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HomeMy WebLinkAboutpitkin.eh.264505404006 (1981)o— cf-7d (o ASPEN PITKIN ENVIRONMENTAL HEALTH DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. � � ca -o TYPE OF PERMIT: ( )InitialConstruction ( )Emergency Use ( )Repair Work,(Pcevious Permit 1 .) ( )Alteration of an existing system, or Installation (Previous Permit i ) ( )Use Permit as a result of Sale I )Others J% ISSUED TO: DATE OF ISSUE Owner(i / U kJ Home Phone Mailing - Address Business Phone r— 3 6, Agent Phone Z7 3 Mail.ing 4.� Address © .� ��� l.✓ k� %Vd'C'7-/,QAJ Sewage Disposal System Work to be performed by = = ��= (,')k This permit valid only for premises location by the following legal descriptions T r� ctf n� LOT SIZE NATER SUPPLY �4 _ LL= AVERAGE PERCOLATION RATE. I�II�iAS This Individual Sewaye Disposal Permit is granted with regard to the following uses Ntr.:tacr oft Dodreoms 3 Lofts 6 Garbage Disposals I DishwashersClothes Washers CALCULATED AVERAGE DAILY WASTE LOAD 4��L) CALLONS. THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT: Type of Tank or Treatment Unitt E C 1Q: 1 AtJ9- r�thod of Final Disposals Absorptiop Description (including brand name, if any) of other equipment or appurtnaneest PUMP A/J0 PUSP/IUC N� Tank.Capacity_� Callon Minimum Area 1� Square Feet Minimum Other Conditions or Specifications' r �0/0 '/ F&M E (MUNI P � Ir I }«.b �f STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: u�_B ( )Before Excavation Upon completion of excavation and prior to placement of gravel ` Before coveringof absorptionfieldn '� � Prior to backfill of any component ( )Other, Specifyt - Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission is hereby granted to tt,r- owner or his agent. to perform the work indicated above in accordance with the Pitkin County Individual Seva;c Disposal Rcvulations in effect on the date of issue. In addition togeneralprovisions act forth on the reverse hereof, this Permit is subject to the following additional terms and conditions: e (title) APPROVED FOR ISSUE B i The above individual scuago disposal system installed by i4 ✓��j•`�^� � has tx•cn ln::pactcd for use by a rcprescnia[ivc of the Aspen 1'st an invtronm.•nW lira t. Dcp•sruncnt. T � owner assumes All • rccitonsibiliiy in case of failure or inadequacy of this sewage disposal system. Complete as -buil[ droving attached. • DATE OF NAL INSPECTI N TITLE _ a"Clv/ • -2020 130 South diens Street Aspen, Colorado 81611 303/925 ASPEN PITKIN ENVIRONMENTAL HEALTH DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT Name of OWNER -)• -12 i PHONE Address of OWNER Name of APPLICANT PERMIT TO BE: ( )Picked Up ON OF PROPOSED SYSTEMt Mailed t�otj ( )owner On Applicant I PHONE TYPE OF PERMIT: New Installation ( )Repair ( Emergency use ( )Alteration NOT due to failure Legal Description L-1 1 Lot Block Filing Subdivision Size of Lot acres Do you plan any furthe dditions to the TYPE OF STRUCTURE:(]Q Single Family Dwelling ( )Others residence? ( )YES ( NO --7/ a /// No. of Automatic Dishwashers xo. of bedrooms � No. of Lofts No. of Garbage Disposals No. of Autonatic Clothes Wasners RATER SUPPLY: (Private Well, Depth 1/7HAIZet(A-) \ /or ( )Public, Name of System ( )Spring ( )Stream or Creek TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSEDs Septic Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Hound ( )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.) tcforc a permit can be issued.4disposal ge disposal permit must be issued before a building permit can be obtained. FINAL INSPECTION APPROVAL M T BN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION OF THE SYSTEM. Application for an individ al t is hereby submitted. The undersigned acknowledges that the above informs :c:i is true and that false inf 1the application and any aubeeque rmit.DATE signature of Applicant This application becomes. invalid 1 nths &Jom 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 undersigned hereby acknowledges receipt of this individual sewage disposal permit appli etion and apermi�S'f ai� tho amount �— Receipt Number Date Fee Received--7=•by " of Sjkdministrativo Officer 130 South Galena Street Aspen-, Colorado 81611 303/925-2020 PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER PHONE MAILING ADDRESS LEGAL DESCRIPTI P V OF PROPERTY LOCATION OF TEST HOLES Three (3) test holes required per system Test Hole Depths (24" minimum) Diameter of Test Holes Water remaining after 8 hour soak Percolation Rate Each Hole Average Rate Comments on soil or site: e � rh2 Date F, /� - TEST HOLE No. 2 TEST HOLE No. 3 TEST HOLE No.1 1 i L Drop Time - (.. Drop Time Drop Time 14 3 I �D T1 1 4- t3Z- Percolation Rate Each Hole Average Rate Comments on soil or site: e � rh2 Date F, /� - ,1 ji I