HomeMy WebLinkAboutpitkin.eh.273303100007 (1993) Barn2- 3J- va -oo 7
ASPEN#PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0. I J b 2 D
TYPE OF PERMIT:
Initial Construction ( mmergency Use ( )Repair Work,(Pievious Permit 1 0 ( )Alteration of an existing system,
or installation (Previous Permit 1 )
( )Use Permit as a result of Sala ( )Other:
ISSUED TO: DATE OF ISSUE.
ownerf zG%c'� l Sr�Gi� Home Phone% 2-3 y ISSUE* -
Phone 5�-"
Mailing
Address
Agent GI>'P', /�� <�/� C_^c��y/�vc�c Phone/�l -
Mail.ing
Address
Sewage Disposal System Work to be performed byaro -
This permit valid only for premises location by the following legal descriptions
LOT SIZE , WATER SUPPLY .pr/lp,47 AVERAGE PERCOLATION RATE
This Individual Sewage Disposal Permit is granted with regard to the following use: Qf:�i _ 5A6ea 57N;/'/S, k
Nuraber oft Dodicoms %J Lofts Garbage Disposals Dishwashers Clothes Washers
„7 /
CALCULATED AVERAGE DAILY WASTE LOAD 34”) GALLONS. 5.- he"'SQS
THF NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT: 1 'd4 54 Pee' A ore DEr 7�* 2_6z9 51A/d
15-6:5 1p 471 4;,,2,>" ftgiui G
of Tank or Treatment Units Tank. �a a/c/hy _Callon Minimum
_thod of Final Disposals L 0410 A E�C'� Absorptioa Ax.e Square Feet Minimum
=scr.iption (including brand name, if any) of other equipment or appurtnancess r -
�. �.� S � 2 i--5��,,�-c�-�^! •Th-r� i �% c, L7-.i2-ece- ��c��" ra-� •J7����5' = ll'
Fol 7/a� l / a L s �t�r� / 7 3_////I '-,.•.--�
:then Conditions or Specifications:
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Before Excavation ( )Upon completion of excavation and prior to placement of gravel ( )system covabsorpdng stributi n
i
( )Prior to backfill of any component ( 10ther, specifyi
Plans and specifications of the proposed sewage disposal system have been reviewed and are considered satisfactory. Permission
in hereby granted to tl,c owrer or his agent. to perform the work indicated above in accordance with the Pitkin County Indivizival
Scwa,c Disposal Revulations in effect on the date of issue. In addition to general provisions set forth or, the +-everse her_er,
this Permit is sutject to the following additional terms and conditions: -
APPROVED FOR ISSUE BY IY''�°�9�L� (title)
;ho a ;•rve in:iividual sc�+ago disposal aystc:n Snstallcd by 'in /
i�as lx•cn i,::pcctcd for use by a representative r.f the Asq:cn i'i in 1'.nVlrUnrh'nta
rc::ponsibility in ccsc of failure or inad�-quacy o hiu :+cwage dispon 1 system.
DATE OF FI' INSPECTION _
Mov✓vu
�_.—�_
nrp•+zunc,rt. The uwnur eea:.oa a i
Complete as -built drawing attached.
6/v is
TITLEjt4V.
130 South Galena Street Aspen, Colorado 81611
303/620-5070
ASPEN*PITKIN
ENVIR0IVa.r1ENTAL HEALTH OEPARTM.._.VT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name of OWNER PHONE g22j ' Z440
Address of OWNER 09700���S
Mame of APPLICANT CK. of C'��15' ue �u� r � PHONE
'ERMIT TO BE: Picked UP ( )Mailed tot _ TYPE OF PERMITS New Installation ( )Repair
( (owner ( )Applicant 1 )Emergency Use ( )Alteration NOT due to failure
:!)CATION OF PROPOSED SYSTEM.
'.egal Description 6 DO • S146)N" 3 Cele- KO }
:,tet Block Filing Subdivision Size of Lot acres
TYPE OF STRUCTURE: ( )Single Family Dwelling Others r�K-Aj Do you plan any further additions to the
residence? ( )YES W NO
of bedrooms No. of Lofts No. cf Garbage Disposals No: of Automatic Dishwashers
-o, of Automatic Clothes Washers j
.'ATER SUPPLYs Private Well, Depth or (1Publie, Name of System
( )Spring
( )Stream or Creek
..YPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED.
NSeptic Tank ( )Aeration Plant/Absorption Field ( )Composting Toilet ( )Incineration Toilet ( )Hound
)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.)
l,efore 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 individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information
is true and that false information wi invalidate the application and any subsequent rmi.
.
DATE 5Z7 C ?)
Signature of Applicant '-
(This application becomes. invalid li 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.
5. 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 perm t appl cation and a rm t fee in a amour.
O! S �'Ol l•� -� Receipt Number � IIR� , Date Fee Received by t
Administrativ Officer
130 South Galena Street Aspen, Colorado 81611 303/980-8070
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