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HomeMy WebLinkAboutpitkin.eh.273514300008 (1990)1' 4L' ASPEN*PITKIN 143--OO-OC8 ENVIRONMENTAL HEALTH DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL PERtiIT N0. YEOF PERMIT: nitial Construction ( )Emergency Use r installation ( )Use Permit as a result of Salo ISSUED TO: OwnerM47ft-K r VC -1 Mailing AddressP. . 0. o)( -5-3© ( )Repair Nork,(Pievicus Permit 1 .) ( )Alteration of an existing system, (Previous Permit 1 .) ( )Othors DATE OF ISSUE. ✓ 0 Home Phone Business Phone 2o5--7077' 077 Agent�ACL �4606144AI - f Phone MailingnASff Address , 7%1,�AJ- (tel b Sewage Disposal System Work to be performed by This permit valid only for premises location by the following legal descriptions o�/_ I �+�/ LOT SIZE y AC►-ts , NATER SUPPLY . AVERAGC PERCOLATION RATF>- Aj19 1AjCf'l Tris Individual Sewage Disposal Permit is granted with regard to the following use: Number ofs Dodicoms Lofts Garbage Disposals Dishwashers Clothes Washers CALCULATED AVERAGE DAILY WASTE LOAD GALLONS. THE NATURE OF THE SYSTEM INCLUDEDUNDERTHIS PERMIT: Type of Tank or Treatment Units SEf�/UDD% ' i AJr Tank. Capacity ODO` Gallon minimum Method of Final Disposals ENGWEEi.ED ADOOD Absorption .Area S uare Feet Minimum Deacclp:ion (including brand name, if any) of other equipment orlappurtnancess d loC go-wiev!3eeljCo+�CbA/Other Conditions or Spec ficationss� ���� �E � p�t-rEd q o PES -Q HAMM N.o f1� /till& V0 LPV6e ,47T �41� �ED STAGES REQUIRING INSPECTION BY THE HEALTH DEPARTMENT: ( )Dcfore Excavation )Upon completion of excavation and prior to placement of gravel Before covering distribution ,,, ���... system of absorption field Prior to backfill of any component ( )Other, Specifys . Plans and specifications of the proposed sewage disposal system have been reviewed andare considered satisfactory. Permission is hcrchy granted to tt:e owner or his agent to perform the work indicated above in a_corda,cc with the Pitkin County Indivi31jal Sewa;.� Disposal Rcvulations in effcr.t on the d:,tc of issue. In addition to general provisinna _et forth on ?Lw reverse iter^ei, th.e: lermit is subject to the following additional terns and conditions: . Aspen/Pitkin Environmental APPROVED FOR ISSUE BY (title) Health Officer Thc• atove in:iividual ncwago disposal system installed by _ has tx en tnapcctcd for use by a representative of the Aspen FiitKin L'nvironn�•nta 7ica th Department. The owner alaumoa &Ti re::>>onsibil1ly in case of failure or inadequacy of tri sewayc di3pos3l system. Complete as -built drawing attached, DATE OF FINAL INSPECTION • Aspen/Pitkin Environmental BY: TITLE _ Health Officer 1303 South Galena Street Aspen, Colorado 91611 303/920-8070 cr_ cLAfilGln•5ci1m1Z�5eA,Gcrldol.�'� Lacy, rN 4 ASPEN6PITKIN ENVIRONMENTAL HEALTH DEPARTMENT APPLICATION FOR AN INDIVIDUAL SEWAGE DISPOSAL•PERMIT PHONE 0,.) Name of OWNER AA2�. �" "Dae . man, Address of OWNER 36A S30 ASWM e:e 11617— Name of APPLICANT C�nh,� �,.,�,�_ Sa��a PHONE 4Z5 -7o-7? PERMIT TO BEs Picked Up ( )Mailed to= TYPE OF PERMIT: ( )New Installation ( )Repair ( )owner ( )Applicant ( )Emergency Use Alteration NOT due to failure LOCATION OF PROPOSED SYSTEMS Legal Description a.& Lot Block Filing Subdivision , Size of Lot 4.40 acres TYPE OF STRUCTURES OO Single Family Dwelling ( )Other: Do you plan any furtheradditions to the residence? ( )YES K NO No. of bedrooms__ No. of Lofts No. of Garbage Disposals J No. of Automatic Dishwashers 1 No. of Automatic Clothes Washers 1 WATER SUPPLY: (W Private Wall, Depth Z �) or ( )Public, Name of System ( )Spring ( )Scream 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 Pri%y ( )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 ��t77he application and any subsequent permit. Signature of Applicant �6k'.6Z./1�4�'"'"`-r la1-M � DATE X-2-1— el D (This applicat n 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. 1-1 The undersigned hereby acknowledges receipt of this individual sewage disposal permit application and a permit fee in the amount of $, Receipt Number , Date Fee Received .by Administrative Officer LOCAL Fit eAID Ashen. Colorado 81611 303/920-5070