HomeMy WebLinkAbout2966N E Lake Creek Rd - 210518401001 - OWTS-4-12-7380 - OWTS-11-13-10052Environmental Health Department P.O. Box 179 500 Broadway Eagle, CO 81631-0179 Phone: (970)328-8755 Fax:(970)328-8788 EAGLE COUNTY 002966 LAKE CREEK RD EDWARDS AREA, CO Private Wastewater Permit NO.OWTS-4-12-7380 System Permit Type: OWTS Permit Work Classification: New Permit Status: Active Issue Date: 8/13/2012 Expires:12111/2012 Parcel No. 210518400001 Owner Information _ _ _ Address _ _ _ CHASE PAIGE LLC 2706 S HORSE SHOE DR Phone: (970)926-2663 CHASE PAIGE LLC NAPLES FL 34104- Cell: Engineer(s) 2706 S HORSE SHOE DR Phone HP GEOTECH NAPLES FL 34104- 970-945-7988 Contractor(s) License Numher Phone Primary Contractor MCCORD CONSTRUCTION 23-12 (970)376-1075 Yes lPermitted Construction / Details: Inspections: For Inspections call: (970) 328-8755 Inspection IVR Install as depicted in the Hepworth Pawlak design report dated July 27, 2012 and stamped August 1, 2012. System consists of a 1,000 gallon two compartment Valley Precast septic tank serving the remodeled cabin, garage and wellness center and a 2,000 gallon, three chamber, Valley Precast top seam tank with 1,473 square feet of soil treatment area credit via 76 pressure dosed Q4 Infiltrator Chambers placed on two feet of sand in four shallow trenches of 19 chambers per trench. An alternating dosing valve will doses among trenches. System serves a remodeled 561R residence and remodeled 1 BR cabin as well as a new garage and activity center with bathrooms. Existing ISDS components to be abandoned. Install cleanouts every 100 feet along sewer and effluent lines. Call the design engineer for conducting inspections at appropriate times during the installation and to conduct final certification of the system. Occupancy of buildings is not allowed until final engineer certification is received along with as -built drawings showing the exact locations of all system components, including sewer lines. CONDITIONS: Customer Copy I. THIS PERMIT EXPIRES BY TIME LIMITATION AND BECOMES NULL AND VOID IF THE WORK AUTHORIZED BY THE PERMIT IS NOT COMMENCED WITHIN 120 DAYS OF ISSUANCE, OR BEFORE THE EXPIRATION OF AN ASSOCIATED BUILDING PERMIT 2. ALL INSTALLATIONS MUST COMPLY WITH ALL REQUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS ADOPTED PURSUANT TO AUTHORITY GRANTED IN C.R.S. 25-10-10L el seq., AS AMENDED 3. THIS PERMIT IS VALID ONLY FOR CONNECTION TO STRUCTURES WHICH HAVE FULLY COMPLIED WITH COUNTY ZONING AND BUILDING REQUIREMENTS. CONNECTION TO. OR USE WITH ANY DWELLING OR STRUCTURE NOT APPROVED BY THE ZONING AND BUILDING DEPARTMENTS SHALL AUTOMATICALLY BE A VIOLATION OF A REQUIREMENT OF THE PERMIT, AND WILL RESULT IN BOTH LEGAL ACTION AND REVOCATION OF THE PERMIT 4. CHAPTER IV, SECTION 4.03.29 REQUIRES ANY PERSON WHO CONSTRUCTS. ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED Ray Merry August 14, 2012 Issued by: Environmental Health Department, Eagle County, CO Date Environmental Health Department P.O. Box 179 500 Broadway Eagle, CO 81631-0179 Phone: (970)328-8755 Fax:(970)328-8788 EAGLE COUNTY 002966 LAKE CREEK RD EDWARDS AREA, CO Private Wastewater Permit NO.OWTS-4-12-7380 System Permit Type: OWTS Permit Work Classification: New Permit Status: Active Issue Date: 8/13/2012 Expires: 12/11/2012 CHASE PAIGE LLC IL CHASE PAIGE LLC Engineer(s) 2706 S HORSE SHOE DR NAPLES FL 34104- W2706 S HORSE SHOE DR Phone HP GEOTECH NAPLES FL 34104- 970-945-7988 Contractor(s) License Number Phone Primary Contractor MCCORD CONSTRUCTION 23 12 (970)376-1075 YE Permitted Construction / Details: Parcel No. 210518400001 Phone:(970)926-2663 Cell: Inspections: fp o For Inspections call: (970) 328-8755 Inspection IVR Install as depicted in the Hepworth Pawlak design report dated July 27, 2012 and stamped August 1, 2012. System consists of a 1,000 gallon two compartment Valley Precast septic tank serving the remodeled cabin, garage and wellness center and a 2,000 gallon, three chamber, Valley Precast top seam tank with 1,473 square feet of soil treatment area credit via 76 pressure dosed Q4 Infiltrator Chambers placed on two feet of sand in four shallow trenches of 19 chambers per trench. An alternating dosing valve will rotate doses among trenches. System serves a remodeled 513R residence and remodeled 1 BR cabin as well as a new garage and activity center with bathrooms. Existing ISDS components to be abandoned. Install cleanouts every 100 feet along sewer and effluent lines. Call the design engineer for conducting inspections at appropriate times during the installation and to conduct final certification of the system. Occupancy of buildings is not allowed until final engineer certification is received along with as -built drawings showing the exact locations of all system components, including sewer lines. CONDITIONS: Office Copy I. THIS PERMIT EXPIRES BY TIME LIMITATION AND BECOMES NULL AND VOID IF THE WORK AUTHORIZED BY THE PERMIT IS NOT COMMENCED WITHIN 120 DAYS OF ISSUANCE, OR BEFORE THE EXPIRATION OF AN ASSOCIATED BUILDING PERMIT 2. ALL INSTALLATIONS MUST COMPLY WITH ALL REQUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS ADOPTED PURSUANT TO AUTHORITY GRANTED IN C.R.S. 25-10-101, el seq., AS AMENDED 3, THIS PERMIT IS VALID ONLY FOR CONNECTION TO STRUCTURES WHICH HAVE FULLY COMPLIED WITH COUNTY ZONING AND BUILDING REQUIREMENTS. CONNECTION TO, OR USE WITH ANY DWELLING OR STRUCTURE NOT APPROVED BY THE ZONING AND BUILDING DEPARTMENTS SHALL AUTOMATICALLY BE A VIOLATION OF A REQUIREMENT OF THE PERMIT, AND WILL RESULT IN BOTH LEGAL ACTION AND REVOCATION OF THE PERMIT 4. CHAPTER IV. SECTION 4.03.29 REQUIRES ANY PERSON WHO CONSTRUCTS, ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED Ray Merry August 14, 2012 Issued by: Environmental Health Department, Eagle County, CO Date DEPARTMENT OF ENVIRONMENTAL HEALTH (970) 328-8755 FAX: (970) 328-8788 TOLL FREE: 800-225-6136 www.eaolecounty.us EAGLE COUNTY PERMIT APPLICATION FOR ONSITE WAS P.O. Box 179 500 Broadway Eagle, CO 81631 www.eaglecounty.us ATER TREATMENT SYSTE OWTS PERMIT # y-1,9 - 73 !