HomeMy WebLinkAboutpitkin.eh.264335103009 (1986)aCo`�3,2s-/_o3-Oo9
ASPEN*PITKIN ��-
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
TYPE OF PERMIT:
)Initial Construction ( )Emergency Use ( )Repair Work,(Piovious Permit 1 .) ( )Alteration of an existing system,
or installation (Previous Permit 1 )
( )Use Permit as a result of Sale ( )Others
ISSITED TO:
DATE OF ISSUE.
Olaner i�JSS ��R.A fit' Home Phone �i -40U Business Phone
Mailing
Address 3oX $Li A CO
Agen% Phone g{ _ 3 -`i 3 38
Mailing
Address /1 i � 1 2 fJspno
Sewage Disposal System Work to be performed by 1 K �p. maj
This permit
valid only for premises location by the following legal descriptions Lar 1L- "i 3 S t pawow
LOT SIZE pI LAA(CiR& WATER SUPPLY ��A�� AVERAGE PERCOLATION RATE
This Individual Sewage Disposal Permit is granted with regard to the following use:
Ntraber oft Dodreomsgc. Lofts — Garbage Disposals_ Dishwashers �r Clothes Washo13 I'
CALCULATED AVERAGE DAILY WASTE LOAD
GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Type of Tank or Treatment UnitsSanta, I
Method of Final Gisposalse �c C/vC,wy Abeorptiod
,Description (including brand name, if any) of other equipment or appurtnanceas
� V� T2�Nc�,t�s au.ow Foy I Q�y Ft . of I INEP11� tlz.�ac�. ,
Tank. Capaac���eiitty I�..��/lJ _Callon Hinimu:a
Area apC� Square Feet Minimum
3 Fit w►de, LJ + a Ftt o F
Other Condition! or Spccificationaspap�w.y� IN FJ 4v(ZR ) I 2.6'0
Due, -40 Ptno#Je4 6xPr►�b,aa Cadd++io,j� t 2, bed
VS6 of dIStaAbut►cP bon 14 P_e C,O1wn41tPJC(C4
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Pcfore Excavation ( )Upon completion of excavation and prior to placement of gravel Before covering distribution
t+ystem of absorptiotl fi,.ld
( )Prior to backfill of any component ( )Other, Specifys
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Pernissl.on
is hareby granted to the owner or his auenr to performthe work indicated above in accordance with the Pitkin County Individual
Sewa;e Disposal Requlations in effect on the d.ite of i0sue . In addition to general provisions set forth on thr reverse hereof,
this Permit is subject to the following additional terms and conditions:
APPROVED FOR ISSUE By2m S51J f, dkM (title) 1.��Z 1')¢ aC. OF�k C-ew,_a__._�.__
r The alxive individual Y- netra.o disposal a s^em installed b
1 P . y 'FJ�
i has been in:pccted for use by a representative of the Ass.e. Ililgin Lnvironrn•nta
re:awnsibiliLy in case of failure or inadequacy of thtu diaporal system.
DAT:XINAL ICiSPE TI
BY : -�
1��a►� C Gee D 4S r4 r C{ �n �1 1 G 1 cL .
Sb ri'a �
1�0 uth Gale Street Aspen, Colorado 81611
NcaT_tTj__f)cpart.uncnt. Tho uwnar "as!iwnan a
Complete as -built drawing attached.
303/S25-2020
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNERPHONE
1` O 5
Address of OWNER
Name of APPLICANT �� �� ��.M. rr. PHONE —
PERM)^ T TO BEo Pieked Up ( )Mailed tot TYPE OF PERMIT: ( New Installation ( )Repair
( 30wner ( )Applicant . ! )Emergency use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM: Q
Legal Description �(� 'l f� 7-4 �Q 1A6)0r,
Lot — `�
Block Filing Subdivision �% r 1�ilif)p Size of Lot �' acres
RTYPE OF STRUCTURE: Single Family Dwelling ( )Others Do you plan any further ad..ditioa3 to "a
residence? OYES ( )NO
No. of bedrooms No. of Lofts No. of Garbage Disposals No: of Automatic Dishwashers
No. of Automatic Clothes Washers /+
EATER SUPPLY: ( )Private Well, Depth or ( TPublie, Nasse of System
( )Spring/5 U%O�ifi%J/�i7,
( )Stream or Creek - f
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDs C /'1:� w i1,' -,,A,f ,
(.)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. 0be.obta.m.)
before a permit can be issued. The individual sewage disposal permit must be issued before a building p2021. can
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 information will invalidate the application and any subsequent /permits.
Signature of Applicant A ';"''i 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 ned hereby acknowledges receipt of this individual savage disposal permit ppl cat on and a peri ea in the amount
�S Receipt Number , Data Fee Received O 1 by
of i
. Administrativo officer
130 South Galena Street Aspen, Colorado 81611 303/925-2020
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