HomeMy WebLinkAboutpitkin.eh.264335107003 (1989)TYPE OF PERMIT:
203-3-5)--07 -0,03
ASPEN*PITKIN Uv� S�q✓'U-)�U
ENVIRONMENTAL HEALTH OEPARTMENT Uv
INDIVIDUAL SEWAGE DISPOSAL
PEMIT NO.�—
PoInitial construction ( )Emergency Use ( )Repair Work,(Pievious Permit 1
or installation
( )Use Permit as a result of Sale ( )Other:
ISSUED fT0:
Olmer L eC 12,4R,0E 76—
Home
Mailing n 0, � �/1��
Address �7
Agent,
Ma i l.in g
Address
DATE OF
_,) ( )Alteration of an existing system,
(Prcviou- Per.*
er.• t ! )
ISSUE•.
Phone IZ7 9/3 Business Phone
00 2102-
?hone
102 -
Sewage Disposal System Work to be performed by
Phone
This permit valid only for premises location by the following legal/description:
L'YT
SELF. Ac,S WATER SUPPLYf}P_rij�*n AVERAGE PERCOLATION RAT F.
This Individual Sewage Disposal Permit is granted with regard to the following use: '�>106�/4sHIuy/\�31p�
N%r-iL.-:r oft Bedreoms .� Lofts Garbage Disposals_ Dishwashers -2— Clothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD 7,5-0 GALLONS. -
THE NATURE OF THE SYSST�E�N! INC.LLU�^DDEDD UNDER THIS PER11IT:
Type •.-if Teak or Treatment Units 'tank Capacity /-SOO Gallon Minina::a
t"f thod of Final Disposalt A65WT1 t);j ` } Absorption Area �V (J U square Feat Hinimun
Description (including brand nano, if any) of other equipment or,eppurtnaneest
Other Conditions or Spccificationst
Q -Ber F670 -774,46,) G Ni7[- �e i tlrr n nl 3c� x A nJV%e61VO c S
f:FD BV I AL-- D I I BUT70A-1-
STAGES REQUIRING INSPECTION BY THE HEALTH DEPAR`rrIENT:
( )Before Excavation ( )Upon completion of excavation and prior to pincement of gravel Before covering distribution
J 111 eystcm of absorption f =1d
IPrior to backfill of any component ( )other, Specifyt
Plans and specifications of the proposed sewage disposal system have born reviewed and are considered --atisfactory. Permission
is hereby granted to tLc owrer or, his agenr to perform the work indicated above in accordance with the Pitkin County Indivi ual
Sewage Disposal Revulations in effect on the date of issue. In addition to general provisions set forth on tlut reverse Ler=oi,
this P.armit is subject to the following additional terms and conditions: _
Aspen/Pitkin Environmental
tlPPROVED FOR ISSUE BY _ title) Health Officer
TL.<• t.`:<wc in.tividual sc•.+a.fo disposal eystca in,ta llcd by ��L JVD„ ---
E -r
i iters b,,cn 1na.citrj for usr_ by a rcprescnt.}tivc 1,f the As1:cn 1'it in nviron:wnti7110alt .:rp•�rtmtnt. Th. r:nnr as -1W,0- a ail
roc:;>ons.billty in cea:: of failure or inad quacy of thlu sewage dispoua system. Completo as -bulli drawing a[tachod,
D ;TE O1'
Aspen/Pitkin Environmental
i C �tCL3Gli� ____ _ _ _ _ i I'f LE _ Health Officer
130 South Galena Street Aspen, Colorado 8161'1 303/920-8070
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER 1 r'i —iPHONE �%��
Address of OWNER ✓�� ��� �-�
Name of APPLICANT 7w, *'C PHONE b � �--
PERMIT TO BE: ( )Picked Up ( )Mailed to: TYPE OF PERMIT: ( )New Installation ( )Repair
f ( )Owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM:
Legal Description
Lot `ITS Block Filing Subdivision ✓ f 'n' I` Size of Lot f_ acres
TYPE of STRUCTURE:
res ence
No. of bedrooms No. of Lofts No. of Garbage Disposals No. of Automatic Dishwashers 7)
No. of Automatic Clothes Washers �
WATER SUPPLY: ( )Private Well, Depth or ( )Public, Name of System
C )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(.)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 PORTIO`?
OF THE SYSTEM.
(P)Single Family Dwelling
( )Other:
Do you plan any further additions to the
)YES ( )NO
Application for an individual sews sposal permit is hereby submitted. The undersigned acknowledges that the above information
is true and that false info o 1 invalidate the application and any subseque t crmit.
t
Signature of Applicant
(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.
5. 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 undersigned hereby acknowledges receipt of this individual sewage disposal permit application and a permit fee in the amount
of S �� , Receipt Number , Date Fee Received --�s� by
Administrativo Officer
130 South Galena Street Aspen, Colorado 81611 303/925-2020
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