�-V BUILDING PERMIT # INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED (SITE PLAN MUST BE INCLUDED) FEESCHEDULE APPLICATION FEE $800.00 MAJOR REPAIR FEE $800.00 MINOR REPAIR FEE $400.00 This fee includes the OWTS Permit, Site Evaluation (Percolation Test, or Soil Profile Observation) and Final Inspection. Additional fees may be charged if a re -inspection is necessary, or a pre -construction site visit or consultation is needed. The re -inspection fee is $135.00 Make all remittance payable to: Eagle County Treasurer. Property Owner: C Hc,�-,1=. - 1"Az-6E Z LC_ Phone: q,71� � ✓ � � V3 Mailing Address: -2,706 S lot5EsIA(p email IQIDVeV Y, () 5TM .0 Registered Professional Engineer: Phone: Applicant or Contact Person: 1 c3 YA MC C, e �CLO Phone: --tj^] fn -) Licensed Systems Contractor:, i a yv\. Iv c coy Q License # q3 Z Company / DBA: I` CC.U' tZ ,- SZV C'i ►� IV Phone: G}�Q ` �Z (� - �G1 5- Mailing Address: PCB 9 VAS L A.,(. L CG o email 111 Permit Application is for: New Installation Alteration Repair Location of Proposed Onsite Wastewater Treatment System: Legal Description: SEc7x.,3W 1ISTowNs #' I- IRAtv6L S Z PG i- I Q 'SF V Tax Parcel Number:® - ��b'� O(J CSC Lot Size: Assessor's Link: www.ea2lecounty.us/patie/ Physical Address: Building Type: qG(o E - [-AYE CRC=E Residential / Single Family Number of Bedrooms: Residential / Multi Family Number of Bedrooms: Commercial / Industrial* Type of Use: *These systems require design my a Registered Professional Engineer Type of Water Supply: —,)( Private Well Spring Surface Public If Public Name of Supplier: Applicant Signature: ************************************************************************************* Office Use Only Amount Paid: �� Receipt #: Check #: f Date:' %�_. Hr G 000** ech HEPWORTH-PAWLAK GEOTECHNICAL May 17, 2012 Hepwort{,-PanlaL Geotechnical, Inc. P.O. 1Jran-er 1887 =ilverthorne, Colorado SQ-1g8 Phone: Q70-468-1489 Far: 970-468-5891 Email: {ipgeo(tl�p¢eotecli.com McCord Construction Attn: Tom McCord P.O. Box 4195 Eagle, Colorado 81631 MccordconstructionAhotmailcom Job No. 412 113A Subject: Preliminary Findings of OWTS Design, Pony Up Ranch, 2966 Lake Creek Road, near Edwards, Eagle County, Colorado Dear Tom: The letter provides preliminary findings of the on -site wastewater treatment system (OWTS) design we are performing for the proposed residential construction at the subject site. Our design report, when completed, should be referred to for more specific infonnation and the system construction. Proposed Construction: The existing five -bedroom residence will be remolded and the one -bedroom caretaker's cabin will be partly demolished and rebuilt. The current OWTS at the site will be replaced. The OWTS will be designed for a total of six bedrooms. OWTS Recommendations: The OWTS will be designed for an average daily sewage flow of 1,350 gallon per day (6 beds x 2 people per bed x 75 gallons x 1.5 peak loading factor = 1,350). Three percolation test holes and a profile pit were excavated in the area of the proposed absorption field. The soils exposed in the profile pit, below about 1'/2 feet of topsoil, consisted of clayey sandy gravel with cobbles to a depth of about 4'/z feet underlain silty sandy gravel with cobbles that extended down to the pit depth of 8 feet. No free water was encountered in the pit. The percolation tests were performed at depths of from 31 to 41 inches with an average percolation rate from the three tests of 29 minutes per inch obtained, which corresponds to a loading rate of 0.50 gallons per day per square foot. The absorption area sizing was calculated using the 1,350 gallons per day flow and a loading rate of 0.50 for the receiving soils for 2,700 square feet. A 50% reduction in field size was applied for utilizing Infiltrator chambers in a trench configuration. The required absorption field size for the proposed construction is 1,350 square feet. There is adequate room in the area tested for the required size absorption field. The caretaker's cabin will have a 1,000 gallon, two -chamber septic tank located adjacent to the foundation that will gravity feed sewage down to the main residence septic tank. Parker 303-841-7119 - Colorado Springs 719-633-556.7 . Silverthorne 970-468-1989 McCord Construction May 17, 2012 Page 2 Sewage generated from the main residence will be gravity fed to a 1,500 gallon, two chamber septic tank located down slope from the main residence. After settling, the effluent will be pressure -dosed to the absorption field by an Orenco high head effluent pumped installed within an Orenco Biotube Pump Vault located within a 500 gallon, single chamber dose tank. The absorption area will consist of 6 trenches with 23 Infiltrator chambers in each trench for a total of 138 chambers. Eagle County Regulations stipulate an area of 10 square feet for each chamber, for a total of 1,380 square feet of absorption area. The absorption trenches will be pressure -dosed utilizing an Automatic Distribution Valve (ADV) with one inlet and six outlets; which will allow alternating dosing to the six absorption trenches. Due to the proximity to the environmental sensitive Lake Creek drainage, we recommend 2 feet of imported sand be placed at the bottom of each