HomeMy WebLinkAbout304 Meadow Rd - 210507401015 - 0505IS - 2023 Pump ReportEAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
.,EASE CALL FOR FINAL P. 0. Box 850 - 550 Broadway PERMIT MUST BE POSTED
INSPECTION BEFORE COVERING Eagle, Colorado 81531 AT INSTALLATION SITE
ANY PORTION OF INSTALLED SYSTEM
328-7311 or 949-5257 or 927-3823 PERMIT NO. N o 50 5
OWNER: Frank Van de Water ADDRESS: 2020 Wadsworth Blvd., Lakewood
SYSTEM LOCATION: Lot 12, Block 3, Lake Creek Meadows
LICENSED INSTALLER: Burnett Plumbing
LICENSE NUMBER:
**CONDITIONAL INSTALLATION APPROVAL is hereby granted for the following:
MINIMUM REQUIREMENTS: 1,250 gallon septic tank or aerated treatment unit.
Absorption area or dispersal area computed as follows:
PERCOLATION RATE: 1 inch in 30 minutes.
Absorption Area per Bedroom 300 sq. ft.
No. of Bedrooms 4 x 300 sq. ft. minimum requirement per bedroom
= 1,200 total sq. ft. minimum requirement.
SPECIAL REQUIREMENTS:
DATE: May 12, 1981 INSPECTOR:
**CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage
Disposal System Regulations, adopted pursuant to authority granted in 25-10-104,
C.R.S. 1973, as amended.
2. 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 building and zoning departments shall
automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
3. Section III, 3.21 requires any person who constructs, alters, or installs an
individual sewage disposal system to be licensed according to the Regulations.
FINAL APPROVAL OF SYSTEM: No system shall be deemed to be in compliance with the Eagle
County Individual Sewage Disposal System Regulations until the installed system is
approved prior to covering any part.
Installed Absorption or Dispersal Area: // 2 sq. ft.
Installed Septic Tank: / 2--Q�7- 0 _ gallons.
Design Engineer of System:
Installer of system:_ rPhone:
�%%`�� -f.—�
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Septic tank cleanout to within 12" of final g ade or
aerated access ports above grade? Yes o
Proper materials and assembly? Yes
Compliance with permit requirements? Yes No
Compliance with County/State regulations requirements? Yes
COMMENTS:
Zen
(Any item checked "No" requires correction before final approval
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PLEASE RETURN THIS PORTION WITH YOUR SITE PLAN AND FEES
328-7311 949-5257 tt[7-3823
ENVIRONMENTAL HEALTH dam'
BOX 850
EAGLE, COLORADO 81631
PERMIT FFE = $75 PERCOLATION TES FE�=$5
--___ APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
NAME OF OWNER: / 4AV Vui✓ _ )' eeIV, �v✓
ADDRESS:
NO. f ro Ci
PHONE:
NAME OF APPLICANT (IF DIFFERENT FROM OWNER): Uez 6,td-L/A<, -6,
ADDRESS: ,t7d krr�5, �G+���� 'l 6 .3 �Z_ PHONE '7-�
DESIGN ENGINEER OF SYSTEM (IF APPLICABLE):�url✓��t'�u
ADDRESS: PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:,,-�y�/�
ADDRESS: PHONE: e7
PERMIT APPLICATION IS FOR: ( //f New Installation ( ) Alteration
LOCATION OF PROPOSED FACILITY: County
City or Town, if within City or Town Limits
LEGAL DESCRIPTION:
( ) Repair
Lot Size s" 1-1
STREET (RURAL) ADDRESS: C rC ee /f IS
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY? ( 1/) Yes ( ) No
BUILDING OR SERVICE TYPE: (Check applicable category)
W ) Residential - Single-family dwelling ( ) Residential - Triplex
( ) Residential - Duplex ( ) Residential - Quadplex
( ) Commercial - State usage
# Persons
# Bedrooms
WASTE TYPES: (Check all applicable)
( ) Commercial or Institutional ( Dwelling
( ) Non -domestic wastes ( ) Transient Use
( ) Other
SOURCE AND TYPE F TER SUPPLY: ( ) Well ( ) Spring
XG'Xdth all wells within 200 feet of the system:
�f by community water, give name of supplier:
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( Septic Tank ( ) Aeration Plant ( )
( ) Vault Privy ( ) Composting Toilet ( )
( ) Pit Privy ( ) Incineration Toilet ( )
( ) Greyriater ( ) Other
J�
(� Garbage Grinder
( ef Dishwasher
( ,-y Automatic flasher
( ) Creek or Stream
Chemical Toilet
Recycling, Potable Use
Recycling, Other Use
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ( ) Yes ( `_�' No
Signature ���Z 1c,
�
INFORMATION BEL014 TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER
GROUND CONDITIONS: Percent Ground Slope: 3 70
Date
Depth to Bedrock (per 8' Profile Hole): 0oDepth to Groundwater Table:
SOIL PERCOLATION TEST RESULTS: 3 C) ^Pe,7__ Minutes per inch in Hole No.
Minutes per inch in Hole No. 2
P1inutes per inch in Hole No. 3
FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Above Ground Dispersal ( ) Sand Filter
( Underground Dispersal ( ) Wastewater Pond
( Other
FEE: $50
APPLICATION NO. ? >
OWNER:
LEGAL DESCRIPTION: ,�%
RURAL ADDRESS: d -e
ii( ric.t �S
TYPE OF MC,7ELLING : G7j 712 - # OF BEDROOMS:
DATE OF TEST:
TEST HOLES PRESOAKED: YES
TYPE OF SOIL:
TIME
WATER DEPTM
TjINCHES OF FALL
RATE
1 2
3 1 2 3
1
2
3
1
2
3
V
-17-
F
f
}1}
3
PERCOLATION PATE:
TANK
SIZE: %�}
SQUARE FOOTAGE PER
BEDROOi1: �
LEACH
FIELD SIZE: / G
Site has been reviewed and tested for per Nation rate.
G'e recommend: APPROVAL DISAPPROVAL
DATE: �l
t
EAGLE COUNTY
ENVIRONTIENTAL HEALTH OFFICER
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SEPne TdNK LOCAT10N
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Name of Syster
Name of Servic
Date of Service
Date of System
Property Owner ! sr'A YF, It gC tl
Property Address 30 q f— ,(')t.��_ La Ld VAP
Lot
Block
Telephone # (F70 -wo j le
Subdivision
Estimated Tank Size loqsc) Tank Material
Iti ff �1
# of Manholes Depth to Manhole Covers (r.,
Estimated Volume Pumped f as # of Compartments
! t i)
Sludge Thickness (? inches Scum Thickness inches
Baffle or Sanitary Tee in Place? PO Inlet _Outlet UNK
Effluent Filter in Place? Y V N (Required after /2000)
Dosing Mechanism Pump Siphon None
Dosing Mechanism/Alarm Functioning Properly? Y ��N
Higher Level Treatment System? Y ,/ N If Yes -Type_
Previous Pumping Date, if known(?
Location of Septage Disposal
General Comments (include any signs of failure and all work done in addition to pumping
iJC n,4Sketch (Location of Tank)
9,2
Under section 8.1 of the Summit County OWTS Regulations, holders of a Systems Cleaner License must report to the Environmental Health Department each O WTS
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 of any
leaking septic tauk or surfacing waste water that is found,
I certify that, to the best of my knowledge, the above information is true and correct.
Signed ��" ~' f �� Date�
