HomeMy WebLinkAboutpitkin.eh.264903300007 (1989)2�gc1-/a3 &,,v-av5
ASPEN*PITKIN+j3"
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0.
TYPE OF PERMIT:
Xinitial Construction ( )Erergency Use ( )Repair Work,(Pievious Permit 1
!/ or installation
( )Use Permit as a result of Sale
ISSUr:D TO:
Ownerl_/if,L
Mailing Pox
address yo rl"qk
Agent
Mailing
Address
( )Othort
DATE
,) ( )Alteration of an existing system,
(Previous GPermit 1 )
OF ISSUE
Home Phone -92,61 Business Phone
,W) '�SPP-IAL-
Phone q
Sewage Disposal System Work to be performed bynNrx19(' T-C%P
This permit valid only for preriscs location by tho following legal descriptions
.SA
� .
LOT SIZE
7 QeC<S . WATER SUPPLY �LL- AVERAr.0 PERCOLATION RATF.exi Sh/�.�
ia MI1
This Individual Sewage Disposal Permit is granted with regard to t).c following use: 'LG Ttf- Du 1iiT/Q�
r / G
Ntrab,-r oft Dedt'coms _) Lofts_ l--� Garbage Disposals_ `-) Dishwashers Clothes Washors
CALCULATED AVERAGE 'DAILY WASTE LOAD -f / GALLONS.
1 THE 1 P.TU ,E OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
Types of Tank or Treatment Uyyn��ltt
Method of Final Disp03311 /J�G'.� ' //E� ��H4 Abeorptioq
,Description (including brand (/name', if any) of other_ equipment or appurtnaneeat
Cthcr Condition! or Specificationat
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Upon completion of excavation and prior to placement of gravel�(iBefore covering distribution
\pystem of absorption fil.ld
Tank Capacity_-- -7- 0 _Callon Hinir,u:a
Area ASQ�0- Square Feet Hinlrrum
C6,1 LF OF 3 F-7- 60 i DC- -i"RE90-
( )Refore Excavation
)Prior to backfill of any component ( lOthec, Specify: --
Plans and specifications of the proposed sewage disposal system have been reviewed andare considered satisfactory. Pernlnsi.on
is hereby granted to the owner or his agenr to p•^rform the work, indicated above in accordance with the Pitkin County IndiviAlia.l
SCVJje DiSposal Revulations in effect on the date of issue. In addition tq�eneral provisions set forth on tho ruvcrse Lereoi,
this Permit is subject to the following additional terms and conditions: IIAAw17
AsperWitkin Environmental
"1K (title)_
r ( Health Officer
1'+PPROVED FOR ISSUE BY /CG
The t!:ivn in.iividual No aqo dispo.val system inatallcd by
has U: en lni�
-..,.c[rd for use try pac
a rcresentctve f the As{:en i'[tnin L'av:rcnr.�nta •iicalt ilcpircmen[. Th. —nor ossu:roaa-1
rc:;pOns:biltty in Cole of failure or inadequacy of tf sew.+. disposal system. corpleCu :.s -built drawing attachod) on ieuerse
DATE OF IN 1I "i SP C;?102!
Aspen/Pitkin Environmental
v ' T' LT +_ Health Officer
130 South Galena Street Aspen, Colorado 81611 303/980-5070
ASPEN*PITKIN �51e Adcfeo5�
ENVIRCnNMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER SLA ly Q � f �2 PHONE /L,�
Address of OWNER ,'.o I i6 k ad, C'tl-t bt dA-Z-o����� 3
Name of APPLICANT . J-. m o-*-� �'/S 7PHONE
9/5 1-1-1 y C-22 C/vni a.�c d S J . lr�i7 V(ICI /
PERMIT TO BE: ( )Picked Up - (A.Mailed tot TYPE OF PERMIT: 04New Installation ( )Repair
( jOwner (,)Applicant ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEMt
Legal Description �S�'' C�t4 lL� j� fl 9-5
Lot Block Filing s� Subdivision Size of Lot acres
6ic/ A
TYPE OF STRUCTURE: ( )Single Family Dwelling ( )Other: -- t^ Do you plan any further additions to the
residence? ( )YES (*ANo
No. of bedrooms i' No. of Lofts No. of Garbage Disposals --4 No. of Automatic Dishwashers
No, of Automatic Clothes Washers /
WATER SUPPLY: ( )Private well, Depth
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
or 04PUblic, Name of System bo le W`
(d¢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 disposal permit is hereby submitted. The undersigned acknowledges that the above information
is true and that false Snformati will invalidate the application and any subsequent permit.
Signature of Applicant testi
DATE_
(This application becomes. invalid 12 m the from the above date.)
NOTE: PLOT PLAN must be filed with this application.
Please locate the following items by measured distances:
I. 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.
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 undersig"q hereby acknowledges receipt of this individual sewage disposal pe ap 1 tion and a permit Lee n the amount
of S ��t! , Receipt Number , Date Fee Received G by "
Administrativo officer
130 South Galena Street Aspen, Colorado 81611 303/92S�2020
0
Leo Jammarc i 6walsircction
4915 STATE HWY. 82
PHONE 945 - 5128
(hGLENWOOD SPRINGS. CO. 81601
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