trench excavation below the Infiltrator chambers. We will forward our OWTS design when complete, in about one week. In the meantime if you have any questions or need additional information, do not hesitate to contact us. Sincerely, Reviewed by: David A. Yo JCP/ksw cc: WLAK GEOTECHNICAL, INC. Specialist Eagle County Enviro—rME itWIlealth — Ray Merry (ray. merry@eaalecounty.us Tom Cole, Architect tcol ointswestvail.com) Jobt No. 412 113A Cy(_6'Fhech a�goff��j g r�8as� 0 m w w _2 w J Q U —_ o uj �w X 0 CL a CL Fy w ca �w E 4 _ k FV9 FINN G(5oTtech HEPWORTH - PAWLAK GEOTECHNiCAL April 30, 2013 McCord Construction Attn: Tom McCord P.O. Box 4195 Eagle, Colorado 81631 mccordeonstructionChotinail cam Job No. 412 113A Subject: As -Built Evaluation of On -Site Wastewater Treatment System, Guest House, Activity Center, and Residential Addition, Pony Up Ranch, 2966 East Lake Creek Road, near Edwards, Eagle County, Colorado. Dear Mr. McCord: As requested, Hepworth-Pawlak Geotechnical observed the installation of the On -Site Wastewater Treatment System (OWTS) for the remodeled five bedroom existing residence, one bedroom guest house, activity center and garage addition at the subject site. The services were part of our proposal to McCord Construction dated May 1, 2012. Our observations of the As -Built construction are presented in this report. We performed our As -Built site evaluation on several visits between April 20 and August 27, 2012. The OWTS components observed included: sewer lines, septic and dose tank, effluent pump, cleanouts, effluent line, manifold piping, trench excavations, sand filter material, Infiltrator chambers, lateral distribution pipes, inspection ports, potable water line location, well location and the location of all components. The As -Built OWTS site plan prepared by us showing the location of OWTS components is provided on the attached Figure 1. The location of the OWTS components and setback distances were obtained by tape measuring in the field. During our site visits, we observed the 4-inch non -perforated sewer lines from the guest cabin and garage were correctly sloped down to the settling tank. The 4-inch non - perforated sewer lines from the settling tank and activity center were properly sloped to the septic tank inlet. The existing sewer line from the residence was properly sloped from the location of the old tank to the new tank. Cleanouts were installed adjacent to each foundation. The 2,000 gallon, three -chamber concrete septic tank with an attached 500 gallon dose tank was installed level at the approximate location shown on the attached Figure 1. The dose tank was equipped with the specified Orenco PF3005 high head effluent pump installed within a Biotube Pump Vault. At the time of our last site visit, the electric was not connected and the pump operation was not engaged. A Valley Precast representative typically will perform a start-up of the system once electrical power is installed to ensure the pump is working properly. This should be confirmed. Glenwood Springs 970-945-7988 0 P'irker 303-841-71 19 0 Colorado Sprinlos 719-611-5562 McCord Construction April 30, 2013 Page 2 The 2-inch non -perforated effluent pipe from the dose tank outlet to Automatic Distribution Valve (ADV) was installed properly with the required slope to allow the effluent to drain between doses. The ADV was installed at the high point between the absorption trenches and the septic tank. The four trench excavations were approximately a 2 to 3 foot cut below existing grade with a minimum 2 feet of imported sand filter material placed at the bottom of each trench. The Infiltrator Quick4 standard Chambers were installed level within each trench. Each trench consisted of 19 chambers for a total of 76 chambers and 760 square feet of absorption area. The 2-inch perforated distribution laterals were properly installed level within each run of chambers to provide each effluent distribution to the entire absorption field during dosing. It is our opinion that the OWTS meets the general intent of our OWTS design dated July 27, 2012. The observations and recommendations presented above are based on our visit and our experience in the area. We make no warranty either express or implied. Alterations to the system including amendments, changing components, backfill and site grading could alter the operation and effectiveness of the OWTS in the future. It is important not to excessively irrigate the areas around the absorption fields to prevent hydraulic overloading and possible premature failure of the absorption field. Please feel free to contact us if you have any questions Sincerely, HEPWORTH - PAWLAK GEOT ECHNICAL, INC. Chad M. Bringle, P.E. Office Manager ( Project Engineer Reviewed by-,---,,>>��jp David A. Young, P.l X 32_216 _ 13 �•� Attachments: Figure e Plan As -Built 44 cc: Eagle County Environmental Health (environment@eaglecounty.us) Job No. 412 113A G(�'of'tecf" t t' u T tU Q t` v � Kt € IMN yW yu+ 0 3 na Lpppper B F > , " # .1 u«w a F. z y 5` a as �wy�� masis� d tech$ n -alg r-Eaa 00 <W ug c we Hill. E 3 moo, #zx Opus s y w w { R ,saz S,ui 4Z> w .. 0 11a2 log s LS rra of Q31o�i '3 2: ph; a. C WHO �S ��+ ugh s m v ti GG i ow 412 113A AS -BUILT PHOTO LOG . Photograph 1: View of the sewer line from the guest cabin to the connection with the sewer line coming from the garage prior to entering the settling tank located near the activity center. Photograph 2: Sewer line from the garage addition with installed cleanout prior to entering the settling tank. Photograph 3: View of settling tank with sewer line from the garage and guest cabin entering the first chamber. 