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HomeMy WebLinkAboutBlk 11, Lot 5,6 - 219723411003INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT Eagle County Department of Environmental Health PERMIT NO 0757 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 Wayne F. Silkwood Address: 6049 South Skyline Drive - System Location: Main Street - Fulford Evergreen, CO 80439 Telephone: Licensed Installer: Owner License Number: - Conditional installation approval is hereby granted for the following: Minimum requirements: 1000 Gallon Tank or 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 regt equals Total Sq. Ft. minimum requirement Special Requirements: Vault Date: %rEnvironmental Health Officer:-�/ 674-6175 CONDITIONS: ,v"/" �.�c��� %"b (3u, 5 l �� �__ _. 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: SQ. FT. INSTALLED SAC TANK: GALLONS; DEGREES; FEET DESIGN ENGINEER OF SYSTEM: INSTALLER OF SYSTEM: PHONE: SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR AERATED ACCESS PORTS ABOVE GRADE: YES NO PROPER MATERIALS AND ASSEMBLY: YES NO COMPLIANCE WITH PERMIT REQUIREMENTS: YES O COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES NO COMMENTS: fF'04 r r: A�-, i'� 9-10 A-' (Any item checked NO requires correction before final approval of system is made. Arrange a re -inspection when work is completed.) DATE (Final Approvai)��/0 ENVIRONMENTAL HEALTH OFFICER: DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER: Name of Applicant: RETAIN WITH RECEIPT RECORDS PERMIT Wayne F. Si 1 kwood Name of Owner: Same Amount Paid: $150, 00 Receipt Number: 2141 Date: 7/15/86 Cashier: Paige Martin White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner APP ICATT^ FOR r'•E;'•L:"_'AL Sr.':A(;- DiS?nS'tL . :S- ?F."T... PER:•fIT APPLICATION FEE: NAME OF OWNER: E:1'IRO."NENTAL f?EALTH OFFICE - EAGLE COU::T`c' P.O. Box S50 Eagle, Colorado 51631 `:o.1306 S150.00 328-7311 PFRCOLATIO`d TEST F F;:: ADDRESS: G d C74 q v Sd (,t n Sf & 4_;r /�r-i°G-e_ PHONE: NAkME OF %2PLIC,LVT (if different from oxrner): C544 .7 ADDRESS: SGc-,, ��'��Gj/ 'iI/ C 04'A3PHO`iE: DESIGN ENGINEER OF SYSTEM (if applicable), ADDRESS: _ t_S-7-dt, -ems PHO::E: INS ALL-NTION OF SYSTEM: Q( .fir" Licensed Installer (see attached list): YES NO �. ADDRESS: • PHONE: PERMIT APPLICATION, IS FOR: (x) New Installation ( ) Alteration ( ) Repair LOCATION OF PROPOSED IJ:DIVIDUAL =JAGE DISPOSAL SYSTE•f: Street/Rural Address: 7-5 jyl�/ ,5, f,,e7, Lot Size: I"© >< l �`� Legal Description: BUILDING OR SERVICE TYPE (check applicable cate^orv_): (JO Residential - Single Family ( ) Residential - Quadplex ( ) Residential - Duplex ( ) Co---::ercial (state usage) ( ) Residential - Tr_Dlex NUMBER OF PERSONS: 7 IML -[BER OF BEDROOMS: WASTE TYPES (check applicable categories): ( ) Commiercial or Institutional ( ) ( ) Non -Domestic Wastes Transient Transient Use ( ) Garbage Disposal) ( ) Dishwasher ( ) Automatic Washer ( ) Spa Tub ( ) Other `TYPE OF TM=UAL SET -,AGE DISPOSAL SYSTE_•1 PROPOSED: (S9p.