HomeMy WebLinkAboutpitkin.eh.264916101024 (1990)7A,2,1 uqq !Ce(- ! Ozq
ASPEN*PITKIN , ENVIRONMC;NTAL HEALTH DEPARTMENT
e •INDIVIDUAL SEWAGE DISPOSAL PERMIT NO. 610 0 1?
TYPE OF PERMIT:
(Initial Construction ( )Emergency Use ( )Repair work,(Pievious Permit (r .) ( )Alteration of an existing system,
or installation (Previous Permit (
( )Use Permit as a result of Sale ( )Others
ISSUED TO: q (p3- bSftATE OF ISSUE
Owneome Phone usiness Phone .
rIa i 1_ in g �� l G
Address �, �. 00X, 3�5 egtt ..t.iT Co 0 ItZI
Agent_
Mailing
Address
Phone
Sewage Disposal System Work to be performed by z�►e u D6 � � 1/� -A)r
3G S -7 1
This permit valid only for✓premises location by tho following legal descriptions I�,���Lj� �/� ��f• Zi4.
LOT S(2E (�_yr1 e5 LATTER sUPf'LY��t/%�I/yI(i(,It� AVERAGE PtiFCOLATIO7 RATE
TMs Individual Sewage Disposal Permit is granted with regard to the following use:4"lr1j j'ti(I
Ntr.,bcr oft Dodreoms _3 Lofts d Garbage Disposals__ Dishwashers�� Clothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD q6 -C) GALLONS.
THF: 'INATURE OF THE SYSTEM INCLUDED LEWDER THIS PEP.:iIT:
Type of Tank or Treatment Units y��•C ���� Tank Capacity Iy�0 Callon Hinim=;%
rkthod of Final Disposals /1 6�DrpV1vr' Treih s Asorption Area I� Square Feat Minimum
Description (including brand nane, if any) of other equipment orlappurtnancest 69 BED OF (000 � 0j '
1
.Other Conditions or Spccificationas
RCU)mvnu�d 3 +yen.cku.5 3 -• w►d - x
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTPIENT:
( )Before Excavation ( )Upon completion of excavation and prior to placement of gravel (Vo�efore covering distritution
system of absorption field
Ix Prior to backfill of any component ( )Other, Specifys
Plans and specifications of the proposed sewage disposal sy.tem have been reviewed and are ecnsidered satisfactory. Pernissi.on
is hercl;y gra;!Leel to tl,c owner or his agenr- to p•-•rform the work indicated above in a_ccrdanec with the Pitkin County Indivialial
Sf,wa,;•, Dinp^sal Rc,n:lations in effect on the d:,tc of i•:su,. In a,!dlt_on to general provisinna _ct fo:t: on _•,. averse
this P,acmit ii sut,ject to the following additional terrs and conditions:
,�/ Aspeil,/Pitkin Environmental
APPROVED FOR ISSUE BY C 7VGu�� (title) "-iealth Officer
Thr• ab vc in.iividual se•.:a,lo disposal system installed by _
ilns b;c:: ingi.cte(l t.)r ut,e r+y i reprt•scntative r_f the �.�.:c::ii'tt�;ln '_:vicon:�.nt..l si.,alf t):�p.trtm�_nt. Thr u_nur n.;u:�.oa aTi
rvalwnsaLility In ceyc of (allure or 1nad-quacy of t('1' ;c-oye d1spJYa1 uystem. Co,.plelu as-Lu11L Crawing attachod.
DATE OF FINAL INSPECTION�� )
Aspen/Pitkin Environmental
BY:TI'TLL Health Officer
130 South Galena Street Aspen, Colorado 81611 303/920-5070
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Porch eo5t
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O1000 gqA.116n
O Co=tk septic �k-
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P 650 -Pin' on 66cl
wI-1-h o "gavel
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IL
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT 1
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of OWNER yY� c,, i �r� = PHONE {i 3 —
Address of OWNER e,
)same of APPLICANT ;���� a`eL i� N� PHONE
EP-MVr To BE$ Picked Vy ; riled tos TYPE OrPERMIT$ New Installation ( )Repair
Owner ( )Applicant , ( )Emergency use ( )Alteration NOT due to failure
,OCATION OF PnOPOsEO SYSTEMs
14 _ a :
,egal Description I(!�
of / �'� Block __ Filing Subdivision \ � - P -i Size of Lot 3. 1 acres
Do you plan any further additions to the
,,YPE'OF STRUCTURES Wingle Family Dwelling ( )Other$ — residence? ( )YES �No
io. Of bedrooms No. of Lofts No. o1 Carbage Disposals r 1 Nod of Automatic Dishwashers
to. of Automatic Clothes washers
LATER SUPPLY$ ( )Private well, Depth -- _-- or oPublic, Name of System -Q--
( )Spring �p
( )Stream or Creek
`YPEs OF INDIVIDUAL SEWACIE DISPOSAL SYSTEM PROPOSED$
feptiC Tank/Absorption Field ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )!sound
(
)Recycling, Po ( )Vault Privy ( )Other:
Cable use ( )Recycling, other use
:he'initial site inspection must be arranged with the Aspen/Pitkin'Environnental Iicalth Depastmenc (925permi can8:3be :]0 a.m.)
:oforc s permit can be issued. The individual sewage disposal permit must be issued before a building permit can be obtained.
.INAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO DACKFILLINC ANY PORTION
W THE SYSTEM.
tpplieation Los an individual savage disposal permit is hereby submitted. The undersigned acknowledges that the above Information
.s true and that false information will inv at the application and any subsequent permit.
® DATE �- i �-_22 9 e
Cignature of Applicant
(This JErplication 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. Domestig water service lines.
4. Proposed and existing buildings, driveways, and other
strubtures.
5. Streams, lakes, ponds, irrigation ditches, and other water
courses.
6. Proposed and e.xisting individual sewage systems on subject
property. I '
�.TION IF INSTALLATION IS TO
SUBMIT A REVISED PLOT -PLAN PRIOR TO CONSTRU
BE CHANGED FROM ORIGINAL PLAN.'
'the undersignpd hereby acknowledges receipt of this individual sewage disposal pares! a 1U tion anby+ po it Lee in the
a amOU"t
Receipt Number n , Date Fee Received A�lnw
of : IS,G . Uc, , p
130 South Galena Street
Aspen, Colorado B1611 303/925-2020
um /Makovec9
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YES NO
ENVIRONMENTAL HEALTH DEPARTMENT CHECKLIST
Does this project include any NEW solid fuel
burning devices, gas log fireplaces, or gas
fireplace appliances?
Does this project involve any CHANGE to an
existing solid fuel burning device, gas log
fireplace, or gas fireplace appliance?
Will this project involve installation of a new
individual sewage disposal system, or modification
of a ixen st ni g sewage disposal`s"'stem?
If connected to an existing individual sewage
disposal system, will this project involve any
additions of bedrooms?
Is the water supply source a private well?
Does this project include any swimming pool, hot
tub, or spa open to the general public or as part
of a public accommodation with rentals of less
than two weeks?
Is a restaurant, catering business, retail food
market, or any commercial food service planned for
this project?
If the project is or includes an existing
restaurant or retail food market, are any changes
being made to the commercial food service
establishment?
Applicant 0, c� a � ti -i, �,.' Dat
Job Address i Permit Number