HomeMy WebLinkAboutpitkin.eh.272909200025 (1988),-7 -q _019 -t4y6_C)2
' ASPEN*PITKIN
<A ENVIRUNMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
TYPE OF PERMIT: ���
( )Initial Construction ( )Emergency Use ( )Repair Work,(Pievious Permit 1 .) XAlteration of an,c
existing system,
or installation Prev't
( )Use Permit as a result of sale ( )Other: iou Petm
ISSUED TO: DATE OF ISSUE. 7,J
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Owner _Home Phone n ''x_;170 Business Phone
Mailing
Address
Agent,
Ma it in g
Address
Phone
Sewage Disposal System Work to be performed by ✓,
This permit valid only for premises location by the following legal description: / , YAt�
ZIAIC 14LOT SIZE - n (- <� WATER SUPPLY �. f L. AVERAGE PERCOLATION RATTF I
This Individual Sewage Disposal Permit is granted with regard to the following use: �� ( f fl��i�'% k2j �1�j Cj C_
Nur.rber of: Dedreoms 3 Lofts -t Garbage Dis//posals__[-__ Dishwashers Clothes Washers
CALCULATED AVERAGE DAILY WASTE LOAD
"1�� GALLONS / O-rAL _,,41LOAIS 70
THE NATUP.E OF THE SYSTE-M INCLUDED UNDER THIS PERMIT.
Typ.:! of Tank or Treatment Unit: h1k Tank Capacity /. Callon Hlnimca
Method of Final Disposals EPA 616- � �- Absorptiop . Area Square Feet Minimum
Description (including brand name, if any) of other equipment or appurtnancess
.Other Conditions or Specifications.
Afi✓D �.���f
Za' y/
STAGES REQUIRING INSPECTION BY�T HF.��LTH DEPARiENT:
( )Refore Excavation (J1)Upon completion of excavation and prior to placement of gravel AlsYstem offore vabsorpnq tion•fr�=ldon
1I
(Prior to backfill of any component ( lochec, Specify:
c
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Pernissi_on
is hereby granted to tt,e owrer or his agent to perform the work indicated above in accordance with the Pitkin County In,iivi3+sal
Sewage Disposal Revulations in effect on the date of issue. Inaddition to general provisions act forth on the reverse her.ef,
this Permit is subject to the following additional terms and conditions:
• Aspen/Pitkin Environmental
APPROVED FOR ISSUE BY
(title) Health Officer A2� 7�
r
The alxwc individual scua,lo disposal system installed by Itca t- pc �rtm(:nt. Tho u.rnur av?rumoa all
: has tx en in:,pectcd for use by a rc rescntative of the Aspen Pit in L'nvlronrZnta P•
re ponsibillty n cana ;f tai deg/uaa of A. cwa)a di poaal system. Complete ai-bulli driving attached.
DATE 0 I' IN P • TION _ Aspen/Pitkin Fnvironmental
/ Heat• •
< fir
B.1: TITLE _
130 South Galena Street Aspen, Colorado 89691 303/S25-2020
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER �� \�;t,,�� �fAti� PHONE
Address of OWNER C)5 t k '�)CvALS U-kc*a
Name of APPLICANT W"A', NyV\ PHONE
PERMIT TO BE: ( )Picked Up ( )Mailed to: TYPE OF PERMIT: ( )New Installation ( )Repair
( )Owner ( )Applicant ( )Emergency Use (,/-)Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM:
Legal Description�� T 101
Lot Block riling Subdivision Size of Lot 7' acres
TYPE OF STRUCTURE: (Single Family Dwelling ( )Other: Do you plan any further additions to the
residence? OYES ( )NO
��kGr (c�cCM
No, of be rooms a�' No. of Lofts No. of Garbage Disposals No: of Automatic Dishwashers
No. of Automatic Clothes Washers
WATER SUPPLY: (Y)Private Well, Depth r✓{� or ( )Public, Name of System
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAnE 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 to 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 information will inv lidate the application and any subsequent permit.
Signature of Applicant �1,f 44 .,s DATE
(This 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.
<. 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.
She undersign4d hereby acknowledges receipt of this individual sewage disposal perm � iic�stion and a permit, fee �n the amount
Receipt Number _ , Date Fee Received by
Administrative Officer
130 South Galena Street Aspen, Colorado 69699 303/925-2020
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SYDNEY LILAC/COME (L.3 14111)
BOX 121 CARBONDALE, COLO. 303-963-3852
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