HomeMy WebLinkAboutpitkin.eh.264335105007 (1986)ASPEN*PITKIN � 2 4 Y�- 3-5-1 _ OSS QU
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0. U lJJ
TYPE OF PERMIT:
f \ / )(Alteration oC an existing totem,
(�)initial Construction ( )Emergency use ( )Repair work.(Provioua Permit 1 ') previous Persalt 1
/� or installation
( )Use Permit as a result of Sale ( )Other: /�
ISSUED TO: DATE OF ISSUE . � 1% 9(' _
Owner �jCiP ���� Home Phoneq23-Ys 93 Business Phone .
Mailing
Address Q
Agent �TI�UC'T��LT 1��I A7F5 Phone
Mailing CL61AJtt)c*oD 5EK9ln/f� �D S/6a1
Address 38"i2- �/GHu.l�Y S�- '—'
Sewage Disposal System Work to be performed by // e
This permit valid only for premises location by the following legal eucriptions� -17 Z
1 I DIrI{SfQ� AVERAGE PERCOLATION RAT F. 5L1L�LL•
LOP SIZE +� . WATER SUPPLY
T11s Individual Sewage DisposalPermit is granted with regard to the following use: ! FAAM(Li ES:De4eX _
Ntrabcr of: Dodreoms ✓ Lofts C' Garbage Disposals_ Dishwashers ^ Clothes washers
CALCULATED AVERAGE DAILY WASTE LOAD 75c; GALLONS.
THE NATURE OF THE_ SYSTEM INCLUDED UNTDER THIS PERMIT:
5-0 Type rsf Tank or Treatment Unitla 11Q, 1/'r"K Tanis Capacity ,Callon Hinlmua
P�thod of Final Dispo3als /ir,r.snOT/Da��Nru.� Ab4orptiod Area Squtirc Feet Hin(num
'
Description (including brand name, if any) of other equipment or appurtnancens
WedOd a Fes) ;-M 11-C777S (nib �0.��1") ,z Y2 &4�A'S
1-2WL 1'9A;,O S1011Y
Other Condition! or Spccificatlonas !&�PA Te-
RIs r 1AX S&F7 ! C 0 s�(9Ji /!`✓ /if (�t� �/
TAGES REQ IRING IN PECTI N BY THE HEALTH DEPARTMENT:
A.Bystem
)Before Excavation ( )Upon cor•.pletion of excavation and prior to placement of gravel Before ofveriorl>tistitld�,t
(Prior to backfill of any comper.ent ( )Other, Specify:_ A1e�NC' _
Plans and specifications of the proposed sewage disposal system have been reviewed and are ecnsidered satisfactory. Perrdgsion
is hereby gra ted to tl,^. owner or his agent to perform the work indicated above in accordance with the Pitkin County
Sewa;c Ji,pesal Re,lulations in effcst on the date of issue. In addition to general provisions set Earth on the reverse her-_oi,
this Permit is suhject to the following additional terms and condition -3 ;A;' J
41/ /
APPROVED
FOR ISSUE BY�
Thr aixwc in:iividual acaago disposal system installed by -- Hca1t D<'p•:rtmont. rh�,nor asou:oa tori
i has been ln:�pccied for use by a representative of tbc. AsS.cn i'itTxnCnv:ron:anta
re::,ons_bility in �e of fa lure r inadequacy of thi sewage disposal system. Complete ns -built drawing attached.
i�A2 ISA /��2�� -�
DATE O1 INAL I 'PF 'T
( _ TITLE�'CZ
BY: _
�Ia C (SI
�� 130 SoutN Galena Strut _ Aspen, Colorado 81611 303/525-2020
�s
ASPEN*PITKIN
ENVIRONMENTAL HEALTH. DEPARTMENT
APPLICATION FOR AN
Name of OWNER
Address of OWNER
Name of APPLICANT
INDIVIDUAL SEWAGE DISPOSAL -PERMIT
PERMIT BE: (Vlpicked Up ( )Mailed to:
( jowner ( )Applicant .
LOCATION OF PROPOSED SYSTEM:
"'Tc
al Description
yot�-�i-_ Block filing
t ..
PHONE q�?,lF'
PHONE
• &.5. ss 16-0
TYPE OF PERMIT: ( New Installation ( )Repair
I )Emergency Use ( )Alteration NOT due to failure
Size of Lot acres
f Do you plan any further additions to the
TYPE'OF STRUCTURE: OSingle Family Dwelling ( )other: residence? ( )YES ("NO
No: of Automatic Dishwashers
No. of bedrooms No. No. of Lofts A� No. of Garbage Disposals
No. of Automatic Clothes Washers
'(� or )`Public, Name of System
WATER SUPPLY: ( )Private Well, Depth
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAC:E DISPOSAL SYSTEM PROPOSEDi '.
(.)Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet )Mound
(
( )Recycling, potable use ( )Recycling ( )Vault Privy ( )Other:
, other use
.
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 ENVIRONMEN?AL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION
OF THE SYSTEM.
Application for an individ ewage disposal permit is hereby submitted. The undersigned acknowledges that the above information
is true and that false in rm tion w 11 inv Sda i the appli� on +yfsd any subsequent permit.
/y(aJ/ DATE rr t 1
Signature of Applicant /
(This ap ication becomes. invalid 12 months from the above date.)
NOTE: P T 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.
t. 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.'
g po rm, t ppl at on and a pezq►�t Is in the amount
The undersigned reby acknowledges receipt of this individual sewage dis sal Pe ' by/
of Receipt Number , Date Fee Received
Administrative officer
130 South Galena Street Aspen, Colorado 81611 303/9252020
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