HomeMy WebLinkAboutpitkin.eh.264505404002 (1989)- D SL/ - 0,-/ 00 01
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
TYPE OF PERMIT:
Initial Construction ( )Emergency Use
or installation
( )Use Permit as a result of Sale
ISSUED TO:
( )Repair Work,(Pievious Permit 1 .) ( )Alteration of an existing system,
(Previous Permit 1 .)
( )Othorl
OUlller��'j Home
Mailing
Address C', ), 4Lk =Ln
Agent
AIa i l.in g
Address
DATE OF ISSUEL_ %Z `-,81
Phone ,�__ > Business Phone
Sewage Disposal System Work to be performed by
Phone c7
This permit valid only for premises location by the following legal dcscriptiont�� �
VATYR C11Pr1.Y mi! Atv, 26,,1, AVERAGE PERCOLATION RATF.
Tris Individual Sewage Disposal Permit is granted with regard to the following usa:Gfdf (� N q�"('�
C'-
NLr.ibcr of: Dadreoms 7 LO f ts L�' Garbage Disposals_ ' Dishwashers �� Cloches Washers _
CALCULATED AVERAGE DAILY WXSTE LOAD � � � GALLONS.
THF: NATURE OF THE SYSTEM INCLUDED UNDER THIS PER24IT:
�
/^
Types of lark or 7reatJnet nUnits N(;i �% ^ T�hJt� ?ark Capacity,`7�) _Gallon tilnir<:u:a
r"ct.horl of Final Disposals Atb Cf* 0%tQ_W-
)• 1 c -%,k6. Absorption Area i l J Square Feet Hininum
Dcscription (including brand name, if any) of other equipment or appurtnancess
Cth42r Conditlond or Spccificationst l Ust 6teQ -ket-06A65 �OR- Qe16R (zek
V0/4
STAGES REQUIRING INSPECTION BY THE HEALTH DEPART LENT:
( )Before Excavation ( )Upon completion of excavation and prior to placement of gravel ( )Before covering distribution
system of absorption f_;-:ld
( )Prior to backfill of any component ( )Other, Specifyt
Plans and specifications of the proposed sewage disposal syntem have been reviewed and are considered satisfactory. Pr_rnis:a.on
is hereby granted to tl:a owner or his agenr to perform the work indicated above in accordance with the Pitkin County Indivi 'sal
Sew�a;c Disposal ReVulatlons in effect on the date of issue. In addition to general provisions set fort: on the reverse leer-
-et:,
this Permit is subject to the following additional terns and conditions:
APPROVED FORISSUE BY (, (title) )-j—
T)to a�lwe in.iividual so•.fa.le disposal system installed by ___
i1..s b: en lasS.ecCed for use ny a [ep[esent.itive of the As{.en i'itLnvrconr�..•nt.a uealtT OeparUnent. 7h0uw'n.�r a��au:noa a
rvcy>onn:biltty in case of failure or inadequacy of thtu scwaye disposal ayztcm. Completo as -built drawing attachod.
DATE O 1' FINAI, INS ECT ION 19
CC'. 00L�r
130 South Galena Street Aspen, Colorado 81131i 303/920-5070
Foe- 9zj
APPLICAT
Name of OWNER ?�
Address of OWNER
Name of APPLICANT
PERMIT TO BE: IX)Picked Up
( )Mailed tot TYPE OF PERMIT: (,New Installation t lxepair
( jOwner ( )Applicant . ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEMS
Legal Description ( ft MCCAP--f,
Lot ;lo
ck filing t�/� �,u� v�Subdivisiony-m 1�6ze of Lot �. f acres
TYPE OF STRUCTURE: ingle Family Dwelling ( )Others MkA* X 0% Do You plan any further dditions to the
%Aiy--I W �IM esidence? ( )PEs XNO
No. of bedrooms_ No. of Lofts No. of Garbage Disposals No: of Automatic Dishwashers
No. of Automatic Clothes Washers
MATER SUPPLY: ( )Private Wall, Depth or 0 Public, Name of System Iv 1t YijtJ� ��
( )Spring r/``
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(p()Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Hound
tt{{)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 lnfor ti n 11 invalidate the application and any subseque
nt permit.
Signature of Applicant DATE 1. 214 - y 1
(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.
<. 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 lie tion and a e it a in the amount
of S ! C": d , Receipt Number Date Fee Received ✓ by
AQmin1 ativo Officer
130 South Galena Street Aspen, Colorado 81611 303/920-5070
I
PITKIN COUNTY ENVIRONMENTAL HEALTH
Field Test Data Sheet on Percolation Test
f
PROPERTY OWNER PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES )-U—
Three
—
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water remaining after 8 hour soak
t1,o C c- 1 7
�,As: ,
S°'
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Time
Drop Time
Drop Time
5�
:
Comments on soil or site:
l
T', 00
t a -
CA 6 Lf
Z'cc�
L-AQa_
Percolation Rate Each Hole
(
( 'A N U / — vI
Average Rate
Comments on soil or site:
l
nn
ra R,
CA 6 Lf
I�� rJ lLott
L-AQa_
Signature Date - - �'