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ENVIRO...MENTAL HEALTH OEPARTk—ENT ie it I Y -h 0 r
INDIVIDUAL SEWAGE DISPOSAL PERMIT NO.
TYPE OF PERMIT:
( Initial Construction ( )Emergency Use ( )Repair Work,(Pievious Permit i .) ( )Alteration of an existing system,
r installation (Previous Permit 1 )
( )Use Permit as a result of Sale ( )Othors
ISSUED TO: DATE OF ISSUE4h 2 --
Owner �:JM villa AM Y Home
Flailing
Address
Phone 55�Business Phone
Agent A(� � ( `T -H ��URnJ� 1 �F� p^. / Phone
-233 9
Mailing
Address �iNIF�VV%iG
Sewage Disposal System Work to be performed by DU'41v�
This permit valid
�7onlyy for premises location by the fo owing legal
jdavcriptions�/,� jj:=Uf7(
Lor SIZE 1- ACIC • WATER SUPPLY fDA1P Ligj-rr . AVERAGE PERCOLATION
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This Individual Sewage Disposal Permit is granted with regard to the following uses z /AI(s[:. / 1;ffu(:Y /) f` --3141c: "L-� •-
Nutaber ofi Dodreoms Lofts Garbage Disposals Dishwashers- Clothes Washers �.
CALCULATED AVERAGE DAILY WASTE LOAD 4S C_y GALLONS.
THE NATURE OF THE SYSTEM /INN.C-LUDEEDD UNDER THIS PERMIT:
epe of Tank or Treatment Units'l-�' "F - ' ' �N Tank. Capacit�)�_ Gallon Minimum
=shod of Final Disposals G�-E P/ C--€ BiEu) Absorptiop Area Square Feet Minimum.
:scrip=ion (including brand name, if any) of other equipment or appurtnancess
lther Condition! or Specifications: r , /1 /6 T1 APP, ✓E0 6g01 V/Ac_.tFAJ7-- ,y-L-7—c—eA11777 ✓�r E` �C_. V
119A S�
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation( pen completion of excavation and prior to pJaCement of gravel ( )Before cowering distribution
k"ior
/ `system of absorption field
to backfill of any component ( )Other, Specifyi
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
iK hereby granted to the owner or his agenr to perform the work, indicated above in accordance with the Pitkin County Indivi3val
Sewa,e Disposal Re.iulations in effect on the date of issue. In addition to general provisions set forth on the reverse her_of,
this Permit is suthject to the following additional terns and conditions:
APPROVED FOR ISSUE BY (title) �' �,enj7El14H�
Pell
i!/!P r Fei�---.v.;hn atxwc in:iividual ac�ra•lo disposal syetca Snstalledthe by _"1 -
has been in::pected for use by a representative of the Ass:n-1tA n l:nvl[onrw•nta !iea t.. Drp.jrtment. The u�.•nor es�cu•T.oa aTl
re:;ponsibillty in case of failure or inadequacy of thi ac aye disposal system. Complete AS -built Drawing attached.
DATE OF N I "PE FON 2—
BY: '1/G' TITLE-s'���i��t%I�L-
930 South Galena Street Aspen, Colorado 81611 303/920-5070
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k ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
-713
I PHONE 331-1-2011
Name oh OWNER C °` "" ` Sr--
Address of OWNER
CON^"C__ ' C p�0—'4J
` w 77573
Name of APPLICANT JA W -Cs PHONE
PERMIT TO BE: ( )Picked Up ( )flailed tot .
( jowner ( )Applicant
tZr-ATION OF PROPOSED SYSTEM&
Legal Description
TYPE OF PERMIT: p(ZNew Installation ( )Repair
( )Emergency Use ( )Alteration NOT due to failure
74�}�
CA —Block- I Filing Subdivision
ze of Lot 1/2 A L acres
TYPE STRUCTURE: (�ingle Family Dwelling ( )Other: Do you plan any further additions to the
her:
residence? ( )YES ( )NO
No. of bedrooms% No. of Lofts No. of Garbage Disposals No: of Automatic Dishwashers
No. of Automatic Clothes Washers
WATER SUPPLY: ( )Private well, Depth or O Public, Name of System � n�=•y /4/ L4=
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE 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. 6:30-9.30 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 in sewage dis sa perm t is hereby submitted. The undersigned acknowledges that the above information
is true and that false format n will i val the application and any subsequent permit.
Signature of Applican DATE Z 2 �� Z
(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.
4. 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 undersignedbgeby acknowledges receipt of this i dividual sewage disposal perms appl cation and a p/ermit dee in the amount
of S �1-���1LG , Receipt Number /�' Date Fee Received �- .by Administrative
Administrativo Officer
130 South Galena Street Aspen, Colorado 81611 303/920-8070
ASPEN40PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
Legal descri
Address of Pte. kt � ..Y .
Name of Owner:
Address:
(# & p.o. box) (city) (state) (Zip)
Name of Agent: �-
i
Lot Area: --Water Supply:Public Utility�/_Subdivision
Private W611 Other
Distance to Nearest Surface Water yp
Dates Observations Made: Soil Borings:z_ by +"
Percolation Tes s: , whyjCF
s
SOIL .BORING TESTS
PERCOLATION TESTS
P-1
Total
.Depth
Observed Depth
to Groundwater
Estimated Depth
to Groundwater
Character
of Soils
B-�
Diameter
'�/ �✓7
z_
Cl7/
ate. . J 'ql/
PERCOLATION TESTS
P-1
P-2
P-3
Depth
P-3
P-3
Diameter
Drop Time
Drop Time
Depth of Water ( 0T_
(left after 8 hr. presoak) 2
!
l
t
P-1
P-1
P-2
P-2
P-3
P-3
Drop Time
Drop Time
Drop Time
Drop
Time
Drop
Time
Drop
Time
q(T"
Rate P-1to P-2 f Rate P-3
AVERAGE RATE:') minutes/inch
Plan of the site and location of test holes on the back
Comments on Soil or Site:,,Q,,��D;l/���—
Date 22 Y Signature Pf
130 South Galena Street Aspen, Colorado 81611 303/920-5070
"If l 11
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