�ic Tank ( ) Composting Toilet ( ) Incineration Toilet ( Vault Privy ( ) Grey'water ( ) Chemical Toilet ( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Potable Use ( ) Other ( ) Recycling, Other Use WILL EFFLUENT BE DISCHA_RC-ED DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO (>C) IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES NO ( ) WASTEWATER FLOW REDUCTION PLAN: YES ( ) NO �) (IS Yes, see attached S.ecty .Ledult(:on rne;i'Leds) NUT E: The E;2vZ'Lo;une;Ltae Heae-ft 0 S a.Zce,'zL macs educe the -teriu i.ted ab.s o tptii.o;t a tea upon apptovae o� an adequate teaSt.-cate't SGoty AeduCt(.oit p'Zait. SOURCE AND TYPE OF WATER SUPPLY: ( ) Well (i�, Spring ( ) Creek/Stream Give depth of all wells within 200 feet of system: If supplied by community water, give name of supplier: C SIGNATURES - I�1_4�.�f? f`- �;.tr-^-'('- - - - - - - - - - - - DATE_ - 7---�- - - - - - 1:/ INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER: GROUND CONDITIONS: Pe)Leejzt G.tou;id Sope r Deptha Bedto eh (pen 8' P.to S tee Ho ee ) Depth to Gnoundtca,te t Tab.ee SOIL PERCOLATION TEST RESULTS:.,,M.ututcs pet .chest in Ho.ee n1 Minutes peA inch .to Hote #2 I K.i'LW(. CJS tJ eA. .(.ILcrt flo•i..e #3 FINAL DISPOSAL BY: - ( ) Abso.tptcoA Tnench, Bed o.t Pit ( ) Evapo,t=tsPiAati.on ( ) Above Gncund DZspetsa2 ( J Sa;td Fi_Uct ( ) Und e,tJ,tound DZspe,mae ( ) Was.texatct Pond r Amount PaEd: � Recec,pt Nulnbe.t NOTE: Site Plan must be attached to -application.- Ct-u-Asp (Env. Health Department - Rev. 4-07-83) EAGLECOUNTY BUILDING DIVISION P. 0. Box 179 Phone: 328-7311 INSPECTION REQUEST BUILDING PERMIT NO. .' - lAfl.11AL.i I I Ready for Inspection: ❑ MONDAY ❑ TUESDAY ❑ WEDNESDAY ❑ THURSDAY ❑ FRIDAY ❑ AM ❑ PM COMMENTS: r APPROVED ❑ DISAPPROVED ❑ REINSPECT ❑ Upon the Following Corrections: DATE: TIME: INSPECTOR EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE Date Routed App 1 ication fJc - �Loation Please review the attached Individual Sewage Disposal System Permit Application and return it with this completed form to the Environmental Health Office. PLANNING: Complies with - YES Pd0 RE'�IE'j7D BY Subdivision Regulations: Zoning Regulations: Recommend Approval: coRlr' �� �,E,•JTS . DATE 7 /7 BUILDING: Complies with - YES I NO I REVIE'.•IED BY DATE Building Permit Applied For: Building Permit Issued: ------------------------ Recommend Approval: �f, �•,/ COMMENTS: j ENGINEER: Complies with - ! YES NO REVIE-1ED BY nATF COMMENTS: Grac Drain Recommend Appro �J/���'( EN'/IROilMENTAL HEALTH: Complies with - Floodplain Permit Necessa I.S.D.S. Regs. Complian Reco,;.mend Approv, CO'XiIENTS: EWED BY DATE 7- / 7-- 9L JOB NAn 0757 Silkwood Lot 6 Blk 11 Main Street Fulford JOB NO" ._�. PERMIT #757 OWNER: Wayne F. Silkwood LOCATION: Main Street - Fulford INSTALLER: Owner SIZE OF TANK: 1000 gallon DWELLING: Res. Single Fam. 1 bedroom PERC RATE: N/A ABSORPTION AREA: N/A FINALIZED: 9/10/87 BY: SID FOX DATE BILLED JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL TOTAL LABOR INSURANCE