412 113A AS -BUILT PHOTO LOG Photograph 4: View of settling tank with sewer line exiting the second chamber. Sewer line leaving the settling tank will connect to activity sewer line, which flows down to the main septic tank. Photograph 5: View of activity center sewer line and installed cleanout, with the sewer line connection from the settling tank. This sewer line will connect to the main septic tank. Photograph 6: Another view of the sewer line leaving the s activity center and the PM . _ settling tank sewer line connection. 412 113A AS -BUILT PHOTO LOG Photograph 7: View of sewer line from activity center prior to entering the main septic tank with 6-inch encasement installed due to crossing a landscaping water feature. Photograph 8: Close-up view on the 6-inch sewer line encasement. Photograph 9: Sewer line from remodeled main house prior to entering the main septic tank. The old OWTS components were abandoned (right side of photo). 412 113A AS -BUILT PHOTO LOG Photograph 10: Grade view of the activity center sewer line and the sewer line from the main five -bedroom residence entering the first chamber of the main septic tank. Photograph 11: Another view of the sewer lines servicing the garage addition, activity center, guest cabin and main residence entering the main septic tank prior to dosing to the absorption field. yl3 11, y-12--43&-U PROJECT 1►l - LV f V_ /_ake- ter=Xr,*.. I w w p%4 -� ;RloS7 1810 1001, PROJECT �qC 6 L project description XA/ � 0 kt S�KrP�� I� Cam' �OIa 6/i zee( 41 �o ! nr S PROJECT CONTACTS name phone/fax e-mail ZO/3 documents enclosed notes �2_ i vs M 3,60 0 0-3 964 Hepworth-Pawlak Geotechnical, Inc. O. Drawer 1887 ilverthorne, Colorado 80498 one: one:970-70-468-1989 HEPWORTH - PAWLAK G Y 970-468-5891 May 28, 2013 a hpgeo4@hpgeotech.com McCord Construction Attn: Tom McCord P.O. Box 4195 Job No. 412 113A Eagle, Colorado 81631 mccordconstruction@hotmail.com Subject: Revised - As -Built Evaluation of On -Site Wastewater Treatment System, Guest House, Activity Center, and Residential Addition, Pony Up Ranch, 2966 East Lake Creek Road, near Edwards, Eagle County, Colorado. Dear Mr. McCord: As requested, Hepworth-Pawlak Geotechnical observed the installation of the On -Site Wastewater Treatment System (OWTS) for the remodeled five bedroom existing residence, one bedroom guest house, activity center and garage addition at the subject site. The services were part of our proposal to you dated May 1, 2012. Our observations of the As -Built construction are presented in this report. We performed our As -Built site evaluation on several visits between April 20 and August 27, 2012. We made a final site visit on May 23, 2013. The OWTS components observed included: sewer lines, septic and dose tank, effluent pump, cleanouts, effluent line, manifold piping, trench excavations, sand filter material, Infiltrator chambers, lateral distribution pipes, inspection ports, potable water line location, well location and the location of all components. The As -Built OWTS site plan prepared by us showing the location of OWTS components is provided on the attached Figure 1. The location of the OWTS components and setback distances were obtained by measuring in the field with a 200 foot tape. During our site visits, the 4-inch non -perforated sewer lines from the guest cabin and garage were correctly sloped down to the settling tank. The 4-inch non -perforated sewer lines from the settling tank and activity center were properly sloped to the septic tank inlet. The existing sewer line from the residence was properly sloped from the location of the old tank W the new tank. Cleanouts were installed adjacent to each foundation. The 2,000 gallon, three -chamber concrete septic tank with an attached 500 gallon dose tank was installed level at the approximate location Shown on the attached Figure 1. The dose tank was equipped with the specified Orenco PF3005'high head effluent pump installed within a Biotube Pump Vault. The 2-inch non -perforated effluent pipe from the dose tank outlet to Automatic Distribution Valve (ADV) was installed properly with the required slope to allow the effluent to drain between doses. The ADV was installed at the high point between the absorption trenches and the septic tank. The four trench excavations were approximately a 2 to 3 foot cut below existing grade with a minimum 2 feet of imported sand filter material placed at the bottom of each trench. The Infiltrator Quick4 standard Chambers were installed level within each trench. Each trench consisted of 19 chambers for a total of 76 chambers and 760 square feet of absorption area. The 2-inch perforated distribution laterals were properly installed level within each run of chambers to Glenwood Springs 970-945-7988 0 Parker 303-841-7119 0 Colorado Springs 719-633-5562 McCord Construction May 28, 2013 Page 2 provide each effluent distribution to the entire absorption field during dosing. At the time of our final site visit, the system was powered and operational. It is our opinion that the OWTS meets the general intent of our OWTS design dated July 27, 2012. The observations and recommendations presented above are based on our visit and our experience in the area. We make no warranty either express or implied. Alterations to the system including amendments, changing components, backfill and site grading could alter the operation and effectiveness of the OWTS in the future. It is important not to excessively irrigate the areas around the absorption fields to prevent hydraulic overloading and possible premature failure of the absorption field. Please feel free to contact us if you have any