HomeMy WebLinkAboutpitkin.eh.273503300022 (1990)435- - 033- 00-C)aa-
ASPEN*PITKIN
• ENVIRONMENTAL HEALTH DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL PERMIT 140. 0
TYPE OF PERMIT:
( )Initial Construction ( )Emergency Use (Repair Work,(Pievious Permit 1 Z D .) ( )Alteration of an existing system,
or installation (Previous Permit I )
( Use Permit as a result of Sale ( )Othor3 ,
ISSUED T DATE OF ISSUE (p iz- 90
Owner "I s Home Phone L9Z5--Z361?Business Phone
Mailing n \^'
Address �'0) - � rx r1 �a{L 'amu Ve
r
Agent,
Ma il.in g
Address
Phone
Sewage Disposal System Work to be performed by,��
This permit valid only for premises location by the following legal descriptions
LOT S(LE 5. 14C�ie.S , WATER SUPPLY j�C 11�. V44t j I AVERArE
✓1 / 1� •
PERCOLATION RATF.
This Individual Sewage Disposal Permit
is granted with regard to the following use: innj
Fa- xx� w
NutatH r oft IIodreoms _ Lofts
Garbage Disposals__ Dishwashcrs�� Clothes
Washers
CALCULATED AVERAGE DAILY
WASTE LOAD 300 GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER TRIS PERMIT:
Ty?.? of Tank or Treatment Unitr f! ar,k Tank. Capacity (0Qd G�ion Hinlmu:
!•r_t.*.od of Final Gisposalr - t 0� �GIL(�C /iD�) �Absorptlop Arse 5�Aj qu c'Fe, Hintmum
fi l✓5 -h o�'l gtr kuQ '
Description (including brand name, if any) of other equipment or appurtnancesr
(eCommcnik Z At4f +YC'n.Vs, 34Wld- < �-01 10 VVI Z D� 1�6tN�I !�)owetPI�J
6 5+-yY 6 ov1 600 .wig
.Other Conditions or 5pccificationsr
--. -a-�.e ski sir ✓t� �cEi .
41950m'h'ovq ke(d ML,.s he lrj6ta Led a. KKrU r►4.0-,A,- of wa) -r bit► e .
STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT:
( )Refore Excavation ( )Upon completion of excavation and prior to placement of gravel 948efore covering distribution
system of absorption field
t/4 Prior to backfill of any 'component ( )Other, Specify:
Plans and specifications of the proposed sewage disposal system have been reviewed and r.rn_ considered satisfactory. Pernigsi.on
is hereby granted to the owner or his agent to perform the work, indicated above in accordance with the Pitkin County Indivi.lUal
,; vi
Sr-waa Disposal Poulnc
tions in effect on the date of issue. In addition to general provisionn qct or+ tlw reverse her,eC,
this P.!rmit ie subject to the following additional terns and conditions:
�1 Aspen/Pitkin Environrrlental
APPROVED FOR ISSUE BY C �- j�G����__ (title)_ Health Officer
Thc. a:xive in:iividual nc�a•lo disposal sy.stem installed by�1(-W —(i A____
i�n9 b�cn ln.: a
�: Ctcd for u`�e t+y a represcntt Lve cf thek; Anpc%/Pita _nvi[.-: n. -rota N^a1 DcparCmtnt Th._v
.not a•��; u.'rn� ail
re:awns.Lil>.ty in case of tailure or inadequacy of thlu 3e1e1je drsi,o�al rystem. Corrplrle all -IU It drawin,] attached.
DATE OF EINAL IN'pECTIO --9r af- -2t-,q
Aspen/Pitkin Envirof)rnental
Health Office,,
BY: TITLE
130 South Galena Street Aspen, Colorado 81611 303/920-6070
ASPEN6PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT
Name of OWNER b th,'Afix) JAPHONE
Address of OWNER QSY A�fiqti) Me- b k _
Name of APPLICANT PHONE
PERMIT TO BE: ("q Picked Up ( )Mailed to: TYPE OF PERMIT: ( )New Installation (+7 Repair
( )Owner ( )Applicant ( enc Mmer
_ 9 y use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEMS / 1
Legal Description L 0 T 11A I I1 6 i Af CIV 6i})L LDjj'
Lot Block Filing Subdivision Size of Lot S+� / acres
TYPE OF STRUCTURE: ()Single Family Dwelling ( )Others
Do you plan any further additions to the
residence? ( )YES ( )NO
No. of bedrooms �' No. of Lofts No. of Garbage Disposals } No. of Automatic Dishwashers
NO. of Automatic Clothes washers 1
f )
WATER SUPPLY: (�4 Private Well, Depth or ( )Public, Name of System
( )Spring
( )Stream or Creek
TYPE/ES 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, 8:30-9:30 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 individual sewage disposal permit is hereby submitted. The undersigned acknowledges that the above information
is true and that false information will invalidate the application and any subsequent permit.
Signature of Applicant 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 lanes 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 undersign d hereby acknowledges receipt of this individual sewage disposal per nit pplication and a per it fee in the amount
Of i_/ Sfillli�/ , Receipt Number Date Fee Received �.by
�
Administrative Officer
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