HomeMy WebLinkAboutpitkin.eh.272904300011 (1982)aa� — 04 3-- CX) -a I 1
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
• INDIVIDUAL SEWAGE DISPOSAL PEP.11IT NO.
7,n;z OF PERMIT:
( ):nitial Construction ( )E:r+crgency Use Repair work,(Pievlous Permit 1 V�. .) ( .Alteration or an existing system,
or installation r.r^revious Permit i )
( )Jac Permit as a result of Sale ( )Othors
!SSUED TO:
Ol ner home
`ddres
c
ing
Address
DATE OF 1SSL'£*_1j_ "1
PhoneQ2-3-V30 Business Phone
o,eiqvo N I S
Agen t /V
Address &l�
Phone
Sev.0;;e Disposal System Work to be pertvrmLd by
This per-lt�val-'J only for premises loeation by tho following legal derscription: ►V / 1VtUSayoAiq 71O6A/�/�Q
LOT SI / .ZE (L-1 /T(ryZLS WATER SUPPLY GL� AVEPA+-,E PERCOLLATION RATF%J
Thls individual Sewnoc Disposal Permit is granted with regard to the following use- SiA1C-t6[AM ILY &'t0CN C
4te+bcr of- Dodrecros _ Lofis Cartage Disposals_ Dishwashers (� Clothes s:ashors l
CALCULATi:CI AVEi1.CE LAILY WASTE LOAD SCS CALLONS.
TEE : NATU77 OF THE 'STE'{ \'c'L1PJ D UNDER TRIS PERMIT:
Ty --.2 o` ;sr.% or Tre:tncnt UnitsS�EPTa7-rAA%r-- Tank Capacity _G Ilon Minimta
I•tr_r;.od of Final Disposalta-a- i�/od jg&—D Absorptiop Area �� r Square Feat Nintmrus
uescrir^tion (including brand name, if any) of other equipment or appurtnaneeas
Ave
Other Condition! or-cpccificationst
1 to til L
STA1.CES REQUIRING I �SPECTION BY =ar- HEALTH DEPAR=-NT: '
( )ecf,>re Exzavatior. ( )Upon co..^..pletion of excavation and prior co pEneement of gravel (jSLBcfore coverin-1 distribution
\\ � system cf ausocptiou field
X-rior to back!ill of any eompercnt ( )other, Speeifyt _ tJ A
:'Ian//s an,! specificationq of the prone=ed srwige digp^sal e:•^tern hay._ b—n reviewed -nd :-.re ccr.sidt red srt'sfactrry. Permission
c.-a;:trd to t�:
ASPEN*PITKIN
ENVIRONMENTAL HEALTH- DEPARTMENT
APPLICA.TIO.: FOR -tLi
Name of OWNER _.
'Address of OWNER
Name of APPLICANT
PERMIT To BE: ( )Picked Up
IZ;OIL Y IDUAL SEWAGE DISPOSAL- PF,RMIT
)Mailed to:
jOwner i )Applicant
PHONE qg J' -4/�3
PHONE CIA3 - ,�) G
T7Yr. OF PERMIT: ,.+yew Installation
j )Emergency Use
Repair
( )Alteration NOT due to failure
-jr n _
LDCATION OF PROPOSED�EM
Legal Description
d
Lt Block__ _ Filing Subdivision _5
L40
"YPE'OF STRUCTURE: Single Family Dwelling
( )Other: Do You Plan any further additions to the
rdai4erxr7 ( ) YES ( ) NO
acres
2. Of bedrooma____j_ No. of Lofts _iio. of Garbaga Cisposais go. of Automatic Dishwashers--
s:o, of Automatic Clothes Washers
�� O o: ( )Public, Name of System
WATER SUPPLY: (►7Priveta Well, DeQt:s
( )Spring
( )Stream; or Creek
,,7PES OF INDIVIDUAL SEWArE LIS?OSA:. SYSTEM PROPOSFOs
( Septic Tank/Absorption Field t )Aeration Plant/A::sozption Field ( )Composting Toilet ( lincineration Toilet ( )Mound
(')Recycling, potable use ! lRucycling, other use ( )Vault Privy ( )Other:
The initial site inspection must be arrar-aed with the Aspen/P:txin Enviromme:-tal ia:.1.h cc-.artnent (925-2020, 8:30-9!30 a.m.)
before a permit can be issued. The indiviauai sevaae o:sp•a a: :.j"jt must be Issued before a Culla.ng per:n..t can be obtained.
