HomeMy WebLinkAboutpitkin.eh.273503300029 (1992)i
'ASPEN*PITKIN�3�'
ENVIRDw-jMENTAL HEALTH DEPARTMENT
co
INDIVIDUAL SEWAGE DISPOSAL PERMIT N0. R0
TYPE OF PERMIT:
( Initial Construction ( )Emergency Use ( )Repair Work,(Previous Permit / .) ( )Alteration of an existing system,
Ir installation (Previous Permit t .)
( )Use Permit as a result of Sale ( )Others
ISSUED T0: l(1t.r.� �.,, �% DATE OF ISSUE O/V ?
Owner &OCLAO OAARIJ R Aome Phone2-.5 Business
Mailing /�'� /�
Address t�lr' A
Agent Phone
Mailing
Address
Phone
Fj
Sewage Disposal System Work to be performed by p� /�_
ts,s. .... ..-46- ..rsi.s nnly (n. --t— laentinn by the followina legal dexcriotions_�-1"/D/�z �lL� S 1<5 � 0.� W
LOT size 2 / s WATER SUPPLY 6tVLL- , AVERAGE PERCOLATION RATE 'Sx- iprttj A4
This.Individual Sewage Disposal Permit is /granted with regard to the following uses1 Nf t! rAN�/LX jl% JiEs�/�
Nutabcr oft Dedreoms Lofts L ` Garbage Disposals �2— Dishwashers 2-- Clothes Bashers
CALCULATED AVERAGE DAILY WASTE LOAD 0 GALLONS.
THE NATURE OF THE SYSTEM INCLUDED UNDER THIS PERMIT:
rp^ of Tank or Treatment Units SE 1.10-- A N e _ Tank -Capacity 12S-0
Gallon Minimum
=thod of Final Disposals Q 100 46 /v` t C Absorpliop .71rea Square Pett minimum
zscription ( neluding brand name, if any) of other equipment or appurtnaneess
:then Condi
t
ion
s ryor specifications:
STAGES REQUIRING I_ZSPECTION BY THE HEALTH DEPARTMENT:
( )Nefore Excavation ( )Upon completion of excavation and prior to placement of gravelBefore covering distribution
ystem of absorption field
Prior to backfill of any component ( )Other, specify: _ - -
Plans a d specifications of the propdsed sewage disposal system have been reviewed and are eonsi.icred satisfactory. Permission
is hereby granted to th�c owner or his agent to perform the work indicated above in accordance with the Pitkin County Indivi:ilial
Sewa;c Disposal Rcvulations in effect on the date of issue. In addition to general provisions set forth on LLc reverse hereof,
this Permit is subject to the following additional terms anti conditi ns:
Aspen/Pitkin Environmentai
APPROVED FOR ISSUE BY - (title) Health Officer
J
ihr. above individual a,-wago disposal systern inntallcd by Ti)n� // r A J `-"""�'6r'r ��- s a 1
-
has txcn la::pcctcd tor use by a representative cf the Aspen vitkin £nvironr,<•nta Hea t.. neparuncnt. Tho .,wnor a��umo
re:awnsibility in Case of failure or inadequacy of thiu sewage disposal system. Complete as -built drawing attachod.
DATE OF INSPECT ON :3 2
--------Aspen/Pitkin Environmental
Zj" TITLE Health Officer
130 South Galena Street Aspen, Colorado 81611 303/920-6070
ASPEN*PITKIN
ENVIRONMENTAL HEALTH DEPARTMENT
APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL -PERMIT
Name o f OWNER C' Y- 0. -'c -o v, R 1� �c r {C 1�0 �e r PHONE 9Z --Z73 7 _
Address of OWNER 3of A 1k g G e n
Name of APPLICANT l-- PHONE 4Z J -Z7 3 7
PERMIT TO BE: ( )Picked Up ( )Mailed tot TYPE OF PERMIT: ( )New Installation ( )Repair
( )'Owner ( )Applicant ( )Emergency Use ( )Alteration NOT due to failure
LOCATION OF PROPOSED SYSTEM: Sec.., 3 rJ O S k gs U-
Legal Description L CIA .2 nE l? kcL+ re cov' de l :•n ?l \.L+ Book- 3 CL+ Daae a ll 8 P4 K C jU 3 -10-gr
Lot Z Block filing Subdivision Size of Lot teres
TYPE OF STRUCTURE: (VfSingle Family Dwelling (')Other: 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
WATER SUPPLY: (✓Private Well, Depth or ( )Public, Name of System
( )Spring
( )Stream or Creek
TYPES OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(4teptic 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 1K^ �a U Q L-- �- DATE 3 1 1-112 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 undersigned hereby acknowledges receipt of this individual sewage disposal permis app ication and aa m," fee the amour.
of Sri/� Receipt Number �) U� Date Fee Received by
Administra ivo officer
130 South Galena Street Aspen, Colorado 81611 303/980-6070
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