HomeMy WebLinkAbout1391 Lake Creek Rd - 210507401031INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
P.O. Box 179 - 550 Broadway • Eagle, Colorado 81631
Telephone: 328-7311 or 949-5257 or 927-3823
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 957
Please call for final inspection before covering any portion of installed system.
John A Baskins 926-3748
OWNER: PHONE:
MAILING ADDRESS: Box 428, Edwards, CO 81632
AGENT: PHONE:
SYSTEM LOCATION: 1355 Lake Creek Road, Lake Creek Subdivision
LICENSED INSTALLER: LICENSE NO.
DESIGN ENGINEER OF SYSTEM,
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
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GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT. i�
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM.
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SPECIAL REQUIREMENTS: to accomodate increased flows; an additional 600 sq. ft. of
absorption area must be added along with a minimum of 250 gallons of tank
capacity.
ENVIRONMENTAL HEALTH OFFICER: leu• DATE: f Q
CONDITIONS:
1. ALL INSTALLATIONS MUST COMP Y WI ALL QUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM
REGULATIONS, ADOPTED PURS ANT TO A HORITY 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 Ill, 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: (TO BE COMPLETED BY INSPECTOR):
NO SYSTEM SHALL BE DEEMED TO BE IN COMLIANCE WITH THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS UNTIL THE SYSTEM IS APPROVED'
PRIOR TO COVERING ANY PORTION OF THE SYSTEM.
INSTALLED ABSORPTION ORY�D'IISPE�RSAL AREA: SQUARE FEET.
INSTALLED SEPTIC TANK: / GALLONS DEGREES FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALSAND ASSEMBLY YES NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: YES NO
ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS COMPLETED.
COMMENTS:
ENVIRONMENTAL HEALTH OFFICER: DATE:
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
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APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number: 3284
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail
328-7311 Eagle
927-3823 Basalt
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00
a A Cl 11 /
NAME OF OWNER:
MAILING ADDRESS:
NAME OF APPLICANT (If different from owner):
ADDRESS; PHONE:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS: PHONE:
PERSON, RESPONSIBLE FOP INSTALLATION OF SYSTEM: Q UW_V�. Y- _
LICENSED INSTALLER: ( ) YES NO
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: ( ) NEW INSTALLATION ( ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM.
Physical Address: Is S 's- FQ k 1�, d
Parcel Number: Lot Size:. j cue.
Legal Description:
BUILDING OR SERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: �0 NUMBER OF BEDROOMS: lr a
WASTE TYPES Check applicable categories):
Commercial or Institutional ( ) Dwelling i-�
( ) Non -Domestic Wastes ( ) Transient Use
{) Garbage Disposal ( ) Dishwasher t1/�3y
Automatic Washer ( ) Spa Tub
( ) Other (Specify):
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank Composting Toilet ( ) Incineration Toilet
(�) Vault Privy ( ) Greywater ( ) Chemical Toilet
( } Pit Privy ( ) Aeration Plant ( ) Recycling, Portable Use
( ) Other ( ) Recycling, Other Usk
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: ( } YES ( ) NO
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: ( YES ( } NO
WATER CONSERVATION PLAN: ( YES ( ) NO
NOTE: The Environmental Health Office may reduce the required absorption area upon
approval of an adequate water conservation plan.
SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( ) Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system: Wyv-e
If plied b/ co nity ater, give name of supplier: q
SIGNATURE:�1�✓ � . � DATE: _5�—
v
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope
Depth to Bedrock (Per 8' profile hole
Death to Groundwater table S0I
SOIL PERCOLATION TEST RESULTS: ,70 Minutes per inch in Hole #1
_ 1�0 Minutes per inch in Hole #2
'rD Minutes per inch in Hole #3
FINAL DISPOSAL BY:
Absorption Trench, Bed
( ) Above Ground Dispersal
( ) Under Ground Dispersal
( } Other
or Pit ( ) Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
AMOUNT PAID: _ k� RECEIPT NUMBER
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
(Environmental Health Dept. - Rev. 4/88)
' w
M
ROUTE FORM
EAGLE C NTY ENVIROf FNTAL HEALTH OFFICE
_Name
Date .out d G Application No.
Locati o '"
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: Z
,Recommend Approval:
COMMENTS:
BUILDING: Complies with -
Building Permit Applied For:
Building Permit Issued:
Recommend Approval:
COMMENTS:
ENGINEER: Complies with -
Roads:
Grading:
Drainage:
Recommend Approval:
COMMENTS:
YES NO REVIEWED BY DATE
IES NO REVIEWED BY DATE
ENVIRONMENTAL HEALTH: Complies with -1 YES NO REVIEWED BY DATE ,
Floodplain Permit Necessary:
I.S.D.S. Regs. Compliance:
Recommend Approval:
COMMENTS:
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MEMORANDUM
Date: May 3, 1991
To: ISDS file #957
From: Raymond P. Merr,#�,. .'H.
Re: Status of ISDS/ j.t,-�#,57
vironmental Health Officer
On May 20, 1990, a final inspection was attempted to verify the
expansion of the system at 1355 Lake Creek Rd. Upon my arrival,
I discovered that many of the components of the system had
already been covered. The installer was asked to provide a copy
of receipts in order to demonstrate what had been purchased for
installation. After several requests for the information with no
response, the permit should be considered NOT FINALLY APPROVED.
However, as long as the system does not fail, a removal of buried
components should not be necessary.
957 Baskins 1355 Lake Creek 1?1�' f—�
JOB NAME Road _ JOB NO.
.1 C]R 1 (IC:�T1nN
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
TOT,
•SENDER: Complete items 1 and 2 when additional services are desired, and complete items 3
and 4.
Put your address in the "RETURN TO" Space on the reverse side. Failure to do this will prevent this
card from being returned to you. The return race lot fee will orovide you the name of the
person
delivered to and the date of deliverv. For additional fees the following services are available. Consult
Postmaster for fees and check box(es) for additional service(s) requested.
1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery Nv
T (Extra charge)T
? (Extra charge) t
3. Article Addressed to: 4. Article Number
792V 7� 5�
Type of Service:
�' K- `'�` ddd❑
t
Rye istered ❑ Insured
L�f'Certified ❑ COD
❑ Express Mail`''ww<�
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Always obtain signature of addressee
or agent and DATE DELIVERED.
5. ature — Add' see 1 8. Addressee's Address (ONLY if
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X requested and fee paid)
6. Signature — Agent
X y
7. Date Delivery
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JOB FOLDER Product 278 Q® NEW ENGLAND BUSI
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PS Form 3811, Mar. 1987 * U.S.G.P.O. 1987-178-268 DOMESTIC RETURN RECEIPT
Community Development P. ()• Box 179
