HomeMy WebLinkAbout4600 Highway 6 - 000000000000 - 211304401002?INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Eagle County Department of Environmental Health PERMIT N2 0749
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:
R. A. Neilsen
Address: P. O. Box 1130 - Commerce City, CO 80022
Telephone: 287-0195
System Location: 4600 Hwy 6
Licensed Installer: None 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 one X n/a Sq. Ft. minimum requirement per bedroom
equals
Total Sq. Ft. mini m urequirement
kr,rict+ re10 V't)vST be
Pry
Zoe �� , � - ke 0 "e, l(
Special Requirements: _Sealed
vault - leach field may be added at later
date. Percolation
test needs to
bedone prior to installation of
leach field
c
Date: H D V �
Environmental Health Officer:
^ �
_r n
t =y
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 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 system is approved prior to covering any portion of the system.
INSTALLED ABSORPTION OR DISPERSAL AREA:
INSTALLED SEPTIC TANK:
DESIGN ENGINEER OF SYSTEM:
INSTALLER OF SYSTEM:
GALLONS;
-SQ. FT.
DEGREES; FEET
SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR
AERATED ACCESS PORTS ABOVE GRADE:
PROPER MATERIALS AND ASSEMBLY:
PHONE:
YES NO
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:
RETAIN WITH RECEIPT RECORDS PERMIT
Name of Applicant: R. A. Nielsen Name of Owner: R. A. Neilsen
Amount Paid: $150.00 Receipt Number:- 2037 Date: 6 16 86 Cashier: G. Parker
Ck #1013
White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner
APPr ICALI FOR ?';D:''I: AL :;r:ti:1G DIcPOSAL S';S- PT^`.tIT
E %TIRO.'ME.:TAL HEALTH OFFICE - EAGLE COUNTY
P.O. Box S50
Eagle, Colorado
81631
(
\l PER`iIT APPLICATION
FEE: S150.00 328-7311
PERCOLATION
TEST FEE: S50.00
NAME OF OWNER:
ADDRESS: 3 6 k 11,30
C- el, wLovy e.i-ee_
PHONE:
.2 �g7-
NAME OF APPLICANT
(if different from owner)
ADDRESS:
(2W6 PHONE:
DESIGN ENGINEER OF
SYSTE`S (if applicable):
ADDRESS: �-- —
PHO:E
PhA6uA4 INSTALLATION OF SYSTEM: /(/ILy Sc'_-(�
Licensed Installer (see attached list): YES- NO
ADDRESS:
PHONE:
PER`fIT APPLICATION IS FOR: (lC) New Installation ( ) Alteration ( ) Repair
LOCATION' OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTE_-1:
Street/Rural Address: �_606 H
Lot Size: S-c7.al--e-s
Legal
Description:
BUILDING
OR SERVICE TYPE (check applicable cate,orv):
trs � u
()
Residential - Single Family
(
) Residential - Quadplev
( )
Residential - Duplex
(
) Co:••r.::ercial (state usage)
( )
Residential - Tr_plex
NUMBER OF PERSONS:
NUMBER OF BEDROOMS:
WASTE TYPES (check applicable cate,ories) :
( )
Commercial or Institutional
( )
Duelling
( )
Non -Domestic Wastes
(
) Transient Use
( )
Garbage Disposal
(
) Dishwasher
( )
Automatic Washer
(
) Spa Tub
( )
Other
TYPE OF
INDIVIDUAL SETIAGE DISPOSAL SYSTEM PROPOSED:
( )
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 DISCHAIRGED DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO (��)
IS SYSTEM DESIGNED FOR LESS 1'rTA:v 2,000 GALLONS PER DAY: YES NO ( )
WASTEWATER FLOW REDUCTION PLAN: YES ( ) NO (1C)
(I6 yes , see attached Lcas tell atet 5-ectu AedLLCt(.on me lLcds )
NOTE: The EnvLmunejztat Heae-fL O'�i.c&L may educe the •terju ,,ed abso,tptjon atea upon
apptovaZ o5 an adequate cc;as.t etcatet 6Zow .,Leduc'tion pea;z.
SOURCE AND TYPE OF WATER SUPPLY: () Well ( ) Spring
l ( ) Creel:/Stream
Give depth of all wells within 200 feet of system: , i bC.'_ CIn' )I4u, vr�t-
If supplied�b c"mm nity/wwate ve name of supplier:
SIGNATURE• •
DATE. .
C
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INFORt{ATION BELOW TO BE FILLED OUT By ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Peneent Ground Slope
Depth ,to Bedto eh (pet 8' P,to 6ZZe Hot e )
Depth to Gtoundwate�t Tabte
SOIL PERCOLATION TEST RESULTS:. '' i;Lu tc,s pe1L .tnc.;z in Hoi.e n I
4Cinutcs pen inch to Hote #2
i.i,i.jW.t ,s peAL iACI L to 11.0te. # 3
FINAL DISPOSAL BY:
( J Abso.tptLoji Tnejtch, Bed o.t Pit ( ) Evapo.ttan5piAati.on
( ) Above Gncund D.i,speisa.l' ( ) Sand F,i ate-t
( J UndCtg.tound Di5 pert saE_ ( ) Was.; cLva.tc t Pond
(� J U.t'Le.t VA-uLT
Amount Paid: ,�,Q�j Recei,ot Ntu:jbe-t r9037 Date:
- - - - - - - - - - - - - - - - - - - - - - - - - - -'`- io�3 - - - - - - - - - - - - - - - - -
NOTE: Site Plan must be attached to'application.
(Env. Health Department - Rev. 4-07-83)
EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE
y - -
.-'4.
fa m e
Dt
a R uted ��_
Gb 10 Application-ffi
cati n
Please review the attached Individual Seiage Disposal System Permit Application and return
it with this completed form to the Environmental Health Office._
PLANNING: Complies with - '. YES ..NO D BY
DATE
Subdivision Regulations: {
Zoning Regulations:
Recommend Approval:
COMMENTS: '
BUILDING: Complies with -
Building Permit Applied For:
Building Permit Issued:
1
ENVIRONMENTAL HEALTH:
Complies with -
Floodplain Permit Necessary:
I.S.D.S. Regs. Compliance:
Recommend Approval:
CO'MMEilTS: e� (r
YES NO REVIE•lED BY
YES NO REVIE14ED BY
DATE
DATE
COMMUNITY DEVELOPMENT
DEPARTMENT
(303) 328.8730
EAGLE COUNTY, COLORADO
October 4, 1990
Dear Applicant:
725 CHAMBERS AVE.
P.O. BOX 179
EAGLE, COLORADO 81631
FAX (303) 328-7207
Please be advised that this office will not be conducting
percolation tests between November 15, 1990 and March 15,
1991. Additionally, all final inspections on installed
systems must be completed prior to December 1.
If you have any questions, please call me at 328-8730 or
927-3823 ext. 730 in the Basalt/El Jebel area.
Sincerely,
Roger Hosea
Asst. Environmental Health Officer
RH/alm
JOB 'NAME _.
749-86 TxPrcl#
4600 Hiway 6 R.A. Nielsen
JOB NO.
JOB FOLDER Product 278 �o NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 JOB FOLDER
a•
