HomeMy WebLinkAbout23414 Colorado River Rd - 168515400041INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Eagle County Department of Environmental Health PERMIT N2 0714
P.O. Box 850 - 550 Broadway
Eagle, Colorado 81631
Telephone: 328-7311 or 949-5257 or 927-3823
YELLOW COPY OF PERMIT MUST PLEASE CALL FOR FINAL INSPECTION BEFORE
BE POSTED AT INSTALLATION SITE COVERING ANY PORTION OF INSTALLED SYSTEM
Owner: U.S. Government Telephone:
Address:
System Location: Burns, Colorado
Licensed Installer: Moos Enterprises License Number: -- - - - - -
Conditional installation approval is hereby granted for the following:
Minimum requirements: Gallon Septic Tank or Aerated Treatment unit
Absorption area of dispersal area computed as follows:
Percolation rate: Inch in Minutes
Absorption area per bedroom Sq. Ft.
Number of Bedrooms X Sq. Ft. minimum requirement per bedroom -
equals Total Sq. Ft. minimum requirement
Special Requirements: No fees Da.i d , so no inspections required.. System i nstaT Ted per specs of
U.S. Government.
Date: Environmental Health Officer:
CONDITIONS:
1. All installations must comply with all requirements of the Eagle 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 zoning and building
departments shall automatically be a violation of a requirement of the permit andcause 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 system is approved prior to covering any portion of the system.
INSTALLED ABSORPTION OR DISPERSAL AREA: SQ. FT.
INSTALLED SEPTIC TANK: GALLONS; DEGREES; FEET
DESIGN ENGINEER OF SYSTEM:
INSTALLER OF SYSTEM:
SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR
AERATED ACCESS PORTS ABOVE GRADE:
PHONE:.
YES NO
PROPER MATERIALS AND ASSEMBLY: YES NO
COMPLIANCE WITH PERMIT REQUIREMENTS: YES NO
COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES NO
COMMENTS:
(Any item checked NO requires correction before final approval of system is made. Arrange a re -inspection when
work is completed.)
DATE (Final Approval) ENVIRONMENTAL HEALTH OFFICER:
DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER:
Name of Applicant:
RETAIN WITH RECEIPT RECORDS
Name of Owner:
Amount Paid: Receipt Number: Date: Cashier:
PERMIT
White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner
APPLICATT_0FOR I.,DICIDUAL SE,�AGE DISPOSAL SrST7-I PFt'—"T-'
bjrngJ
PERMIT APPLICATION FEE;
NAME OF
ADDRESS:
E:;tiIROZZIE:;TAL 111EALTH OFFICE - EAGLE COU:::1'
�-� P.U. Box 850
Eagle, Colorado 81631 No.
$150.00 328-7311 PERCOL\TION TEST FEE: S50.00
NAME OF APPLIC,INT (if different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (if applicable):
ADDRESS:
PHONE:
fiM2i c 3p q Wwaa,nA 3)npV�
PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
Licensed_Installer (seed attached list): YES ;�N7_ NO
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: " New Installation ( ) Alteration ( ) Repair
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Street/Rural Address:
Lot Size:
Legal Description:
BUILDING OR SERVICE TYPE (check applicable category):
( ) Residential - Single Family
( ) Residential - Duplex
( ) Residential - Triplex
NUMRFR OF PFRgnNc-
WASTE TYPES (check applicable categories):
( ) Commercial or Institutional
( ) Non -Domestic Wastes
( ) Garbage Disposal
( ) Automatic Washer
( ) Other
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTa-f PROPOSED:
1.
Residential Quadplex
Commercial S g
ram-
NUMBER OF BEDROOMS:
Dwelling
(' )� Transient Use
( ) Dishwasher
( ) Spa Tub
Septic Tank ( ) Composting Toilet ( ) Incineration Toilet
( ) Vault Privy ( ) Greywater
( ) Chemical Toilet
( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Potable Use
( ) Other ( ) Recycling, Other Use
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO (f
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES ( ) NO
WASTEWATER FLOW REDUCTION PLAN: YES ( ) NO
(I S Yes, see attached waste rote& Stow Leduc t, .on methods)
NOTE: The Env.itconmentat Heath' 064icen may reduce the teq i ted absotptc:on area upon
appnovat oS an adequate wasteoaten Stow neductc:on plan.
SOURCE AND TYPE OF WATER SUPPLY: Well ( ) Spring ( ) Creek/Stream
Give depth of � wells hin 00 feet of system:
If supplied y mmunitter, give name of supplier:
SIGNATURE: j-
INFOMATION BELOW TO BE LLED 0
- _-Z E
DATE:
ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: PeAcent Gttound Slope
Depth to Bedtock (pe)t 8' Pno6ae Hote)
Depth to Groun&vatet Tabte
SOIL PERCOLATION TEST RESULTS:. A nutu pen inch n Ho 7e l
Ati;iutn pen .inch to Ho ee # 2
A{.c.nutes pen -inch to Hote #3
FINAL DISPOSAL BY: -
( ) Absorp-tion Trench, Bed on Pit ( ) Evapo;tiansPikati.on s
( ) Above Ground D.i s petusae ( ) Sand Fit ten
( ) Undetg,7ound Dispetusa.E ( j Wastevaten Pond
( ) Otilet
Amount Paid: rl Receipt Nwiibe.t Date: Q
---------------------------------------------_.
NOTE: Site Plan must be attached to appl icati on.
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(Env. Health Department - Rev. 4-07-83) s cs a-F (A.S, C u�rnryx_Q�
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0714 U.S. Post Office
:JOB NAME -
JOB Joa Ha. %1/ ,
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BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIALF/7
---------------
TOTAL LABOR
— --- --
PERMIT #714
OWNER: Federal Government - U.S. Postal Service
LOCATION: Burns, CO
INSTALLER: Moos Enterprises
P.O. Box 770184
Steamboat Springs, CO 80477
303) 879-1951
SIZE OF TANK: per gov't specs
PERC RATE: per gov't specs
INSURANCE
SALES TAX
M I SC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
.JOB FOLDER Prgdu 111MLactU: No inspections required. No fees paid.
Of
Printed in U.S.A.
