of adequate water supply: for private wells, recent well driller's pump test
showing gpm actually produced, well permit showing legal supply, and test showing
good quality; for community systems, proof there is adequate water for all houses
served by the system; for other systems, proof of adequate quality and number of
gallons/minute. Well must be drilled before septic permit can be issued.
sb Env. Health has been called to look at profile hole
Percolation tests (make sure to do lesser of 3 holes or one/ 1200 sq. ft. of field
Per it fee
Copy of county approval (1041 approval, subdivision approval, etc.)
Check if your septic system is within the building envelope and no part of the
system is more than 30 above grade. If both of these conditions are not met, you
must obtain written approval from Community Development before submitting
this application.
ASPEN/PITJUN ENVIRONMENTAL HEALTH DEPAUMENT
ISDS DESIGN CALCULATIONS �
Owner's Name Parcel ID #
House Size (sq. ft.) 45M (75 gpd, 100 gpd, or 130 gpd) 100
Number of Bedrooms in Main House
Number of Offices, Libraries, Studies, Similar -sized Rooms in Main House
Number of Bedrooms in Detached Caretaker unit
Number of Offices, Studies, Similar -sized Rooms in Caretaker Unit
(If the caretaker unit is ATTACHED, treat as if part of main house.)
verage Daily Waste Flow: 800
State Review Required?: no
Perc Rate (t) _
Design Flow (Q) _ # potential bedrooms X 2 people/bedroom X gpd X 1.75
Q = 1400
Absorption Area = A = Q x11 L
5
A = 1252.20 sq. ft. of absorption area required
81 infiltrator units without reduction
A maximum 30% reduction is allowed for use of deep gravel or gravelless chambered system,
only if the lot size and soil conditions are optimal.
If a reduction is being proposed, describe why lot size and soil conditions are optimal:
A = 876.54 sq.ft. with reduction
57 infiltrator units with reduction
Type of system: DAbsorption trenches nAbsorption bed n Gravelless chambers
GDry well OSeepage Pit 00ther (hype)
Minimum tank capacity: 1750 gallons
SETBACK FROM WELL
# of feet = 132
SETBACK FROM POND, STREAM OR IRRIGATION DITCH
# of feet = 82
SETBACK FROM DRY GULCH
# of feet = 57
FINAL INSPECTION BY:
Page 1 of 1
DATE:
PERCOLATION TEST
RESULTS
FORM
MEASURE DROP in WATER
MENT LEVEL
PERCOLATION
RATE
REMARKS
HOLE DEPTH OF
No. TEST HOLE
TIME INTERVAL
TME
(min)
0:15
(inches) (inches)
(min/in)
(in)
(min.)—r--
# 13'-2"
19:30
9:45
12 3/8
15 1/4 2.875
5
17 3/4 2.500
6
10:00
0:15
20 1/8 2.375
6
10:15
0:15
21 7/8 1.750
9
10:30
0:15
0
refill test hole
10:35
10:40
0:05
13 1/4
15 1.750
5
10:49
0:09
19 3/4 4.750
6
#2 8'
#3 5'-7"
11:19
11:34
9:27
9:29
9:46
10:01
10:16
10:31
10:35
10:41
10:48
11:18
11:33
9:29
9:32
9:47
0:30
0:1521
0:02
0:17
0:15
0:15
0:15
0:06
0:07
0:30
1/2 1.750
9
12 3/8
16 1/8 3.750
5
18 1/4 2.125
7
19 1/2 1.250
12
20 3/4 1.250
12
refill test hole
13 5/8
14 7/8 1.250
6
18 1/2 3.625
8
-
0:15
19 1/2 1.000
15
0:03
0:15
9 1/16
-
11 1/4
2.188
7
12 1/2
13 1/2
14 1/4
15 1/8
16
16 7/16
1.250
1.000
0.750
0.875
0.875
0.438
12
15
20
17
34
34
- -
10:02
10:17
10:32
10:47
11:17
11:32
0:15
0:15
0:15
0:15
030
0:15
ASPEN/PITKiN ENVIRONMENTAL HEALTH DEPARTMt-,,IT
ISDS DESIGN REQUIREMENTS -DEPARTMENT USE ONLY
Name elizabeth & Luigi
4,500 (75 gpd, 100 gpd, or 130 gpd) 100
House Size 4
#of Bedrooms, Similar Rooms accessible to baths in Main Residence
# of Bedrooms, similar rooms w/ access to bath in ATTACHED caretaker
# of Bedrooms & Similar Rooms w/ access to baths in DETTACHED caretaker
Average Daily Waste Flow 600 # bedrooms X 2 people/br X 75
State Review Required? no
Perc Rate 20 (T)
3 equals # of Perc Holes Required
Design Flo w (Q) = # bedrooms X 2 people/bedroom X gpd X 1.75
Q= 1400
Minimum tank capacity 1750 gallons
Absorption Area (A= Q/5 X SQRT)
A = 1252 sq. ft. of absorption area required
81 infiltrator units without reduction
A maximum 30% reduRtion is allowed for use of deep gravel or gravelless chambered system.