questions. Sincerely, HEPWORTH - PAWLAK GEOT ECHMCAL, INC. E Chad M. Bringle, P.E. Office Manager I Project Engineer 41153 pp '413 Rev. by: DAY . •' 0 �SS�ON A-�� Attachments: Figure 1, OWTS As -Built Site Plan As -Built Photograph Log cc: Eagle County Environmental Health (environment@eaglecounty.us) Job No. 412 113A G q6___h 412 113A AS -BUILT PHOTO LOG Photograph 4: View of settling tank with sewer line exiting the second chamber. Sewer line leaving the settling tank will connect to activity sewer line, which flows down to the main septic tank. Photograph 5: View of activity center sewer line and installed cleanout, with the sewer line connection from the settling tank. This sewer line will connect to the main septic tank. Photograph 6: Another view of the sewer line leaving the activity center and the settling tank sewer line connection. I 412 113A AS -BUILT PHOTO LOG Photograph 10: Sewer line from remodeled main house prior to entering the main septic tank. The old OWTS plastic tank was crushed and backfilled. Photograph 11: Grade view of the activity center sewer line and the sewer line from the main five -bedroom residence entering the first chamber of the main septic tank. Photograph 11: Another view of the sewer lines servicing the garage addition, activity center, guest cabin and main residence entering the main septic tank prior to dosing to the absorption field. 412 113A AS -BUILT PHOTO LOG Photograph 12: Picture of ADV prior to backfilling. Photograph 13: Picture of the lateral at the far left end with a north-northwest - alignment. { Photograph 14: Picture of the two laterals at the east end prior to backfilling. 412 113A AS -BUILT PHOTO LOG six>�.'• .. ,q�:. . Photograph 15: Installed ADV with insulated cover. Photograph 16: Installed insulated first compartment septic cover. 412 113A AS -BUILT PHOTO LOG Photograph 1: View of the sewer line from the guest cabin to the connection with the sewer line coming from the garage prior to entering the settling tank located near the activity center. Photograph 2: Sewer line from the garage addition with installed cleanout prior to entering the settling tank. Photograph 3: View of settling tank with sewer line from the garage and guest cabin entering the first chamber. MINIMUM HORIZONTAL DISTANCES FIELD TO: TANK TO: PROPERTY LINES 10' HOUSE 5' • ADDED 8 FT. FOR TANK 6' WATER LINES 10' EACH 100 GAL. / HOUSE 20' SURFACE WATER 50' WATER LINES 25' DRY DITCHES 10' DAY DESIGN FLOW SURFACE WATER 82' • WELLS 50' OVER 1,000 DRY DITCHES 57' • PROPERTY LINES 10' GAL. / DAY. WELLS 132' ' IRRIGATION DITCH 82' • BUILDING SEWER TO: EXISTING FIELDS 20' WATER LINES 10' CUT BANKS 4X VERT. CUT HEIGHT WELLS 50' �j 150 s o'� O • Z/ WATER WELL (PUMP) / •`r < t � 49 �O CLEANOUT (TYP.) RY� ONE BEDROOM 1 GUEST CABIN Sp INSTALLED 4" NON -PERFORATED SCH40 SEWER PIPE SLOPED AT 2% MIN. FROM THE GUEST CABIN FOUNDATION TO THE CONNECTION WITH THE GARAGE SEWER LINE. INSTALLED 4" NON-PERFORAT CH4( SEWER PIPE SLOPED AT 2% MIN. FROM THE GARAGE FOUNDATION TO THE SETTLING TANK INLET, (TYP.) LEGEND p PERCOLATION TEST HOLE PROFILE PIT EXCAVATION FT CLEANOUT (TYP.) PLOWED ---- GRAVEL ROAD INSTALLED VALLEY PRECAST 1,000 GALLON, TWO -CHAMBER SETTLING TANK EQUIPPED WITH AN EFFLUENT FILTER INSTALLED WITHIN THE SECOND CHAMBER. INSTALLED ABSORPTION AREA CONSISTING OF 4 TRENCHES WITH 2 FEET OF IMPORTED SAND PLACED IN BOTTOM OF EACH TRENCH. EACH TRENCH HAS 19 INFILTRATOR STANDARD QUICK4 CHAMBERS FOR A TOTAL OF 76 CHAMBERS AND 760 SQUARE FEET OF ABSORPTION AREA. P 3 INSTALLED 1.5" PERFORATED SCH40 DISTRIBUTION LATERALS HUNG LEVEL VIA ZIPTIES IN THE INSIDE OF THE INFILTRATOR CHAMBERS WITH �p PERFORATIONS POINTING UPWARDS. m� 2 FEET WAS CREEK oOf 58 R� P PP A QISURE0ssIp' EDSABSIHEION MEAS OF 1NST At-WT A\NS CK. y AND wic" MAST SE18A 1P F1EO�IREO 82 FE RE • ; INSTALLED 1.5" SCH40 t19 NON -PERFORATED EFFLUENT '• TRANSPORT PIPES SLOPED AT 2% �— MIN. FROM THE ADV DOWN TO THE TRENCH INLETS. WOOD " DECK INSTALLED ORENCO V4404 AUTOMATIC DISTRIBUTION VALVE (ADV) WITH ONE INLET AND FOUR OUTLETS. THE ADV WAS PROPERLY INSTALLED AS THE O HIGH POINT BETWEEN THE SEPTIC TANK AND TRENCHES. O INSTALLED 1,5" NON -PERFORATED SCH40 EFFLUENT TRANSPORT PIPE SLOPED AT 2% MIN. FROM THE EXISTING (REMODELED) FIVE EXISITNG 4" SEWER ADV BACK TO THE DOSE BEDROOM RESIDENCE PIPE FROM THE CHAMBER OUTLET. MAIN RESIDENCE INSTALLED 4" TO OLD SEPTIC NON -PERFORATED SCH4 TANK INLET. SEWER PIPE SLOPED 2% MIN. FROM THE MAI INSTALLED VALLEY PRECAST 1,500 RESIDENCE FOUND ION TO GALLON TWO -CHAMBER SEPTIC TANK THE SEPTIC TA INLET. WITH AN ATTACHED 500 GALLON DOSE CHAMBER EQUIPPED WITH AN ORENCO PF3005 HIGH HEAD EUNT PUMP INSTALLED ORENCO WITHIN AN ORENCO BIOTUBE PUMP VAULT LOCATED IN THE DOSE CHAMBER. CLEANOUT (TYP,) r S CLEANOUT (TYP _ PROPOSED CENTER THE INSTALLED 4-INCH NON -PERFORATED SEWER OUT (TYP.) LINE WAS PROPERLY ENCASED MATH 6-INCH SCH40 PIPE FOR 60 FEET ON EACH SIDE OF THE WATER FEATURE CROSSING. INSTALLED 4" NON -PERFORATED SCH40 SEWER PIPE SLOPED AT 2% ATY MIN. FROM THE ACTIVITY CENTER FOUNDATION TO THE SEPTIC TANK INLET. °� � 'o 0 CLEANOUT (TYP.) INSTALLED 4- NON-PERFORATED SC\2% SEWER LINE SLOPED MIN. FROM SETTLING OUTLET TO THE ACTICENTER SEWER LINE APPROX. j — C/L WATER WOOD TIE FEATURE STEPS �O\ DECIDUOUS 0 40 80 TREELINE APPROXIMATE SCALE IN FEET PONY UP RANCH AS -BUILT SITE PLAN Ge Ptech HEPWORTH-PAWLAK GEOTECHNICAL 412 113A NeiviNa U }3 rat, 1 DESCRIPTION LATITUDE (NAD83) LONGITUDE (NAD83) A LEACH FIELD 39'36'39.249" N 106'36'52.895" W B LEACH FIELD 39'36'38.607" N 106'36'52.499" W C LEACH FIELD 39'36'38.430" N 106'36'52.797 W D LEACH FIELD 39'36'39.043" N 106'36'53.249" W E TANK LID 