HomeMy WebLinkAboutBlk 17, Lot 6A - 219723423002INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT } ` Eagle County Department of Environmental Health PERMIT N2 0853 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: Edward and Lorraine Grange Telephone:- 945-6627 Address:_ 1310 Blake Avenue Glenwood Springs, CO 81601 System Location:_ 0022 Ennan Avenue Ful ford Licensed Installer: Owner License Number: - Conditional installation approval is hereby granted for the following: Minimum requirements: 160 HUCoj �� q _Lw Gallon Tank or Aerated Treatment unit Absorption area of dispersal area computed as follows: Percolation rate: Inch in Minutes I n Absorption area per bedroom Sq. Ft. y� Number of Bedrooms X Sq. Ft. minimum requirement per bedroom - equals Total Sq. Ft. minimum requirement Special Requirements: UQUI eA-ST /UUCP Date: July 6, 1988 Environmental Health Officer: Sid Fox 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 DISPERSAL A E SQ. FT. INSTALLED SEPTIC TANK:J �ALC�fi$; 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: N� YES NO PROPER MATERIALS AND ASSEMBLY: YES Lf'NO COMPLIANCE WITH PERMIT REQUIREMENTS: YES_J,�_NO COMPLIANCE NYVH COUNTY / STATE REGULATION REQUIREMENTS: YES �/�O COMMENTS: r , C -�Uac s (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: Edward & Lorraine Grange Name of Owner: Same Amount Paid: $150.00 Receipt Number: 32 Date:_6-28-28 Cashier:_ ,1 _ Rrnph� Check # 6445 White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner AP?L1CAT'r!' FOR � .�.. ir•r,�..AL SC..�AGr)IC-. r"C AL .0 L T'. r. ^•.� EN-VIRO: MENTAL HEALTii OFF ICE - EAGLE COUNT:' P.O. 3u:•:n50 f�- Eagle, Colorado 81631 No. PERMIT AP?LICATTON FEE: S150.00 328-7311 � PERCOLITIO`d TEST FEE- $129,00 NAME OF OI.r.% ER : JL0 i0191e D 40.-R,91.UE �', �'r, RA1GE ADDRESS: l3iQ SLAKE" RVe-. - 43 -AJ4 CQQ �SQ IAJ&Se OnL,, PHONE: HoMs- 9V6-66;Z7 NA.'�fE OF APPLICtL-11T (if different from owner) : SANE- offlcE- 174$- S-"/ ADDRESS: i PHONE: DESIGN ENGINEER OF SYSTDI- (if applicable) : 41� 01.LWe-P' ADDRESS: PHO"E: Prn�v�v t:i .ai V�,J1L:.L I IIIS A11- TION OF SYSTEM: ' ` Licensed Installer (see attached list): YES- NO ADDRESS: • PHONE: PER`fIT APPLICATION IS FOR: ( X) New Installation ( ) alteration ( ) Repair LOCATION OF PROPOSED INDIVIDUAL SET -'AGE DISPOSAL SYSTE-4: Street/Rural Address: 60;2Z CAIMF1&I 4Q9-- 7&&jP.95fTr-r [ac�,_Foje > Lot Size: 126' X 126' ' Legal Description: j2LQr_C 17,-o7--6,9 &&EMIRS! ,j Lars -/O BUILDING OR SERVICE TYPE (check aoolicable cateacrv_) : (X) Residential - Single Family ;Lo'XB©I LoG, ( ) Residential - Quadolex ( ) Residential - Duplex G'q'Bf�1 ( ) Co.