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HomeMy WebLinkAboutBlock 24, Lot 1,2 - 219723403004INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT Eagle County Department of Environmental Health PERMIT Np 0795 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: Stephen Smith Telephone: 328-1657 Address: P- 0. Box 602, Eagle, CO System Location: Lots 1 & 2, Blk 24, Fulford - Nolan Avenue Licensed Installer: License Number: Conditional installation approval is hereby granted for the following: Minimum requirements: Gallon Septic Tank or Absorption area of dispersal area computed as follows: Percolation rate: Inch in Minutes Absorption area per bedroom Sq. Ft. Aerated Treatment unit Number of Bedrooms X Sq. Ft. minimum requirement per bedroom - equals Total Sq. Ft. minimum requirement Special Requirements: Date: Environmental Health Officer: `i I UT 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: SQ. FT. OA- INSTALLED SEPTIC TANK: GALLONS; + ll DEGREES; FEET 1`�l DESIGN ENGINEER OF SYSTEM: A C./� �7�-- N INSTALLER OF SYSTEM: (�(Jj 0 PHONE: SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR AERATED ACCESS PORTS ABOVE GRADE: 7J, YES NO PROPER MATERIALS AND ASSEMBLY: YES NO COMPLIANCE WITH PERMIT REQUIREMENTS: YES _sG NO COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES NO COMMENTS: � �� ��' G k \k UV\ �LO tit (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: Stephen Smith Name of Owner: Same Amount Paid: 150.00 Receipt Number: 3364 Date:7/13/87 Cashier: E. Huenink Check #1399 White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner APPT IC:, T ` FOR aL :;F:;:\(; DTc ,� AL : S_ P•. •.,T_ l E:;VIRO."`fENTAL i.EALTii OFF :CE - EAGLE COU.,T% P.O. rad njp 3 �J Eagle, Colorado 51631 NO PERMIT APPLICATTON; FEE: S150.00 3 8-7311 PFRCOL:\TIO`; TEST F=- 550.00 NA2IE OF OUNER: ADDRESS: 6 `��� �Cj PHO;;E: NAME OF APPLICANT (if different from owner) ADDRESS: DESIGN ENGINEER OF SYSTEM (if applicable): ADDRESS: PHONE: _PIG PHONE: Phm-:JVIV t<i:ii v;:.�iL:.�, i s ,; INS ZALLATION OF SYSTEM: S' S-r-nJ . Licensed Installer (see attached list): YES NO . ADDRESS: Wilco . PHO:;E : PER`fIT APPLICATION IS FOR: (✓) New Installation ( ) Alteration ( ) Repair LOCATION OF PROPOSED INDIVIDUAL SE?•?AGE DISPOSAL SYSTE-4: Street/Rural Address: N6 CO Lot Size: �p IDS Legal Description: —��k a�( Lot (d BUILDINTG OR SERVICE TYPE (check applicable cateeorv): ( Residential - Single Family ( ) Residential - Quadplev ( ) Residential - Duplex ( ) Cc:•-:ercial (state usage) ( ) Residential - Tr_olex C NUMBER OF PERSONS: r NL.13ER Or BEDROOMS: WASTE TYPES (check aoplicable cate^ories): ( ) Co«:ercial or Institutional ( Dwelling ( ) Non -Domestic Wastes (v) Transient Use ) Garbage Disposal ( ) Dish:aasher ( ) Automatic Washer ( ) Spa Tub ( ) Other -TI'PE OF INDIVIDUAL, ME AGE DISPOSAL SYSTE'•I PROPOSED: ( ) Septic Tank ( ) Composting Toilet ( ) Incineration Toilet (x) Vault Privy ( ) Greywater ( ) Chemical Toilet ( ) Pit Privy ( ) Aeration Plant l ( ) ( ) Rec}•c�in�, Potable Use Other ( ) Recy cling, Ot:ier Use WILL EFFLUENT BE DISCHARGED DIRECTLY INTO T.ATERS OF THE STATE: YES ( ) NO ()() IS SYSTEH DESIGNED FOR LESS THAT 2,000 GALLONS PER D tiY: YES NO ( ) WASTE?dATER FLOW REDUCTION PLAN: YES ( ) N,0 (x ) (I 6 Yes , see atitached tv�2s tei�tz tet S.ec cv .teductc oil methods ) NOTE: The EnvZtoiuneitta.e Hea.e.�i 03' .i.eet mail «educe ;'te •teoui,.ed ab.se-tption atea upon appiova.e o 6 an ade0ua.tZ tCaS.i zxa.te 1L 6Zct,J -,Ledu- tCo j pX a;i. SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( ) Spring ( ) Creel:/Stream Give depth of all wells within 200 feet of system: If supplied by community water, give name of supplier: 6(i I hqy( iW li1At£2 SIGNATURE:'„_ DATE: 7 — . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INFORt{ATION BELOW TO BE FILLED OUT BY ENVIRON!V.FTAL HEALTH OFFICE;: GROUND CONDITIONS: Peneent G,touiid S.(-'-'ope r Depth to Bedtoeh_ (pen k' P.to i ee Ho ee ) Depth .to Gtoundcva,te,t Tab& SOIL PERCOLATION TEST RESULTS:. d.utu,tcs pe.,c inch in Ho,.e n l At6aLteb pen inch .to Ho.ee #2 r•i.<.icu,i C,S 1.3ell, i,EC'i t_0 HOZe 03 FINAL DISPOSAL BY: ( ) Abso.tp.ti oil TttencJi, Bed o-t PZt ( ) Evapo.ttanspiAati.on ( ) Above Gnceutd DZSpena,2 ( ) Sand Fi?_tc.t ( ) Undetg.towid Dispe,tsae ( ) Was.tccva.tct Pond ,x..l.7 Arnauii-t Pczi.d: ��� Recci.pt Ntunbc•t ------------------ - - - - -� 1321------------------- NOTE: Site Plan must be attached to'application. (Env. Health Department - Rev. 4-07-33) EAGLE COUNTY ENVIRON',MENlTAL HEALTH OFFICE _ o Name v Date Routed Location App i i cation-110 Please revie,:i the attached Individual Seiage Disposal System Permit Application and return it with this completed form to the Environmental Health Office, PLANNING: Complies with - YES Nfl RFWrFm�7n Rv Subdivision Regulations: Zoning Regulations: Recommend Approval: COMMENTS: ' BUILDING: Complies with - Building Permit Applied For: Building Permit Issued: Recommend Approval: COMMENTS: YES I NO I REVIE•IED BY DATE G ENGINEER: Complies with - YES NO Roads: Grading: Drainage: Recommend Approval: COMMENTS: ENVIRON ,'IENTAL HEALTH: Complies with - Floodplain Permit Nlecessary: I.S.D.S. Regs. Compliance: Recommmend Approval: COMMENTS: REVIEIvIED BY DATE YES NO REVIE14ED BY DATE 0795 Smith Lot 1 & 2 Nolan Ave JOB NAME Fulford JOB NO.L._ JOB LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED JOB COST SUMMARY TOTAL SELLING PRICE PERMIT # 795 OWNER: Stephen Smith LOCATION Lots 1 & 2, Blk 24, Fulford-Nolan INSTALLER: OWNER SIZE OF TANK: 1000 gallon DWELLING: Single Fam. 1 bdrm. PERC RATE: N/A ABSORPTION AREA: N/A FINALIZED: 8/4/87 BY: Sid Fox TOTAL MATERIAL Avenue JOB COST ASS PROFIT VERHEAD COSTS F SELLING PRICE NET PROFIT JOB FOLDER Product 278 NEW ENGLAND BUSINES Printed in U.S.A.