39'36'38.397" N 106'36'52.689" W F TANK LID 39'36'38.335" N 106'36'52.644" W G TANK LID 39'36'38.307" N 106'36'52.624" W H TANK LID 39'36'38.246" N 106'36'52.580" W I CLEANOUT 39'36'38.338" N 106'36'52.945" W J CLEANOUTS(2) 39'36'37.962" N 106'36'53.948" W 1 K CLEANOUT 39'36'37.741 " N 106'36'52.998" W L CLEANOUT 39'36'37.007" N 106'36'53.704" W M CLEANOUT 39'36'36.602" N 106'36'54.221 " W N CLEANOUT 39'36'36.132" N 106'36'54.368" W 0 TANK LID 39'36'36.118" N 106'36'54.387" W N 0 SEPTIC P C4 TANK LIDS U; c►+ o_ CA n 1 r" Cry N .P WEST LAKE CREEK ROAD (60') 1 1 SW CRN. SECTION 18 TSS, R82W, 6TH P.M. SECTION 19 1 N l 1 N_ 1 1 PROPERTY LINE 1 SS�Y �6 N N U� cr► C51� Wi I 60' 90' NNW PAf LAKE CREEK MEADOWS BLK 2 L3 L4 L1 RI V 7 NOTES: RCEL 6 1) DATE OF SURVEY: 5/31 /13 2) ADDRESS: 2966 EAST LAKE CREEK ROAD. 3) NOTICE: ACCORDING TO COLORADO LAW YOU MUST COMMENCE ANY LEGAL ACTION BASED UPON ANY DEFECT IN THIS SURVEY WITHIN THREE YEARS AFTER YOU IRST DISCOVER SUCH DEFECT. IN NO EVENT, MAY ANY ACTION BASED UPON ANY DEFECT IN THIS SURVEY BE COMMENCED MORE THAN TEN `BARS FROM THE DATE OF THE CERTIFICATION SHOWN HEREON. 4) BASIS OF PROPERTY LINE LOCATION: MONUMENTS FOUND AT THE 1/4 CORNER SECTION 18/19 AND THE WEST CORNER OF SECTIONS 18/19, TSS, R83W, 6TH P.M. 5) THE PUPOSE OF THIS EXHIBIT IS TO SHOW LOCATION OF NEW SEPTIC COMPONENTS ON SUBJECT PROPERTY. OTHER IMPROVEMENTS EXIST ON PROPERTY THAT ARE NOT SHOWN HEREON. 6) THIS SURVEY AND THE INFORMATION CONTAINED HEREON IS THE PROPERTY OF EAGLE VALLEY SURVEYING, INC. AND IS INTENDED FOR THE SOLE USE OF THE ORIGINAL CUINT ONLY. ANY USE OF OR TRANSFER TO OTHERS IS PROHIBITED. Stan Hp` d},?r Colorato qi� 26598 Lam. 26598 ?� Date: - 3 r \ �,f 11 IIIi�,1{i\ SEPTIC AS -BUILT EXHIBIT SOUTH PARCEL PONY UP RANCH EAGLE COUNTY, COLORADO VICINITY MAP SCALE: 1" = 500' SECTION 18 SECTION 17 ----------- SECTION 19 SECTION 20 TSS, R82W, 6TH P.M. 41199 HIGHWAY 6 & 24, EAGLE—VAIL P.O. BOX 1230 EDWARDS, CO. 81632 �970)949-1406 3237SETIC EX DRN. BY: DJE DATE: 6/7/13 PAGE: 1 OF 1 JOB No. 3237 Environmental Health Department P.O Box 179 500 Broadway Eagle, CO 81631-0179 Phone: (970)328-8755 Fax:(970)328-8788 EAGLE COUNTY Prefect Address 2966N LAKE CREEK RD Owner Information Dekko Family Trust Private Wastewater Permit NO. CIMS-11-13-10052 System Permit Type: OWTS Permit Work Classification: New Permit Status: Active Issue Date;1112612013 Expires: 3126/2013 Parcel No. 210518401001 Address CO Phone: 970-926-2663 Cell: Engineer(s) Phone Inspections; �i�i o For Inspections call: (970) 328-8766 — - -- - Inspection IVR 011VT5 Final Inspection 095 Contractor(s) License Number Phone Primary Contractor McCord Construction 57-13 Yes Permitted Construction 1 Details: Install one 2000 gallon two compartment septic tank with a cleanout between the dwelling and the tank. Since this tank is acting as a vault at this time, install a signal device to indicate when pumping is necessary. Maintain all required setbacks. Tank lid access ports are to be within 8 inches of finished grade. The tank inlet and outlet shall have 14 inch "T's" on the piping, if there will be a leachfield added in the future. CONDITIONS. Office Copy I THIS PERMIT EXPIRES BY TIME LIMITATION AND BECOMES NULL AND VOID IF THE WORK AUTHORIZED BY THE PERMIT IS NOT COMMENCED WITHIN 120 DAYS OF ISSUANCE, OR BEFORE THE EXPIRATION OF AN ASSOCIATED BUILDING PERMIT 2 ALL INSTALLATIONS MUST COMPLY WITH ALL REQUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS ADOPTED PURSUANT TO AUTHORITY GRANTED IN CR.S. 25-10-101, el seq., AS AMENDED 3 THIS PERMIT IS VALID ONLY FOR CONNECTION TO STRUCTURES WHICH HAVE FULLY COMPLIED WITH COUNTY ZONING AND BUILDING REQUIREMENTS. CONNECTION TO, OR USE WITH ANY DWELLING OR STRUCTURE NOT APPROVED BY THE ZONING AND BUILDING DEPARTMENTS SHALL AUTOMATICALLY BE A VIOLATION OF A REQUIREMENT OF THE PERMITAND WILL RESULT IN BOTI LEGAL ACTION AND REVOCATION OF THE PERMIT 4 CHAPTER IV, SECTION 4.03.29 REQUIRES ANY PERSON WHO CONSTRUCTS, ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED Laura Fawcett November 26, 2013 Issued y: Environmental HealthDepartment, Eagle County CO Date Environmental Health Department P O. Box 179 600 Broadway Eagle, CO 81631-0179 Phone:(970)328-8755 Fax:(970)328-8788 EAGLE COUNTY Project Address 2966N LAKE CREEK RD Owner Information Address Dekko Family Trust CID Private Wastewater Permit NO. OWTS-1 1-13-10052 System Permit Type: OWTS Permit Work Classiftcation: New Permit Status: Active Issue Date: 11126/2013 Expires: 3/26/2013 Engineer(s) Phone Contractor(s) License Number Phone Primary Contractor McCord Construction 57-13 Yes Parcel No. 210518401001 Phone: 970-926-2663 Cell: Inspections: For Inspections can: (970) 328-8755 Inspection IVR OWTS Final Inspection _ _ 095 Permitted Construction 1 Details: Install one 2000 gallon two compartment septic tank with a cleanout between the dwelling and the tank. Since this tank is acting as a vault at this time, install a signal device to indicate when pumping is necessary. Maintain all required setbacks. Tank lid access ports are to be within 8 inches of finished grade. The tank inlet and outlet shall have 14 inch "T's" on the piping, if there will be a leachfield added in the future. CONDITIONS: Office Copy 1. THIS PERMIT EXPIRES BY TIME LIMITATION AND BECOMES NULL AND VOID IF THE WORK AUTHORIZED BY THE PERMIT IS NOT COMMENCED WITHIN 120 DAYS OF ISSUANCE, OR BEFORE THE EXPIRATION OF AN ASSOCIATED BUILDING PERMIT 2. ALL INSTALLATIONS MUST COMPLY WITH ALL REQUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS ADOPTED PURSUANT TO AUTHORITY GRANTED IN CR.S. 25-10-101, of seq., AS AMENDED 3. THIS PERMIT