HomeMy WebLinkAbout976 Pilgrim Dr - 210519202009 - IS-1032-91INDIVIDUAL 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. 1032
Please call for final inspection before covering any portion of installed system.
OWNER: George Vanderlinden PHONE: 476-8154
MAILING ADDRESS: 710 W. Lionshead Cr., Vail, CO 81657
AGENT: I I4 PHONE:
SYSTEM LOCATION: 0976 Pilgrim Dr. Lot #20 Filing #7/ Pilgrim Downs
LICENSED INSTALLER: J.A. Baskins LICENSE NO. 14-91
DESIGN ENGINEER OF SYSTEM:
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
1250 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED 570 SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Keep installation relatively shallow
(200' of 10" SB2) (19 infiltrator galleries)
ENVIRONMENTAL HEALTH OFFIC /'�✓ DATE:
CONDITIONS:
1. ALL INSTALLET NS MUST COMPLY WITH ALL RE IR S OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM
REGULATIONS, ADOPTED PURSUANT TO AUTHOR/ 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 OR DISPERSAL AREA: 7 a SQUARE FEET.
INSTALLED SEPTIC TANK: ..% O GALLONS Ly0 DEGREES FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALS ANDASSEMBLY — 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: n�� DATE: R
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF N C SARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number: ��_
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail 328-7311 Eagle 927-3823 Basalt
I PERMIT APPLICATION FEE $150.00 nr6'Cni.nT!"^! TEST FEE tl"0�?7
NAME OF OWNER: �—,--ec L L,;.r�e-✓
MAILING ADDRESS: Z/0 PHONE:
NAME OF APPLICANT (If different from owner):
ADDRESS: PHONE:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS: PHONE:
PERSON RESPONSIBLE FOR INSTAL������PION OF SYSTEM: yat �,� �f«�,y�
LICENSED INSTALLER: (J�/) YES ( ) NO
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: (NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address: og,-6- /���;_,_
Parcel Number: Lot Size:
Legal Description: z x
BUILDING OR SERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: 2 NUMBER OF BEDROOMS: y
WASTE TYPES Check applicable categories):
j Commercial or institutional (X Dwelling
( ) Non -Domestic Wastes ( ) Transient Use
( ) Garbage Disposal ( ) Dishwasher
( ) Automatic Washer ( ) Spa Tub
( ) Other (Specify):
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank Composting Toilet ( ) Incineration Toilet
( ) Vault Privy ( ) Greywater ( ) Chemical Toilet
( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Portable Use
( ) Other ( ) Recycling, Other Us
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: ( ) YES ( ) NO
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: ( t j YES ( j NO
WATER CONSERVATION PLAN: ( ) YES ( 1 NO
NOTE: The Environmental Health Office may reduce the required absorption area Upon
approval of an adequate water onservation plan.
SOURCE AND TYPE OF WATER SUPPLY: Well ( ) Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system:
If supplied by community water, give name of supplier: �!
SIGNATURE: ���� DATE: 4e!!�4/f/
POEM
�:.. :. .": �7 ^Fells nllx ya.r isS'T [l! 6ir i?$ T!.1 fW�:%��.
!NFORrlA i01� ii LLO'N1 IJ BE FILLED OUT Bf I-11 11,v l�i'i_ i!l_ i.L iti lr: v:: "-
GROUND CONDITIONS: Percent ground slope
SOIL PERCOLATION
Depth to Bedrock (Per 8° profile hole) --------
Depth to Groundwater table
TEST RESULTS: Minutes per inch in Hole #1.
Minutes per inch in Hole #2
Minutes per inch 'hi Hole #3
FINAL DISPOSAL BY:
Absorption Trench, Bed
( ) Above Ground Dispersal
( ) Under Ground Dispersal
( ) Other �
or Pit
AMOUNT PAID: v� %
( ) Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
�31 DATE:
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
(Environmental Health Dept. - Rev. 4/88)
Application ; p 3a
PERCOLATION TEST 1610
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
votOWNER: Po
LEGAL DESCRIPTION: L,51 do rl D-
f /
v
MAILING ADDRESS: 7 /0 46#) L �a�Sh�t C'fr._ ��� ` ?/6S7
TYPE OF DWELLING: S,ti ��z „� NUMBER OF BEDROOMS
TEST HOLES PRE-SOAKED: YES NO
11�=�+ rrriinx Lar"1n 1NC
ME6 OF FALL RATE /Ip/
SOIL PROFILE
T12
3
1
2
3
1
2
3
1
-
2
6
0'
1
3 `'
--
--
11 sNf yl
30
//_3
3,3R
a. S
13
3'
ya
l q
// 40
aS
2-
asJy
1 a
'v
3,3
3_3
41
Ys
/r 'sr6
?
3 -:
6a
y
!
l a
I a
3.3
3.3
5'
a
7
S
S�
i
6
"00
k(O
=8'
3
34,
'v
3 Y
Time to drop last inch
PERC RATE: !� 2 /� P�- as MINIMUM SEPTIC TANK SIZE:
MINIMUM LEACH FIELD �-�SIZF 3 70 ,(' �� �� a� �� ��Gh' ' `/ • 7S
�-
r R
COMMENTS: /�+
PERC
Enviro
BY:
r DATE:
Officer
l
rev. 6/90ks
�ll���� A he�C^ 61 7A
fS�
JOB NAME
1032-91 TxPrcl#W57- IgZ'oa-oo,*
-0976 Pilgrim Dr., Lot 20
Filing 7, Pilgrim Downs
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 �p NEW ENGIAND BUSINESS SERVICE, INC., GROTON, MA 01471
.JOB FODDER
Printed in U.S.A.
16b6 t� /O IaL Vag der I (Mol
bq7(� P, I r V)3 a�
i6b6 it lo3q- yaooe✓il,�-An
7 5
I? I
