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HomeMy WebLinkAbout291 Mountain View Rd - 239122402001 - 1044-91ISINDIVIDUAL 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. 1 044 Please call for final inspection before covering any portion of installed system. OWNER: Royal & Lezlie Laybourn PHONE: 963-3422 MAILING ADDRESS:-0248 Surrey St., Carbondale, CO AGENT: PHONE: SYSTEM LOCATION: Lot 15, Oak Ridge I, Aspen Mtn. View LICENSED INSTALLERWelch Trucking & Excavating LICENSE NO. 36-91 DESIGN ENGINEER OF SYSTEM, INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING: GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT. DISPERSAL AREA REQUIREMENTS: SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM. SPECIAL REQUIREMENTS: ENVIRONMENTAL HEALTH OFFICER: DATE: 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 1/1, 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: SQUARE FEET. INSTALLED SEPTIC TANK: GALLONS DEGREES FEET SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: PROPER MATERIALS ANDASSEMBLY YES NO COMPLIANCE WITH COUNTYISTATE 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: ISDS Permit # /a 7 Building Permit # L�,CGS APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE- EAGLE COUNTY P.O. BOX 179 EAGLE, CO 81631 328-8730/927-3823(Basalt) PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00 PROPERTY OWNER: Royal & Lezlie Laybourn MAILING ADDRESS: 0248 Surrey St. Carbondale PHONE: 963-3422 APPLICANT/CONTACT PERSON: Royal Laybourn PHONE: 927-8061 LICENSED SYSTEMS CONTRACTOR: To be arranged/possible owner builder ADDRESS: lithe_ l GA PHONE: ********************************************************************** PERMIT APPLICATION IS FOR: (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Legal Description: Lot 15 Oak Ridge I Aspen Mtn. View Parcel Number: Lot Lot size: acres Physical Address: NIA BUILDING TYPE: - - (Check applicable category) (X) Residential / Single Family Number of Bedrooms 3 ( ) Residential-/ Multi -Family* Number of Bedrooms ( ) Commercial / Industrial* Type HOT TUB Yes WATER CONSERVATION PLAN: Yes (X) No ( ) TYPE OF WATER SUPPLY: Well( ) Spring ( ) Surface { ) Public (X) Name of Supplierl�spen Mtn View Sys. Give depth of all wells within 200 feet of system: *These systems require design by a Registered Professional Engineer NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER" SIGNATURE: DATE: *************************************************************************** AMOUNT PAID: TIME LOG Travel Perc Final RECEIPT# DATE: CHECK # CASHIER: EAGLE COUNTY ENVIRONMENTAL HEALTH P.O. BOX 179 EAGLE, CO 81631 328-8730 or 927-3823 P ase Check Appropriate Blank Systems Contractor New Systems Contractor Renewal_ Systems Cleaner New Systems Cleaner Renewal - APPLICATION TO CONDUCT BUSINESS AS AN INDIVIDUAL SEWAGE DISPOSAL -SYSTEMS CONTRACTOR OR CLEANER To obtain Environmental Health Department approval, please answer all items fully and attach proper remittance. An examination to demonstrate aduquate knowledge of the applicable Regulations will be required. Make remittance payable to: EAGLE COUNTY TREASURER and send with application to: Enbironmental Health Department, P.O. Box 179, Eagle, CO 81631. 