877 sq ftv0 duction
57 infilt tori with reduction
AREA NEEDED FOR STANDARD ABSORPTION TRENCHES
417 1252 Total sq ft /3 =lineal ft of trench needed
7 417 lineal ft/assumed trench length of 60ft = # of 60ft trenches needed
6 # trenches minus 1 = rows of 6ft wide undisturbed soil between trenches
21 7 times 3 = total width of of 60" long field needed for just the trenches
36 6 times 6' = total width of 60' long field needed just for undisturbed soil
57 width of trench +width of undisturbed soil = total width needed
57 by 60 ft is the area needed for a standard absorption field in a trench configuration with no
reductions taken and ASSUMING AN AVERAGE PERCOLATION RATE OF 20
SLOWER PERCOLATING SOILS WOULD REQUIRE MORE AREA.
SETBACK FROM WELL SETBACK FROM POND, STREAM OR IRRIGATION DITCH
# of feet = 132 # of feet = 82
SETBACK FROM DRY GULCH
# of feet = 57
Remember: 8 feet of additional distance for each 100 gallons/day of design flow over 1,000 gallons/day
should be added unless an RPE can verify that it is not necessary to prevent contamination. 1/20/99
Printed on Recycled Paper
Aspe""` P;tkin Environmental Health Department
Contact Log Sheet
ame:
arcel I D#: Address:
Date Person Socken To 1 Comments / Action to be Taken pis Time
i
'tir' `rrf
JEROME GAMBA & ASSOCIATES, INC.
CONSULTING ENGINEERS & LAND SURVEYORS
113 9TH STREET, SUITE 214
P.O. BOX 1458
GLENWOOD SPRINGS, COLORADO 81602-1458
PHONE: (970) 945.2550 FAX: (970) 945-1410
Monday, January 17, 2000
Nancy McKenzie
Pitkin County Environmental Health
130 South Galena
Aspen, CO 81611
Re: Giordani Residence I.S.D.S.
Dear Nancy:
On October 4, 1999 Jerome Gamba & Associates, Inc performed a final inspection of the Giordani
Residence ISDS.
The system as observed by Jerome Gamba & Associates, Inc., was found to be in substantial
conformance to the plans and specifications signed and dated September 21, 1999.
If you have any questions or comments, please call me.
Sincerely,
JEROME GAMBA & ASSOCIATES, INC.
r
Chris Strouse
Robert W. Pennington, P.E. 293
Cc: Luigi Giordani
Page 1 of 1
G:\99845-GIORDANITI N_LETTER.DOC
JEROME GAMBA & ASSOCIATES, INC.
CONSULTING ENGINEERS & LAND SURVEYORS
113 9TH STREET, SUITE 214
P.O. BOX 1458
GLENWOOD SPRINGS, COLORADO 81602-1458
PHONE: (970) 945-2550 FAX: (970) 945-1410
Thursday, September 16, 1999
Luigi Giordani
P.O. Box 2616
1038 Owl Creek Road
Aspen, CO 81612
RE: Percolation testing and Soil Profile results.