IS VALID ONLY FOR CONNECTION TO STRUCTURES WHICH HAVE FULLY COMPLIED WITH COUNTY ZONING AND BUILDING REQUIREMENTS. CONNECTION TO, OR USE WITH ANY DWELLING OR STRUCTURE NOT APPROVED BY THE ZONING AND BUILDING DEPARTMENTS SHALL AUTOMATICALLY BE A VIOLATION OF A REQUIREMENT OF THE PERMITAND WILL RESULT IN BOTI LEGAL ACTION AND REVOCATION OF THE PERMIT 4. CHAPTER 1V, SECTION 4.03.29 REQUIRES ANY PERSON WHO CONSTRUCTS, ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED Laura Fawcett November 26, 2013 issued y: Environmental HealthDepartment, Eagle County, CO Date DEPARTMENT OF ENVIRONMENTAL HEALTH (970) 328-8755 FAX: (970) 328-8788 TOLL FREE: 800-225-6136 www.eaglecounty.us P.O. Box 179 500 Broadway Eagle, CO 81631 www.eaglecounty.us EAGLE COUNTY PERMIT APPLICATION FOR ONSITE WASTEWATER TREATMENT SYSTEM OWTS PERMIT # 11— 13 — /QQS-cZ_ BUILDING PERMIT # INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED (SITE PLAN MUST BE INCLUDED) FEESCHEDULE APPLICATION FEE $800.00 MAJOR REPAIR FEE $800.00 MINOR REPAIR FEE 400.00 This fee includes the OWTS Permit, Site Evaluation (Percolation Test, or Soil Profile Observation) and Final Inspection. Additional fees may be charged if a re -inspection is necessary, or a pre -construction site visit or consultation is needed. The re -inspection fee is $135.00 Make all remittance payable to: Eagle County Treasurer. Property Owner:PE LO F— Tia uST Phone: -7,Lfc Mailing Address: email 3410 y Registered Professional Engineer: Phone: Applicant or Contact Person: 1-0yti i- l (rssLo Phone: n26 - "16 - ) 0-71 Licensed Systems Contractor: a License # 5-7- d 3 Company / DBA: K—eKG x 0 N y, Phone: Mailing Address: 'PO 4l`Z 16 I�A(,LT C<22 email VC-MdfV �- 1-tsyy��. Permit Application is for: -)o- New Installation Alteration Repair l50Q!I GAL. JA,5 -4=-IV 6 TAfuY,, Location of Proposed Onsite Wastewater Treatment Svstem: Legal Description: _ z --+ 2.105 - 18Li - 41 YCSOA- Tax Parcel Number: ' -;-C 144 q -`& K F P t) SC-14 { Lot Size: _ GG - z AcP�;5 Assessor's Link: www.eaelecounty.us/uatie/ Physical Address: = C- - L_ Building Type: Residential / Single Family Number of Bedrooms: 5 f9kS Residential / Multi Family Number of Bedrooms: be -"ry Commercial / Industrial* Type of Use: A4.% j3Ln PXNG 1aiaTHtCOo �`'� *These systems require design my a Registered Professional Engineer Type of Water Supply: f� Private Well If Public Name of Supplier: Applicant Signature: Office Use On Amount Paid: I i Receipt #: Spring Surface Public ******************************************* . Check #• , �[ Date: 1 / 10,0 1 3 Valley Precast, Inc. P.O. Box 925 Buena Vista, CO 81211 Phone: 719-395-6764 Fax: 719-395-3727 frontdesk@valleyprecast.com www.valleyprecast.com Name / Address McCord Construction P.O. Box 4195 Eagle, CO B 1631 Delivery Location 2966 E. Lake Creek Rd Edwards Contact Name Danny Estimate Estimate # 3142 Date of Estimate Estimate Expires 1111I/2013 01/11/2014 Item Description Qty Cost Total 200OT-2CP 2000 Gallon Top -Seam, Two Compartment Tank 1 1,850.00 1,850.00T Set Fee Tank Set Fee 1 300.00 300.00 I' BH Riser I' Big Hole Concrete Riser (To match High Level Alarm 1 42.00 42.00T riser estimated at one foot) Holding Tank / Hi... AHW 115v Stand -Alone or Remote Alarm Panel 1 105,22 105.22T MF1 A Signal FIoat with, Collar 1 31.10 31.10T PRTA24 24" Tank -to -Riser Adapter 1 26.17 26.17T PRTA24BDKIT 24" Adapter Bolt Down Kit 1 10.48 RRFB Float Bracket 10 48T RR2412+V1 PVC Dosing Riser with 1' Vent 1 18.29 18.29T FL24GI2-4B 24" Fiberglass Lid with 2" insulation and urethane gasket 1 98.18 1 109.82 98.18T 109.82T SBI PVC Splice Box with I Cord Grip 1 46.49 46.49T Product Mod Tech Installation 1 HOLDING TANK ---- With Alarm Setup — Complete 100.00 100.00 with 12' Riser 545.75 Thank you for your business. Subtotal $2,737.75 Sales Tax (4.9%) Any specialty items require two weeks $l I4.55 notice; including some tanks. Total $2,852.30 Item # 000 Gallon Top Seam 20OUT-2CP Two Comportment 162' Top Ckw View /c igMob udar . 10 li 0 Section View *Meets ASTM C-1227 spec including C-1664-06 for resilient connectors • 6000 psi concrete n Delivered complete with internal piping O PVC, poly or concrete risers available 9 Option of pump or siphon installed nIM qpm hrmt Dbrarmillan 16 Long X V wide Inlet oubet Length Width Height 560 below inlet invert 56" W 162" 780 W Netcapeft Irdet Side ' outtat Side Tdd 1.M gail m 5050600M ZON 9MM a w11 W a PrOd FE-77 vAzz o Inc. Sucts ervice Net wwo Lid Tent Told 5A20 Ibe 15 530 On 20,W be (719) 393-8784 286 Coy Rd.317 P.O. eox925 Foc (719) 39&ZWBUBM Vkft CO 81211 websft: wwwmalieyprecake m EMWI.- 11%xi WAnc ,00m 5/9/2014 Eagle County Government Mail -Status of septic file � �Goc�gle EAGLE CCU Status of septic file Terri Vroman <terri.vroman@eaglecounty.us> To: Tom McCord <mccordconstruction@hotmail.com> Terri Vroman <terri.vroman@eaglecounty.us> Wed, May 7, 2014 at 3:55 PM Tom, am going through the septic files and came across one that you are listed as the contact person on. It is 2966 E. Lake Creek Rd, the Dekko Family Trust. Can you tell me what the status of this permit is? I know we sent the permit out but that is the last information have about it. Thanks Terri Vroman Environmental Health Administrative Technician 590 Broadway P.O. Box 179 Eagle, CO 81631 (970) 328-8755 Office (970) 328-8788 Fax terri.