1. Indicate type of ownership: Individual Corporation 2. License to be issued in name(s) 3. Trade Name: JELL4 -- UG(4-1 Copartnership or Company Other (specify) wwI" of: Uy Vv E. (full name(s) of ownership) 4. Business Location: C)OS- C P-P50 ID Ye- CO Phone: 5. Mailing Address: Q(n, B% 4D©S O.A��'ON} -lam 6. Disposal site (Cleaners only) 7. Name and address of person taking licensing examination: 8. License fees: Systems Contractor New $25.00 Systems Cleaner New $25.00 Systems Contractor Renew $10.00 Systems Cleaner Renew $10.00 I do hereby certify that I will comply with all requirements of the Eagle County Individual Sewage Disposal Regulations and that I will comply with all orders given me by authorized inspectors of the Eagle County Environmental Health Office. I do hereby agree that in the event the Individual Sewage Disopsal Regulations are not complied with, I and/or my employees will discontinue installation/cleaning of sewage disopsal syptems and forfeit my license at the discretion of the Eagle County Board of Health. (Signature) /(Date) License #:= Date Issued: By: 40 Exam Score: Receipt # : LTD WINDOW&DOOR FAX 1-303-92?-9179 PAGE 01 WINDOW & D)00fi, INC. RECEIVE® L.T.P. WINDOW & DOOR, INC. Ruyml Layboarn A � � 6 2 1991 402 Park Avanuw guilt P- EPRE COUNTY BASALT, COLORADO 81621 d (849) 827.8061 CtiYYilelhJ�d $ " EL0`- i% ENT VAX TRANSKITTAk ATTENTION . • FAX NUMBER:! - FIRM NAME: 4 6aAv # OF PAGES a- FROM.- L.T.D. VINDOW & DOOR, INC SPECIAL MESSAGE _ /� �y����� �1�•/ /,�j�� ��a�-� 11� NQ f d. FU ` i�Y � �l._ r/�i(//r �'�►'.�s+t rf V..w � .d,� � f 6L_� � -�' *ehaf*0**pLFA5E NOTE OUR FAX NUMBER*4"p- " 3o3-Sze-9179 �,✓ t� u. 3 .o�rws . tuca u,ee �f� oj�� � ,c.� �✓e �'..si u, aG4o�o e�,� � O�a-,a�a d _g.5. P. 0. a 1-7 9 Ecle, COty V-C� OLn Sib 3 l C� ?P ira` j# a e tea, Ldure- use . To Rock Q }�1es 1 +*2- = 1-7 3 11 fA�A-hfwk Dc"); �11,E. GENERAL NOTES 1 ALL CONSTRUCTION SHALL BE IN ACCOI:DANCE WITH THE EAGLE COUNTY REGULATIONS OF INDIVIDUAL SEWAGE DISPOSAL SYSTEMS, EVEN THOUGI•I ALL SUCH REQUIRE14ENTS ARE NOT SPECIFICALLY NOTED ON THE DRAWINGS. THE CONTRACTOR SMALL BE RESPONSIBLE FOR SUCH SPECIFIC DETAILS AS ARC REFERRED TO IN THE ABOVE MENTIONED REGULATIONS. 2. SEC ACCOMPANYING CALCULATION SHEETS FOR ADDITIONAL INFORMATION. 3. CLEANOUTS ARE REQUIRED AT ALL BENDS AND AT LEAST EVERY 100 FEET ALONG THE HOUSE SEWER. 4. THE CON`.CRACTOR SHALL BE RESPONSIBLE COMPONENTS OF THIS SYSTEM WATER TIGHT FOR INSTALLING ALL TO PREVENT INFILTRATION; AND FOR AN INSTALLATION WITH SUI.FIC]:ENT COVER AND/OR INSULATION TO 'PRCVENT E.�REC%:LNG. 5. TOPSOIL COVER MAY BE VARIED (WITH .l FOOT MINIMUM) TO ALLOW LANDSCAPING. 6. INSTALL RISERS AS IVI';CESSARY TO BRING AIL ACCESS POIN`L'S TO WITHIN 1/2 FOOT OF [FINAL GRADE. 7. LOCATIONS OF ALL CO[',lI'ONE[•TS MAY BE V!•.lt:IED AS NECESSARY AS LONG AS ALL MINIMUb1 DISTANCES AND '.['FIGS[; IRLQUII2ED, -U-0, C-P, Dk117107A( '5�s� �Acv,j ?".CA 4:1 L4 11—1 /In 0 0 6-A to n 0 0 qOl8 30 19 q I De sa, ?\� C-C.-I C-u ear ,ac,%Cct (:n{ems 7�5� �les I A\fa,ra� 'Fia-o L ? -Arm Per )1150 Glq1 C. cl� rep. 1,— - IV—t V2-0 - 4S1 A, -� ,Coo 7+ -780 I , /"d � Fv CA e-:4 LL,e ,j 7o (-,A 6 QT S i-ovr- xZ . .......... 9 is '07.1 Wed c� t 5 s,,rp o5e- ?D Le b-)r );� s-1 )f ) / �& g Zz SD 1 plr�tt � � i � �rj„y- M (P va (N- 'A ­0 C- P OD 10 1044-91 TxPrcl#2391-224-02-001 JOB NAME _ Lot 15, Oak Ridge I, Aspen Mtn View 0991 PAfh,V;?oPQ, JOB NO. JOB LOCATION BILL TO DATE STARTED FAM N v to QA z Z a W R C IL HO Z W rnco- a O W r wV G x�;^ m°U00 Ja: O °' o a � c� W� aZ W Q O I — DATE COMPLETED I DATE BILLED CD r J H O c O a � El t co �J � � U C 7 O (� i U Q �k Y U N t U )B COST SUMMARY N co cl L SELLING PRICE 'ERIAL .ABOR N U NN CD0 x V N �J c � E 0 LL C Z c6N In L. 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