HomeMy WebLinkAboutBlk 2, Lot 3,4 - 219724307003INDIVIDUAL 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 O 46-
Please call for final inspection before covering any portion of installed system.
OWNER: John Lutke PHONE: 616-895-4493
MAILING ADDRESS: 8365 -Warner, West Olive MI 49460
AGENT:
PHONE:
SYSTEM LOCATION: Lots 3 & 4 Fulford, Block 2
LICENSED INSTALLER: LICENSE NO.
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: Vault privy required due to lot size need licensed installer.
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 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: (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 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:
ISDS Permit # V
Building Permit #
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE- EAGLE COUNTY
P.O. BOX 179
EAGLE, CO 81631
3��730/927-3823(Basalt)
PERMIT APPLICATION FEE V $150.0 PERCOLATION TEST FEE $125.00
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PROPERTY OWNER:
MAILING ADDRESS
APPLICANT/CONTA
LICENSED SYSTEMS CONTRACTOR:
ADDRESS:
PHONE:
PERMIT APPLICATION IS FOR: NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIV L SEWAGE �j SPOSAL SYSTEM*
Legal Description:
,b��C���G�-Qj
Parcel Number: Lot size:
Physical Address:
BUILDING TYPE: - - (Check applicable category)
( Residential / Single Family Number of Bedrooms
( ) Residential ./ Multi -Family* Number of Bedrooms
( ) Commercial / Industrial* Type
HOT TUB Yes ( ). No
WATER CONSERVATION PLAN: Yes ( ) No ( )
TYPE OF WATER SUPPLY: Well( •Spring ( ) surface )
Public Name of Supplier:
Give depth of all wells within OO 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: "EP,6GLE COUNTY TREASURER"
r
SIGNATI7RE : DATE
AMOUNT PAID: 1,� RECEIPT# DATE:
CHECK # CASHIER:
TIME LOG
Travel Perc Final -
COMMUNITY DEVELOPMENT
DEPARTMENT
(303) 328.8730
EAGLE COUNTY, COLORADO
May 3, 1991
John Lutke
8365 Warner
West Olive, MI 49460
725 CHAMBERS AVE.
P.O. BOX 179
EAGLE, COLORADO 81631
FAX (303) 328.7207
RE: Issuance of Individual Sewage Disposal System Permit No. 1046
Enclosed is your ISDS Permit No. 1046. The enclosed copy of the
permit must be posted at the installation site. You must call
our office for final inspection before covering any portion of
the installed system; the deadline for final inspections is
December 1.
If you have any questions, please feel free to contact us at the
following numbers for your calling area: Basalt/El Jebel
927-3823 ext. 730; Eagle Valley 328-8730.
Sincerely,
Roger Hosea
Asst. Environmental Health Officer
community Development
cc: ISDS file.
encl.
RH/alm
DESIGN STANDARDS
VAULTS
A vault shall have a minimum 1,000 gallon effective capacity and
may be permitted under limited use occupancy for water carriage sewage
systems on property which cannot accommodate a sewage treatment system.
A signal device shall be installed to indicate when pumping is necessary.
Vaults shall meet the .same installation and construction standards as
apply to septic tanks except that no effluent outlet shall be provided.
VAULT PRIVY
A vault privy shall be built to include:
1) Fly -tight construction;
2) A superstructure affording complete privacy;
3) An earth mound around the top of the vault and
below floor level which slopes downward away from
the superstructure base;
4) A floor and riser of concrete or other impervious
material; and
5) Seats and covers of easily cleanable, impervious
material, hinged, self -closing and fly -proof.
All venting shall be fly -proofed with No. 16 or tighter mesh
screening. Effective capacity of the vault shall be no less than
400 gallons.
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1046-91 TxPrcl#2197-243-07-003
JOB NAME _ Lots 3 & 4, Block 2, Fulford
John Lutke
JOB NO.
JOB LOCATION
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DATE STARTED
DATE COMPLETED
DATE BILLED
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