FINAL INSPECTION APPROVAL MUST HE C_VEW t'Y THE "`PEM/P1TX.'.'l ENV:IONbEN.'AL HE:.. ' 1)P.PAA7r=ti? Pi:OR TO LACXFZLL.`1G ANY PJRTIO!J
OF THE SYSTEM.
Application for an individual sewage dizosal parmit is hereby submitted. The undersigned a:kaoviedges that the above Information
o
is true and that false Z2��12
application and any aubsequent permit.
ignature of Applicantmonths izem(This application becomes. invalidthe above date.)
NOTE: PLOT PLAN must be f1led with tj-.is application.
Please locate the following items by mea.suzed 3istanze s:
1. Property lines and dimensions.
2. Proposed and eristinc water we!1 'In subject procerty and
adjacent proper_;;.
3. Domestic water service 'fres.
4. Proposed and existing buildings, I.i-Jeuays, and other
structures.
S. Streams, lakes, ponds, irrigatior. ditchna, and other water
courses.
6. Proposed =d existing individual sawYgr_ systems on sub;ezt
property.
SUBMIT A REVISED PLOT>'iKN PRIGR T:; =G =rS rlUCTIC'ty IF ?NSTALLATION IS T�
BE CHANGED FR -011 ORIGINAL PL-kN
She under gned herety ackrev:el.^,es receipt of 'his individua-, se"or's disroeal Permit a ieation and a permit fee in the amount
pi by
Of : 0ReeeipL `sumbe: � 1 , Data fe+s Rez ived r�
Administrative Officor
130 South Galena Street
Aspen, Colorado 81611
303/S25-2020
70
C
�1
I
I
1
c
M
� x
n., A
t�..,
7z 114AII
A R
PITKIN COUNTY ENVIRONMENTAL HEALTH
Fiel Tet Data S eet on Percolation Test
PROPERTY OWNER PHONE
MAILING ADDRESS
LEGAL DESCRIPTION OF PROPERTY
LOCATION OF TEST HOLES
Three (3) test holes required per system
Test Hole Depths (24" minimum)
Diameter of Test Holes
Water r! aining after 8 hour soak
r l�
AL�,
q-7
-.EAAJ LA
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Time
Drop Time
Drop Time
-5-3-7z
3 a
Percolation Rate Each Hole
Average Rate
Comments on soil or site:
Signature
Date
?-�3 - e2,-
/,/ 0 , R -2,-
STU"MARD BACTERIOLOGICAL WATER TEST
Colorado Department of Health c� RESU €�,
4210 Easi filth Avenue - Denver, Colorado 80220 '—MEMBRANE FILTER y W
DIRECT r c)
., ,f AME OF,f.a *p.._?,s. 1
( TIME GC� UPPLY VERIFIED U
SAMPLE TAKEN. DATE n'- H
s
CHLORINE
y ' """^`""""�" pr
e} l RESIDUAL _ --------MG / L
COUNTYSAMPLERR
( )COMMUNITY SUPPLY ( ) ROUTINE DISTRIBUTION SYSTEM SUPPLY ADJUSTED COLIFORM ! 100 ML
( ) NON COMMUNITY ( ) CHECK S�AAMPLLE,E ( ) PROCESS WATER COUNT: r
RAW (�rgtiROUND ( ) SURFACE LAURYL SULFATE BROTH
( ) OTHER PUBLIC ( ) �"
PRIVATE ( ) SPECIAL PURPOSE SAMPLE
**NOTE: IF ALL INFORMATION IS NOT SUPPLIED, THE SAMPLE WILL 24
BE DISCARDED. :r 48 O
BGB
RETURN TO t - ---------
---- COLIFORM / 100 ML a
r: MPN
11� �
ADDRESS= t RESULTS GREATER THAN ONE
COLIFORM PER 100 ML INDICATES
f
CITY-STATE .
_ -- -- NON-COMPLIANCE WITH MINIMUM
C3 M
SEE REVERSE�FOR�IstE LIMtTAil0idS, SAMPLING INSTRUCTIONS AND DEFINITIONS. DRINKING WATER STANDARDS.
LAB -MICRO 100 (Rev. 3.79) 100M
PITKIN COUNTY ENVIRONMENTAL HEALTH
Fiel Test Data Sheet on Percolation Test
PROPERTY OWNER ` C��� PHONE
MAILING ADDRESS � �1 D /�✓� fi /3S
LEGAL DESCRIPTION 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 sok
a
TEST HOLE No.1
TEST HOLE No. 2
TEST HOLE No. 3
Drop Time
Drop Time
Drop Time
t4
37,0
�16a
Percolation Rate Each Hole
Average Rate ^�.
Comments on soil or site: e,
Signature
Date����—