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HomeMy WebLinkAboutpitkin.eh.264522400559 (1987).2y-oa-Ssi ' ^ ASPEN*PITKIN y, ENVIR�MENTAL HEALTH HEPAR ENT INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. TYPE OF PERMIT: ( nitial Construction ( )Emergency Use r Installation ( )use Permit as a result of sale ISSUED TO: ( )Repair Work,(Pievious Permit 1 .) ( )Alteration of an existing system, (PreviousPcr it i ) ( )Others DATE OF ISSUE. Ownerr/?M/�S /�-19Home Mailing Address �� �T. Agent_ Mailing Address Phone a,//o Business Phone o0o,Q1 0— 6 Vt // ---- Phone Sewage Disposal System Work to be performed by c� This permit valid only for premises )ocation by the following legal deacription: Ili ' JG r C� 7i2 LOT SUE&J2 , WATER SUPPLY EA�ELL AVERAGE Pbb'RCOLA7ION RATE This Individdal sewage Disposal Permit is granted with regard to the following use: Nu•.:ber of: Dodreoms / Lofts——O-- Garbage Disposals_L— Dishwashers " Clothes Washers _ __• CALCULATED AVERAGE DAILY WASTE LOAD I Lq(Do GALLONS. THE NATUZE OF THE SYSTEM INCLUDED UNDER THIS PER11IT: Typ•:? of Tank or Treatmentunits VC.I" f 1C 1A1UK- tdethod of Final Disposals SeCPA GF -D Absorption Description (including brand name, if any) of other equipment or appurtnancess Other Condition, or Spccificationes - IV®,/,-'- - Tank capacity,_ —Callon Minimu:a Area square Feet Minlnum STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: ' ( )Aefore Excavation ( )upon completion of excavation and prior to placement of gravel )ayste� of absorpting distribution oj Rola n (Prior to backfill of any component ( lother, specify: __--------- Plans and specifications of the proposed sewage disposal system have been reviewed and arc considered satisfactory. pernission in hereby granters to tt,c owner or his agent to perfnrm the work indicated above in accordance with the Pitkin County Indivival Scwa;c Disposal Revelations in effc(:t on the date of issue. In addition to general provisions set forth on _hlr-reverse hereei, this Permit is suvject to tare following additional terras and conditions: • APPROVED FOR ISSUE BY — She above in:iividual xc•rago disposal eyatcrn installed by -- ucultfirp• runcnt- Tho uwnuros ATl t has b c,r in:p•cted for usn_ by a representative of the Ai en T, =77, environ�•nta r rcc:pons:Lility in came of failure or Inadequacy of thiu sewaqu disposal system. Complete os -Coils drawing attached. DATE OV FINAL INSPECTION, BY: TITLE' ►�a C W 13f3 to +£H. met Aspen, Colorado 81611 303/525-2020 ASPEN*PITKIN ENVIRONMENTAL HEALTH DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT OWNER �� S CEJ Name •f • PHONE � � Address of OWNER PHONE Name of APPLICANTQ�f F PERM2� BE: ( )Picked Up (141failed tos - TYPE OF PERMIT: ( )New Installation ( )Repair (j,6wner ( )Applicant ! )Emergency Use ( )Alteration NOT due to failure Legal Description Size of Lot acres Iqi Block_____.Filing Subdivision ( Do you Plan any further additions to the TYPE'OF STRUCTURE: Single q Family Dwelling )Other: residence? ( )YES ( )NO No. of Garbage Disposals __ No. of Automatic Dishwashers 0 No. of bedrooms __ No. of LoCts� No, of Automatic Clothes Washers // or ( )Public, Name of System WATER SUPPLY: (`.YPrivate Well, Depth 2 a ( )Spring ( )Stream or Creek TYPES OF INDIVIDUAL SE rI DISPOSAL SYSTEM PROPOSEDs (),fSeptie Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ` )Other:ration Toilet ( )Mound )Vault Privy (*)Recycling, potable use ( )Recycling, other use ( tment 5 a-30-9-30 a.m. on must be iAspen/Pitkin Environmental Health ar Theinitialseiscdividualsewage disposalPermitmusbeissuedbefore a building permit can be obtained. t�cfitenbeissucdTin H DEPARTMENT PRIOR TO SACKFIL:.ING ANY PORTION FINAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALT OF THE SYSTEM. Application for an individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information L is true and that false informs ion will invalidate � yappliea on and any subsequent perm;=• 2,2 � DATE Signature of Applicant (This application becomes. invalid—12 nths 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. I SUBMIT A REVISED PLOT PLAN PRIOR TO CONSTRUCTION IF INSTALLATION IS TO BE CHANGED FROM ORIGINAL PLAN. g Permit pplle t on and a permit fee in the amount The undersigned hereby acknowledges receiptf!s Individual sewage disposal pe by L , Receipt Number , Date Fee Received 1►dministrativo officer 303/925-2020 130 South Galena Street Aspen, Colorado 81611 4SPENObPITKIN ENVIRONMENTAL HEALTH DEPARTMENT FIELD TEST DATA SHEET Legal decription: Name of Owner: Address: Name of Agent: Z/ P) Water Supply: Public Utility Subdivision Private Well Lot Area: f�e- Distance to Nearest Surface Water '0-t&q Dates Observations Made: Soil Borings: Po& by Percolation Tests: 2 by QF SOIL BORING TESTS IN DEPTH TO /MOUND MAT[[, /[[T ^' 74 TEST TOTAL DEPTH Ig MUM [[N •([T CHARACTER 0/ SOIL MiI TN TNTC FN [[• IN /[[ 7G2 OSICPV [O [ST141AT[D NILN B-1 91 B-2 PERCOLATION TESTS Average Rate: 'Q minutes/inch Plan of the site on the back Date Signature —zw 9108 N>wi.SON ASPEN/PITKIN SANITARIAN 130 S. GALENA ASPEN, CO 81611 XOIIRS WATER TEST fIM[ DROP IN MATES LEVEL. INCHES MINUTES SECONO TO LAST PERIOD HC.T TO LAST PERIOD LAST PERIOD TEST DEPTH N VM SER INCN(S CHARACTER 0/ SOIL THICKNESS IN INCNCS !INCE HOLOIN 1!T WET HOC. INTERVAL OVERNIGHT N MINUTE LL TO I. I ONE N ClI SI LTY O��'I I P-1 SgwoyetAi2,Y Yed 19/4,' "gym /y Y� 5 r3 11 P-2 5tn! e� 2 SlL7)' C.©fYM 1 S 3 7 9 P-3 Ii Y4 2y a P-4 Average Rate: 'Q minutes/inch Plan of the site on the back Date Signature —zw 9108 N>wi.SON ASPEN/PITKIN SANITARIAN 130 S. GALENA ASPEN, CO 81611