HomeMy WebLinkAboutpitkin.eh.264335105004 (1992)ASPEN#PITKIN � 3 S'_ OS r CO
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. 2 0 11
TYPE OF PERMIT: 715 %'
( )Initial Construction ( )Emergency UseRepair Work,(Pievious Permit 1 G�Z .) ( )Alteration of an existing system,
or installation (Previous Permit 1 )
( )Use Permit as At result of sale ( )other( __' j
ISSUED TO: DATE OF ISSUE : ) r/ /' 9
Home Phone S Business
Owner MA66Mailing �
Address CIG'i� / "_' 5 A5 e(5- ole')> 616 l
Agent,
Mailing
Address
Sewage Disposal System Work to be performed b,j-
(20AJ;VeT/OA/
This permit valid only for premises location by the following legal description: I -r
Lar SIZE _ Kl ? . WATER SUPPLY %I�1c �1�(W AVERAGE PERCOLATION RATr.OW5Tl146 22-t
This Individual sewage Disposal Permit is granted with regard to the following use: J[/lC L (5A_M1 Y, )& I OCWC'1
Mraber of: Dodicoms .1:3 Lofts ® Carbage Disposals Dishwashers Clothes Washors
CALCU TED AVERAGE DAILY WASTE LOAD GAI-LUt1S•
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
fpr of Tank or Treatment Unit: Tank Capacity �f�0. Callon Minimum
a..��/' %��
=shod of Final Disposal:�P�� �� Absorptiop .Area Square Fent Minimum
oscrlption (including brand name, if any) of other equipment or appurtnaneos:% B ��
rE l�/�T/.tlC- �ALi✓'L` �C� , 'cr �e,u �r �c t s riNa 0SO IAI C?iUf�
ATE
:thrr Conditiond or specificationat �A bG � ,00CE0 ! % �'
�,6AGt4t4G eHAMFEP_ I -S SED.
Phone
Phone
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation ( )Upon completion of excavation and prior to p'sCement of gravel ( )system covering aionrfield ution
of
( )Prior to backfill of any component ( )Other, Specify:
Plans and specifications of the proposed sewage disposal system have been reviewed and are eonsidcred satisfactory. Permission
is hcrehy granted to thr, owner or his aacr.t to perform the work indicated above in accordance with the Pitkin County Individual
Se_wa,e Disposal Re,nilations in effect on the date of issue. In addition to general provisions set forth on the reverse her-=eP,
this Permit ie sutject to the following additional terns and conditions:
/ JA /„ � Aspen/Pitkin Environmental
./ Health. Officer
APPROVED FOR ISSUE BY 4 /7, (title)
;hc• alxive individual sc•.ra,o dispcsal system inatallcd by �e � C� t-N�`ST�u�) Lf'►ly
has txen ln:jpccted for use by a representative Cf the Aspen Pit kin L•nvironm rita liea t.. Dcpartmcnt. ThO u,.•nor an�iun'Aa a
rc::ponslbilily in CC9e of failure or inad -q uacy of thiu scwayc dispoosl system. Complete ns --built drawing attachod,
DATE O1 FINAL INSPECT Oi �-2.._-
Aspen/Pitkin Environmental
BY: TITLE Health O'"
130 South Galena Street Aspen, Colorado 81611 303/820-5070
ASPEN*PITKIN
ENVIkL3NMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of OWNER p� 4 �;/,�,r,n ��L���r- PHONE
Address of OWNER
Name of APPLICANT � rr�_Q1 PHONE
PERMIT TO BE: (JAcked Up • 1' )Mailed tot TYPE OF PERMIT: ( )New Installation (ilxepair
( )'Owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM:
Legal Description
Lot Block riling Subdivision Size of Lot acres
TYPE'OF STRUCTURE: ( Single Family Dwelling ( )Other: Do you plan any further ditiona to the
residence? ( )YES O
No. of bedrooms No. of Lofts No. of Garbage Disposals_ No. of Automatic Dishwashers
No. of Automatic Clothes Washers -r
WATER SUPPLY: ( )Private Well, Depth or Public, Name of System S;Td c000y
( )Spring
( )Stream or Creek
TYPES OF -INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDS
t*51eptic 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 hereby submitted. The undersigned acknowledges that the above information
is true and that false irikormation, will invalidate the application and any subsequent permit.
Signature of Applicant a L2 a_k heDATE- �
(This application becomes. invalid 12 months0from�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 undersignne�d hereby acknowledges receipt o f this individual sewage disposal permit application and a permit fee n the amoun
of S _, Receipt Number G-% !! a, , Date Fee Received S `/I l �- ,.bY
Administrativo Officer
130 South Galena Street Aspen, Colorado 81611 303/920-8070