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HomeMy WebLinkAboutpitkin.eh.272920305057 (1984)T— - ' q- -�,5 4 ASPENoOPITKIN 3 ENVIRONMENTAL HEALTH DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL PERMIT N0. F O.2 7 TYPE OF PERMIT: Initial Construction ( )Emergency Use ( )Repair Work,(Pcevious Permit 1 .) ( )Alteration of an existing system, or installation (Previous Permit 1 ) ( )Use Permit as a result; of Sale ( )Othort ISSUED T0: DATE OF ISSUE. `�'�� '-sanecome Phone 96 Mailing Address R �. CJD 1 73 . &k&AIQAJit< - Z/ Agent___, Ma il.in g Address Business Phone L,vef► Do 81 Phone Sewage Disposal System Work to be performed by DOk'AIS This permit valid only for premises )ocation by tho following legal descriptions LOT SIZE I . Z- Ae-,e Ems,, WATER SUPPLY 1j*L L - , AVERAGE PERCOLATION RATE. � 7C M I A)11 A)Ci+ This Individual Sewage Disposal Permit is granted with regard to the following use: �)jJ�'SLE MIL J%�ENt (��• Number oft Dedreoms Lofts _ Carbage Disposals_ (/ Dishwashers © Clothes Washers CALCULATED AVERACE DAILY WASTE LOAD 1)- 3-0 CALLONS. THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT: ype o£ Tank or Treatment Units o�G►'(iC��+ Tank. Capacity, /SO _Callon Hlnimua Mathod of Final Disposalt�Qy%Ef/Frj Absorptlop . Area 360 /�Stquare Feet Minimum Description (including brand name, if any) of other equipment or'appurtnanceet (,ro4 2 FT OF GRi4VE7L B L.OtJ 1-JA1F5 _ PP,e� v>✓� PvM� C? o�Ir�c.s PUMP��I cffhM 06-e o F 375- GALZONS .A Piet ry A/ J.D '4.� /.�12 Other Condition! or Spccificationet IvoiE STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: ( )Before Excavation ( )Upon completion of excavation and prior to placement of gravel Before covering distribution A/ _ system of absorption field Prior to backfill of any component ( )Other, Specifyi _ A e�" E Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Perminaton is hereby granted to thr, owner or his agent to perform the work, indicated above in accordance with the Pitkin County Indiviaval Sewa a Disposal Rc•nrlations in effect on the date of issue. In addition toral ral provisions act forth on the reverse Lercof, this Permit is subject to the following additional terms and conditional /v O c APPROVED FOR ISSUE BY (title) r The above individual scwaga disposal system installed by Lf.� GINAI$ �x(af✓%�%/�(; I has brcn innpcctcd for use by a representative of the Aspen/Pitkin L'nvirona%crita ttca t. Ocp.trtment. The uwnor aseu•^ws a ry ponsibillty in cage oC failure or i adequacy of this scwaga disposal system. Complete as-buLlt drawing attachod. DATE OF FINAL INSPECTIONOS BY: ` _ TITLE _ 130 South Galena Street Aspen, Colorado B1611 303/925-2,R ASPEN*PITKIN ENVIRONMENTAL HEALTH DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT Name o f OWNER _ PHONE / % 73 :� -7 7 �4 Address of OWNEFr� Name of APPLICANT n) zz PHONE 96 3 0 3 // PERMIT TO BE: (Y)Picked Up ( (OU ed tot TYPE OF PERMIT: ( New Installation ( )Repair ( ;j Owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure LOCATION OF PROPOSED SYSTEM: Legal Description r Lot 3 Block Filing ubdivision/,Z2 '?( 87'X 113')( '1% Size of Lot acrea TYPE OF STRUCTURE: (v)Single Family Dwelling ( )Other: re you plan any further aydditions to the residence? ( )YES ( )NO No. of bedrooms ? No. of Lofts O No, of Garbage Disposals — tP No: of Automatic Dishwashers No. of Automatic Clothes Washers / p WATER SUPPLY: (f )Private Well, Depth (14VPJZ0Y or ( )Public, Name of System ( )Spring ( )Stream, or Creek TYPES OF INDIVIDUAL SEWAGE DISPCSAL 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 -n-) before a permit can be issued. The individual sewage disposal permit must be issued before a building permit can be obtainei. FINAL INSPECTION APPROVAL MUST BE GIVEN BY THE ASPEN/PITKIN ENVIRONMENTAL HEALTH DEPARTMENT PRIOR TO BACKFILLING ANY PORTION OF THE SYSTEM. Application for an indivi sE:wage dispos4peits hereby submitted. The undersigned acknowledges that the above information is true and that false foatin wiles/, application and any subsequent permit.Signature of Applicant ��� DATE applica ion 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 lanes 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 undersigned hereby acknowledges receipt of this individual sewage disposal permit &PPI cation and a permit fee in the amount of $ ('� , Receipt Number ___ Date Fee Received .by 1D jkdministrativo officer 130 South' Galena Street 'Aspen, Colorado 91611 303/925-2020 PITKIN COUNTY ENVIRONMENTAL HEALTH Field Test Data Sheet on Percolation Test PROPERTY OWNER — � � `' PHONE MAILING ADDRESS LEGAL DESCRIPTIO 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 soak P 7 { TEST HOLE No.1 TEST HOLE No. 2 TEST HOLE No. 3 Drop Time Drop Time Drop Time / f 3 _ �r!< Ct 7 3 I z s 3 , �. ti3 � I 4 Percolation Rate Each Hole Average Rate Comme is on soil or site: Signature rl� Date 9-2 - rf�EP�o�� r __ X67_ 016TMO " s �Loo F Is -40 PSG - 22_ i. 4-21 ep NTRGL'3 W wre Sc"rrc. ti<1.: _ ��... 15,-,!7! N uMPIG CHAMWL. 04"YaM,�cr1e- '�3 RP ! POACH+ Sp--go A it /fir �l 'ISS S f � � f 5 WA bL