\/roman@eaglecounty.us "People will forget what you said, people will forget what you did, but people will never forget how you made them feel" Maya Angelou Tom McCord <mccordconstruction@hotmail.com> To: Terri Vroman <terri.vroman@eaglecounty.us> Fri, May 9, 2014 at 7:04 AM Hi Terry We just hooked up water last week to building installing alarm system to tank on monday I will bring pictures and paper work in next week. Tom From: terri.vroman@eaglecounty.us Date: Wed, 7 May 2014 15:55:01 -0600 Subject: Status of septic file To: mccordconstruction@hotmail.com [Quoted text hidden] hftps:Hmail.google.corrdmail/u/0/?ui=2&ik=30478a9c52&\Aevwpt&search=inbox&th=l45d8aebde68c3Oa&siml=145d8aebde68c3Oa&siml=145ell5dO648eble 1/1 0U2TS_ 11--15 /00s C;.), Valley Precast, Inc. P.O. Box 925 Buena Vista, CO 81211 Phone: 719-395-6764 Fax: 719-395-3727 frontdesk@valleyprecast.com www.valleyprecast.com Name / Address McCord Construction P.O. Box 4195 Eagle, CO 81631 Estimate Contact Name Estimate # Danny Delivery Location 2966 E. Lake Creek Rd Edwards 3142 Date of Estimate Estimate Expires 11/11/2013 01/11/2014 Item Description Qty Cost Total 2000T-2CP 2000 Gallon Top -Seam, Two Compartment Tank 1 1,850.00 1,850.00T Set Fee Tank Set Fee 1 300.00 300`00 I' BH Riser I' Big Hole Concrete Riser ( To match High Level Alarm 1 42.00 42.00T riser estimated at one foot) Holding Tank / Hi... AHW 1 15v Stand -Alone or Remote Alarm Panel 1 105.22 105.22T MFI A Signal Float with Collar 1 31.10 31.10T PRTA24 24" Tank -to -Riser Adapter 1 26.17 26.17T PRTA24BDKIT 24" Adapter Bolt Down Kit 1 10.48 10.48T RRFB Float Bracket 1 18.29 18.29T RR2412+V i PVC Dosing Riser with I' Vent 1 98.18 98.1 ST FL24GI2-4B 24" Fiberglass Lid with 2" insulation and urethane gasket 1 109.82 109.82T SB I PVC Splice Box with 1 Cord Grip 1 46.49 46.49T Product Mod Tech Installation 1 100.00 100.00 HOLDING TANK ---- With Alarm Setup -- Complete 545.75 with 12' Riser Thank you for your business. Any specialty items require two weeks notice; including some tanks. Subtotal $2,737.75 Sales Tax (4.9%) $114.55 Total $2,852.30 Item 0 200OT-2CP Top View Section Boot View 6" 5" 2000 Gallon Top Seam Two Compartment 62" /2a" HCkW W I I . cam *Meets ASTM C-1227 spec including C-1664-06 for resilient connectors • 6000 psi concrete • Delivered complete with internal piping • PVC, poly or concrete risers available • Option of pump or siphon installed 5" DkNft Spew h"Wt Dhnendon IS Long x W Wide Inlet Outlet Length Width Height 56" bWw inlet invert 56" 53" 162" 78" 68" Wafer a Was�ewadter FLE77 VALLEY•Products ,Inc. • swloe Net Oa mft Inlet Side , Outlet side 1150 gallons W5 gallons Nett Lid Teak 5,420Ibe 15,630Ibe Total 2,064 ge0m Total 20,M Me 28005 Co. Fiji 317 P.O. BO K925 Faoc (719) 39 3777 BueneNl 0081211 VVdWW wwwxell yprecest oom E=U: Roi ikksk&WkW scant oom (719) 39547U All- 400 cz� LP jr- v �x Lq cn Ln ' x f. x � /�� \ \ _ \�� , RL jar. . . . . . . . . . ..... f V.-f jd 4 - J 5 f J i :..... �' �. J �� Cmo:5- 4it County Systems Cleaners Reporting Form (Please Print) Name of Systems Cleaner SWbo-tet is'4 r ZfiGG Name of Service Person44ItL 9C`L*�- Date of Service 8 // % // s Date of System I Property Owner 3�mr l %( o a F- lot sic- w Telephone # q Z 0 `C Z6 — q 1 & % Property Address Z G( (;s b tr 1_10.1 G2 Le k ?==; _ 0 St-P-tRs) je L" Lot Block Subdivision Estimated Tank Size Z C900 Tank Material C dd-) CiGrt-L*� # of Manholes Depth to Manhole Covers Estimated Volume Pumped OCC3 # of Compartments Z Sludge Thickness —inches Scum Thickness inches Baffle or Sanitary Tee in Place? i- Inlet Outlet UNK X-11A Effluent Filter in Place? Y N (Required after 6/2000) �/� Dosing Mechanism Pump Siphon None la%%1 Dosing Mechanism/Alarm Functioning Properly? Y N /V/"V Higher Level Treatment System? Y N If Yes -Type A-///9- Previous Pumping Date, if known, vu �" Location of Septage Disposal /�/L� �B'� L yt;�Ooi5 General Comments (include any signs of failure and all work done in addition to pumping ZOO© 6'i9/�O�✓ 4/ Z DIWrr' TiS� NC f�� 1� � ►�j� �v� Try �'� Sketch (Location of Tank) �o� S ]-Pe- Under section 8.1 of the Summit County OWLS Regulations, holders of a Systems Cleaner License must report to the Environmental Health Department each OWTS which is cleaned, serviced or inspected not more than thirty (30) days after such service is performed. In addition, report within 7 days of service the location ofany leaking septic tank or surfacing waste water that is found. I certify that, to thebestof my know) the above information is true and correct. +� Signed /- Date i �&m"ffMf County Systems Cleaners Reporting Form (Please Print) Name of Systems Name of Service Person Pk kC Date of Service / 7 !J Date of System Installation Property Owner Pe),y Cie ep.,Axµ Telephone #q'70 -Q26 1 % Property 3C�7.7S L Subdivision Estimated Tank Size Tank Material # of Manholes-r 'J�iUS Depth to Manhole Covers CD> �_, Estimated Volume Pumped 17,00 # of compartments TOO Sludge Thickness 0YJ�C inches Setmo Thickness inches Baffle or Sanitary Tee in Place? _Inlet Outlet UNK Effluent Filter in Place? Y V, N (Required after 6/2000) Dosing Mechanism _Pump Siphon None Dosing Mechanism/Alarm Functioning Properly?_Y N �,r� , ,' Higher Level Treatment System? Y N if Yes -Type Uk- - � 4:71 Previous Pumping D Location of Septage General Comments (include any signs of failure and all work done in addition to pumping ?o rr' P rt� iFf ti_O�t S \ tic 4% Sketch (Location of Tank) SWz o N P Rc�P �1o_ `rC� ' 0 iT�i uo�� d n� IPAGt 'fVOF ,,,, Under section 8.1 of the Summit County OWTS Regulations, holders of a Systems C ner License t o the Environment l Health De tigtem a ch OW TS which is cleaned. serviced or inspected not more than thirty (30) days after such sery a is pe ormed. In addition, report within 7 days of servi tC� (oc on of any leaking septic tank or surfacing waste water that is found. f I certify that, to the best of my knowledge, the above information true and corree . D Signed Date C7 l7