HomeMy WebLinkAboutpitkin.eh.264517400001 (1993) Cabin A-ASPEN+PITKIN
ENVIRa RENTAL HEALTH DEPARTI NT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
ZIE OF PERMIT:
Initial Construction ( )Emergency Use
r installation
( )Use Permit as a result of Sala
ISSUED TO:
i
( )Repair Work,(Pievious Permit 1 .) t )Alteration of an existing syutem,
(Previous Permit 1 .)
( )Othor:
DATE OF ISSUE . 2
Owner Ra)a,.)C1J AdAs-cey Home Phone Business Phone
Mailing
Address %®Q DA1,q d q �-Ot,01403sl
l-�V
Agent K� �00 1- Phone 27
RE01-0S6AA-K l VC SNT-rP61 I MOA)
Sewage Disposal System Work to be performed by /
This permit valid only for premises location by tho foljjlowi_ng legal
IAT SIZE WATER SUPPLY �i— AVERAGE 7RCOLAT10N RATj'FI ln/G
This Individual Sewage Disposal Permit is �/ % �1�I a A �+
y po granted with regard to the following asst
l/uraber oft Dodreoms Lofts r/ Carbage Disposals Dishwashers_ Clothes flashers
CALCULATED AVERAGE DAILY WASTE LOAD l 2 0 GALLONS.
THE NATURE OF THE SYSTEM INCLUDED ,UNDER THIS PERMIT:.
tpe of Tank or Treatment U its j C //� F` Tank.capacity-7—S-0 _Callon Minimum
:shod of rinal disposals A�—S kP7-10A - / �eAIOV-16S Absorptiop .Area Square rent Hinimum
_scriptio (including brand' name if any) of other equipment or appurtnancess �
P�0 vc / �Q :7T ,�.� U of '° ✓��LT,e�iz�,e Tiv� / eN
C . Fj
:ther Conditions or Specificationss
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Aefore Excavation ( )Upon completion of excavation and prior to placement of gravelfore covering distribution
A,':ystem of absorption field
(Prior to backfill of any component ( )Other, Specify: _
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
i:r hereby granted to the owner or his aacnt to perform the work indicated above in accordance with the Pitkin County Individual
Scwa,e Disposal Re-:ulations in effect on the date of issue. In addition to general provisions set forth on the reverse hereef,
this Permit is subject to the following additional terns and cond'tlions: _
Aspen/Pitkin Environmental
APPROVED FOR ISSUE BY (title) Health Officer
The ah«vc in:iividual Sewage disposal system installed by_(j S 4 A �`14
IZ-7q AAoviA)t✓ -
has b,cn in::pected for use by a represcntative of the ASPcn v'lt 1n Lnvlronr:�nta .ilea t.. Dcparunent. Tho uwnur eesumoa a 1
re::ponsibility in cele of failure or inadequacy of thiu sewage disposal system. Complete ax -built drawing attached.
DATE OF FINAL INSPECTION
FAY: TITLE-�1/ �.tZ � `t
130 South Galena Street Aspen, Colorado 81611 303/920-5070
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APPLI
Name of OWNER
Address of OWNER
Name of APPLICANT
ASPEN*PITKIN
ENVIR( MENTAL HEALTH OEPARI ENT
EON FOR INDI IDU SEWAGE DISPOSAL -PERMIT
PHONE �L7•�1�I�
9
PHONE 7Z�-'
PERMIT TO BE: ( )Picked Up ( )Mailed to: . V TYPE OF PERMIT: KN,, Installation ( )Repair
( )Owner ( )Applicant j )Emergency Use ( )Alteration NOT due'to failure
LOCATION OF PROPOSED SYSTEMS , i A ,
Legal Description / (// (r 1-_ (4 (�7
Lot Block Filing Subdivision Size of Lot acres
TYPE'OF STRUCTURE: ( )Single Family Dwelling ( )Others C-q�� �A Do you plan any further additions to the
residence? ( )YES ( )NO
No. of bedrooms_ No. Of Lofts No. of Garbage Disposals No: of Automatic Dishwashers _
No, of Automatic Clothes
Washers--
WATER SUPPLY: Private Wall, Depth or ( TPub11c, Name of System
( )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 PORTION
OF THE SYSTEM.
Application for an individual sewage p al permit is ereby submitted. The undersigned acknowledges that the above information
Is true and that false infp4m n w 1 idate he pplication and any subseque t p
ermit:
Signature of Applicant L DATE ' G v
is 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.
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 unde q ed hereby acknowledges receipt of this individual sewage disposal permit application and a permit,,, fee �n the amour.
of S , Receipt Number_, Date Fee Received ,.by X f
Administrativo Officer
130 South Galena Street Aspen, Colorado 81611 303/920-5070