•-::ercial (state usage) ( ) Residential - Tr:-jlex NUMBER OF PERSONS: 2 P;I::I= OF BEDROMIS : WASTE TYPES (check aoolicable catezories): ( ) Co«:.mercial or Institutional (X) Dwelling ( ) Non -Domestic Wastes ( ) Transient Use ( ) Garbage Disposal ( ) Dish,asher ( ) Automatic Washer ( ) Spa Tub ( ) Other "TYPE OF I?9DIVIDU.AL SET -.?AGE DISPOSAL SYSTE:•I PROPOSED: ( ) Septic Tank ( ) Composting Toilet ( ) Incineration Toilet 00 Vault Privy ( ) Greywater ( ) Chemical Toilet ( ) Pit Privy ( ) Aeration Plant �' ( ) O( ) Recycling, Potable Use Other ( ) Recycling, Other Use WILL EFFLUENT BE DISCH_�RGED DIRECTL`i INTO T-!ATERS OF THE STATE: YES ( ) i:O l X 1 IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PE_ DAY: YES (X) \0 ( ) WASTEi•?ATER FLOW REDUCTION PLAN: YES ( ) NO ( ) (1 S Yes, see attached wa s-t ex Ltet S.tc•cv .'Leducti.o;i me;dtods ) NOTE: The Env.i,to;une;Lta-t Heae-t;t OSa.icc,L mau 'seduce .t,'te-'Leoui,ted ab.so,tptio;t atea upon apptovat oS an adequate cvas i rc�te•t S.tccv .teductcou p.ta;2. SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( ) Spr;ng (X) Creek/Stream Give depth of all wells within 200 feet of system: NOME' If supplied by community water, give name of supplier: - n m SIGNATUREC�u'x A_ Wlan e, ��_ DATE: UZE 2'% /988S ---�-6---- - - - INFORfATION BELOW TO BE FILLED OUT BY ENVIR00ENTAL HEALTH OFFICEN: GROUND CONDITIONS: Percent Ground S.tope r Dept.t .to Bedtoeh (pen &' Puo'ite Hole) Depth to Gnounckc tc t Tab.2e SOIL PERCOLATION TEST RESULTS:. M-c.;nLtcs pe•Y .c.)te;t J;i Hone- , i �\ Mi.ntLtes pen inch .to Ho.te #2 \ Z�";u.L,t C S pe ._;tc1t do HOZe 43 FINAL DISPOSAL BY: ( ) Abs o.tp tc o;l TneneA, Bed o,t Pit ( ) Evapo'ta;ts PiAa tc on ( ) Above Gnccuid D.LspetsaL' ( ) Sand F.i.Un ( ) UndnLg.tound Dispe•tsat ( ) (Uast.�ratct Pond 441. CkAi (PLa q AinvWlt Paid: J ' �` • Receipt Ncunbe.t SQ - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - NOTE: Site Plan must be attached to•application. (Env. Health Department - Rev. 4-07-83) <s. T L.I L fmm W/USITE- Couar of �AGt.E" S it R83LO -SEc, 23 E-owAeo L. 4- !-_oP-,-ICI oe- C. GQF)Ny-- t,(L�Fd��E'ST' f1 l�1IT 11 rl��.• EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE Edward L. � Lorraine 6roNe. Name (o -30- 88 31b5 Date Routed 0022 E n n ar\ AN e. d Application No. Location Please review the attached Individual Sewage Disposal System Permit Application and return it with this completed form the the Environmental Health Office. PLANNING: Complies with - YES NO REVIEWED BY DATE Subdivision Regulations: Zoning Regulations: Recommend Approval:. -so - 8 COMMENTS: BUILDING: Complies with 1- Building Permit Applied For: Building Permit Issued: Recommend Approval: COMMENTS: ENGINEER: Complies with - Roads: Grading: Drainage: Recommend Approval: COMMENTS: ENVIRONMENTAL HEALTH: Complies with - Floodplain Permit Necessary: I.S.D.S. Regs..Compliance: Recommend Approval: COMMENTS: P P:—'0- -; :z' g 7 YES NO REVIEWED BY nATF YES NO REVIEWED BY DATE YES NO REVIEWED BY DATE 953 Grange Lot &A Bloch 1? JOB NAME, 0022 Ennan Ave JOB NO. JOB 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 278 Qp NEW ENGLAND BUSINESS SERVICE, INC.. GROTON. MA 01471 JOB FOLDER Printed in .U.U. �e