Dear Luigi;
As per your request Jerome Gamba & Associates, Inc. performed Pecolation testing at the site as
described above. The testing was performed on August 19, 1999. The Percolation testing was
performed for a Dry Well System design. Therefore the percolation tests were performed at three
different depths and in each different soil strata encountered in the excavation. The test holes
were pre-soaked the night before testing.
The results of the percolation testing are presented on the attached table.
The average percolation rate is 20 min/in.
The soil profile as observed by Jerome Gamba & Associates, Inc., is as follows:
DEPTH
(IN)
SOIL DESCRIPTION
12 to 14
Dark brown organic top soils
14 to 44
Dark brownish red soil with cobbles up to 6" dia.
44 to 96
Light brown sandy soils, river alluvium material
96 to 152
Sandy clay with large cobbles up to 12" to 18" dia.
Giordani Soil Investigation
G: W845-GIORDANPGEO_TECH. doc
Page 1 of 2
0 •
On September 1, 1999, the profile hole was extended down four (4) feet for further soil
investigation as per our August 26, 1999 meeting. The soil was uniform with the lower soil
description mentioned above and no ground water was encountered.
This report has been conducted in accordance with generally accepted engineering principles and
practices. The recommendation in this report is based upon the data obtained from the
percolation testing. If conditions encountered during construction appear to differ from those
described in this report, we should be notified at one to evaluate these soil conditions.
If you have any further questions regarding the percolation testing, please contact us.
Sincerely,
Jerome Gamba & Associates, Inc.
wP_2erQ0
Chris Strouse
Robert W. Pennington, P - V/
G:19984i GIOR ANIIGEO— JEROME GAMBA & ASSOCIATES, INC.
G:199845-GIORDANIIGEO TECH.doc
Page 2 of 2 CONSULTING ENGINEERS & LAND SURVEYORS
JEROME GAMBA & ASSOCIATES, INC.
CONSULTING ENGINEERS & LAND SURVEYORS
113 9TH STREET, SUITE 214
P.O. BOX 1458
GLENWOOD SPRINGS, COLORADO 81602-1458
PHONE: (970) 945-2550 FAX: (970) 945-1410
August 30, 1999
Luigi Giordani
P.O. Box 2616
Aspen, CO 81612
Re: I.S.D.S. Application
Dear Luigi;
This information was sent back to me reguarding your I.S.D.S. Design for your existing residence and the proposed
additions. I was not aware that you had not submitted the application for this I.S.D.S.
I have checked off the information Jerome Gamba & Associates, Inc. has provided to you.
Also, Pitkin County and Jerome Gamba & Associates, Inc. must perform 'final' inspections of the system prior to
the covering of the final system construction.
If you have any further questions please contact us.
Sincerely,
Jerome Gamba & Associates, Inc.
f
Chris Strouse
JEROME GAMBA & ASSOCIATES, INC.
CONSULTING ENGINEERS & LAND SURVEYORS J o oG
POST OFFICE BOX 1458
113 NINTH STREET - SUITE 214
GLENWOOD SPRINGS,
COLORADO 81602 (970) 945-2550
1 I
°�- -TRANSMITTAL
a 0 �{ 3
Date Aust 26, 1999 1 Time: 2.51 PM
,,
Project Name: Giordani ISDS, 1038 Owl Creek Road
Project Number. 99845
To: Nancy McKenzie
Company: Pitkin County Department of Environmental Health
Address: 130 S. GALENA Street
Aspen, CO 81615
Phone: (970) 920-5070
From: Chris Strouse{ '
Re: ISDS Design
CC:
We herewith transmit the following:
Fax:
x Drawings ❑ Contract Documents ❑ Bid Documents ❑ Specifications
❑ Product Literature ❑ Change Order ❑ Other
For your:
x Approval ❑ Review & Comment ❑ Distribution to Parties ❑ Record ❑ Info
• Comments:
Please find enclosed:
2 sheets – Original Stamped ISDS design
3 sheets - Soils information
1 Pitkin County Design
for the Giordani Reside
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APPROX EDGE OF
DRY—WELL EXCAVATION
1 1/2" Sch. 40 F
FROM PUMP (
1-1
19.00'
DRY -WELL PLAN VIEW
N.T.S.
