HomeMy WebLinkAbout34999 Hwy 6 - 210504412007 - 0519IS TEMPEAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH PLEASE CALL FOR FINAL P. 0. Box 850 - 550 Broadway PERMIT MUST BE POSTED INSPECTION BEFORE COVERING Eagle, Colorado 81631 AT INSTALLATION SITE ANY PORTION OF INSTALLED SYSTEM 328-7311 or 949-5257 or 927-3823 PERMIT NO. N ° 519 OWNER: r e t'—, ACrg_ R C , ADDRESS: 14ZG4 SYSTEM LOCATION: FdwAR-0 &s.c:,eve_ D^t -thg _A&Z-f tem,e LICENSED INSTALLER: � �MQ AAd� .� �2cfru -4-j(1LICENSE NUMBER: "CONDITIONAL INSTALLATION APPROVAL is hereby granted for the following: MINIMUM REQUIREMENTS: j Z-5-0 gallon septic tank or aerated treatment unit. Absorption area or dispersal area computed as follows: 141 A PERCOLATION RATE: inch in minutes. Absorption Area per Bedroom sq. ft. No. of Bedrooms x sq. ft. minimum requirement per bedroom = total sq. ft. minimum requirement. SPECIAL REQUIREMENTS: 7srAtf-0 0-a _- _ ALO DATE: INSPECTOR:1�V�I�r7 "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: sq. ft. Installed Septic Tank: Design Engineer of System: Installer of System: gallons. Septic tank cleanout to within 12" of final grade or aerated access ports above grade? Yes No Proper materials and assembly? Yes No Phone: Compliance with permit requirements? Yes No Compliance with County/S ate regulatio s requirements? Yes No COMMENTS: U�I ' /yl(9 G(lXwLZO GD r W'271 (Any item checked "No" requires correction before final approval of system is made. Arrange a re -inspection when work is completed , DATE: 6> INSPECTOR: RE -INSPECTION DATE: INSPECTOR: RETAIN WITH RECEIPT RECORDS PERMIT NO. NI-0 519 CHARGES Name of Applicant:e Percolation Test = $50. 00 M I A Name of Owner: 'P� t F� � � i e2 rA C,, 6 Co rj Permit Fee (includes final inspection) = Amount Paid: 7-5.6 p ALL CHECKS OR MONEY ORDERS ARE TO BE Receipt Number: `7 MADE PAYABLE TO: EAGLE COUNTY Cashier: White and Pink Copies - Environmental Health Department Green Copy - Applicant/Owner VLLHJt KtIUKN IHIJ HORiIUN W.1IH YOUK SITE PLAN AND TEES 328-7311 949-5257 927-3823 ENVIRONMENTAL HEALTH BOX 850 EAGLE, COLORADO 81631 PERMIT FEE _ $75 PERCOLATION TEST FEE _ $50 APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT NO. � NAME OF OWNER:-��Cp�,C,�, ADDRESS : \L4a(c\ ,ytt�. /'%�.� PHONE: 3y©-2Cs�b NAME OF. APPLICANT (IF DIFFERENT FROM OWNER):,��C ADDRESS: .(� � ,�,�y ��0� `GCS �3�k,a0 PHONE: 4=04G,-90A\ DESIGN ENGINEER OF SYSTEM (IF APPLICABLE): ADDRESS: PHONE: PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: ADDRESS: u�&& PHONE: PERMIT APPLICATION IS FOR: (}v New Installation ( ) Alteration ( ) Repair LOCATION OF PROPOSED FACILITY: County Lot Size City or Town, if within City or Town Limits =_0�� ���5�.��►� LEGAL DESCRIPTION: STREET (RURAL) ADDRESS: IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY? ('X) Yes ( ) No BUILDING OR SERVICE TYPE: (Check applicable category) ( ) Residential - Single-family dwelling ( ) Residential - Triplex Residential - D'ur 1ex t 1 nesilden+;al (lu adplav (� Commercial - State usage # Persons 6;z # Bedrooms WASTE TYPES: (Check all applicable) ( ) Commercial or Institutional ( ) Dwelling ( ) Garbage Grinder ( ) Non -domestic wastes ( ) Transient Use ( ) Dishwasher (k) Other Ck �k7E�\� =6 Sia '� ( ) Automatic flasher SOURCE AND TYPE OF 14ATER SUPPLY: ( ) Well ( ) Spring Give depth of all wells within 200 feet of the system: If supplied by community water, give name of supplier: TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: ( ) Septic Tank ( ) Aeration Plant ( ) (X) Vault Privy ( ) Composting Toilet ( ) ( ) Pit Privy ( ) Incineration Toilet ( ) ( ) Greywater ( ) Other ( ) Creek or Stream Chemical Toilet Recycling, Potable Use Recycling, Other Use WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ( ) Yes (X) No Signature C�c�s�C �oC a t e cc> INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER GROUND CONDITIONS: Percent Ground Slope: Depth to Bedrock (per 8' Profile Hole): SOIL PtRCOLATION TEST RESULTS: Depth to Groundwater Table: Minutes per inch in Hole No. 1 Minutes per inch in Hole No. 2 Minutes per inch in Hole No. 3 FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) 'Above Ground Dispersal ( ) Sand Filter ( Underground Dispersal ( ) Wastewater Pond ( X� Other 0519 Reserve on the Eagle River Dn� Yct��,� JOB NAME � m - - Gl r JOB NO. . - EDWARDS y , .— O8 LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL TOTAL LABOR INSURANCE SALES TAX MISC. COSTS TOTAL JOB COST GROSS PROFIT LESS OVERHEAD COSTS % OF SELLING PRICE NET PROFIT JOB FOLDER Product 27$ Neas O NEW ENGLAND BUSINESS SERVICE, INC., OROTON, MA 01471 JOB FOLDER Printed in U.S,A. w