19.00'
FINISH
WOVEN GE
PLACED ON TOP
1 1/2" Sch. 40 PVC PIPE
FROM PUMP CHAMBER
4" PVC RI;ER W/ CAP
19 mm.
DRY -WELL CROSS SECTION
N.T.S.
1/4-- HOLE IN CAP.
3'
i.vrvirr�. i JVO—O/"JG
TO 987o STANDARD PROCTOR
CROSS SECTION OF PUMP CHAMBER
NOT TO SCALE
DISCHARGE TO
DRY WELL
JC PIPE
1)
dlons
4
lATIONS OF TOP OF LEACH
FIELD DISTRIBUTION LINE AND PUMP CHAMBER
SHALL BE PROVIDED TO THE DESIGN ENGINEER TO
VERIFY THE PUMP SPECIFICATIONS.
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50' SETBACK FROM SEPTIC TANK
MIN. LIMITS OF DITCH LINING
FOUND REBAR & CAP
L.S. NO. 18478
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£ SHED
CARPORT
ACCESS DRIVE FROM OWL CREEK RD.
OVERHEAD POWER LIP'S`
PROPERTY BOUNDARY
N 90.00'00' E,,442.18'
102.84'
NEW 1000 gal. SEPTIC TANK
W/0 INTERIOR BAFFLE.
NEW 1000 gal. SEPTIC TANK PROPOSED DRY -WELL
W/, ,!,VM-RIOR BAFFLE LOCATION
1000 gal. CONC.
PUMP CHAMBER
1 1/2" Sch. 40
PVC PIPE.
(5 ft. min cover)
FOUND REBAR & CAP
L.S. NO. 18478
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S 90.00'00' V 164.46'
-19.00' *-I
EK ROAD
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10 0 10 20 30
GRAPHIC SCALE IN FEET
1 INCH = 10 FEET
NOTE:
EXISTING STRUCTURES, UTILITY LOCATIONS
AND PROPERTY BOUNDARY INFORMATION
PROVIDED BY SCARROW AND WALKER,
INCORPORATED, Glenwood Springs, Colorado.
oI I CALCULATIONS FOR LEACH FIELD SIZE
c I ( DESIGNED FOR A FOUR BEDROOM SINGLE FAMILY RESIDENCE.
7;
FOUND REBAR & CAP
L.S. NO. 18478
ASSUME 2 PEOPLE PER BEDROOM AND AN AVERAGE DAILY SEWAGE
FLOW OF 100 GALLONS PER PERSON PER DAY ACCORDING TO THE
PITKIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT REGULATIONS.
THEREFORE:
(4 BEDROOMS) X (2 PEOPLE/BEDROOM) = 8 PEOPLE
(8 PEOPLE) X (100 GPD/PERSON) = 800 GALLONS PER DAY (AVERAGE DAILY FLOW)
MAXIMUM DAILY FLOW = 175% OF AVERAGE DAILY FLOW,
THEREFORE: MAXIMUM DAILY FLOW = (1.75) X (800 GPD) = 1400 GALLONS PER DAY
MINIMUM LEACH AREA SHALL BE CALCULATED PER PITKIN COUNTY DEPARTMENT
OF ENVIRONMENTAL HEALTH DESIGN CRITERIA USING THE FOLLOWING FORMULA.
THE ABSORPTION AREA FOR A NORMAL GRAVEL -TYPE LEACH FIELD IS CALCULATED
USING THE FOLLOWING FORMULA.
A = (0)X
5
WHERE:
Q = MAXIMUM DAILY SEWAGE FLOW = 1400 GALLONS PER DAY
t = PERCOLATION RATE = 20 MINUTES PER INCH
THEREFORE:
A = 140 X 20 = 1252.20 SQUARE FEET L
5
DRY -WELL SHALL BE 19' WIDE by 19' WIDE AND 12' DEEP.
TOTAL AREA INCLUDING BOTTOM AREA = 1273 s.f.
MINIMUM SEPTIC TANK VOLUME = 1750 gallons, use 2000 gallon tank.
MINIMUM HORIZONTAL DISTANCES BETWEEN SEPTIC SYSTEM COMPONENTS:
ABSORPTION BED TO ANY DRY GULLY:
57 Ft.
ABSORPTION BED TO ANY DITCHES OR WATER COURSES:
82 Ft.
ABSORPTION BED TO POTABLE WATER SUPPLY OR SUPPLY LINE:
25 Ft.
ABSORPTION BED TO PROPERTY LINES:
10 Ft.
ABSORPTION BED TO SEPTIC TANK:
6 Ft.
ABSORPTION BED TO RESIDENCE:
20 Ft.
ABSORPTION BED TO SPRING OR WELL:
132 Ft.
ALL COMPONENTS OF THE SEPTIC SYSTEM SHALL BE INSTALLED ACCORDING TO PITKIN COUNTY
ENVIRONMENTAL HEALTH REGULATIONS AND ACCORDING TO MANUFACTURERS SPECIFICATIONS.
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Lot 2
A tract of land situated in Tract 72, Section 23, Township 8 South. Range 87 West of the
6th Principal Meridian. Pitkin County, Colorado, lying northerly of and adjacent to the
centerline of a 30 fool: wide County Road right-of-way as built and in place, said tract of
land being more particularly described ,os follows:
Beginning at Angle Point NO. 4 of said Tract 72: thence E((ist 313.06 feet along the North-
erly houndary line ,:r said Traci. 72; thence S 15002153" E 1204.40 feet to the centerline
of said County Road right-of-way; thence S 59°12'50" W 285.05 feet along saia centerline;
thence N 25002'53" W 1365.45 feet to the point of beginning, containing 8.37 acres more
)r less.
Lot 3
tract of land situated in Tract 72, Section 23, Township 8 South, Range 87 West of the
fth Principal. Meridian, Pitkin County, Colorado, lying northerly of and adjacent to the
centerline of a 30 font wide County Road right-of-way as built and in
dace, said tract of land being more, particularly described as fellows:
leginning at Angle Point No. 4 of said Traci: 72: thence East. 313.06 feet to the True Point
Beginning; thence East 332.86 feet; thence S 2.5002153" E 942.64 feet, to the centerline
cf said County Road right-nf-way: thence S 43°06150" 14 324.87 feet along said centerline;
Thence N 25002'53" W 1204.40 feet to the True Point of Beginning, containing 7.43 acres
^1'e ;lr less.
aiy(2~r' -- -
Applicant acknowledges that he/she has been informed by Pitkin County of the existence of
t "1041 Hazard Areas" that might affect the property, any improvements and the use and occu-
pancy thereof.
ZI- Approved 1041 Hazard Review by: Date:
Pitkin oun y Planning Director
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APPLICANT'S NAME:
Albert Mosc2So
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Surveyor's Certificate
I, Sydney Lincicome, do hereby certify that I am a registered land surveyor licensed
under the laws of the State of Colorado, that this Site Plan is a true, correct and
complete plat of a 1041 Hazard Review as shown hereon, that said Site Plan was made
from an accurate survey of the real property described hereon by me and under my di-
rect supervision and correctly shows the location and dimensions of the property and
of the building envelope. This survey is true and correct to the best of my knowledge
and belief.
k 9 In witness whereof I have set my hand and seal this Nday of SCog efn by
�
A.D. 19 ��!u�ltpr�i�ii
By
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n y i come oo mom<a=;
14111 m°
ACCEPTANCE FOR RECORDING
This 1041 map has been accepted for filing i°ff ; Cte of the Clerk and Recorder
of Pitkin County, Coloardo on this day of
,�i,,� A.D. 19
in Plat Book at Page asTeception No.
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