HomeMy WebLinkAbout270 Alcazar Dr - 210701404033 - 1070-91ISINDIVIDUAL 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. 1070 Please call for final inspection before covering any portion of installed system. OWNER: PHONE: MAILING ADDRESS: AGENT: PHONE: SYSTEM LOCATION: 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: 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 Building Permit # 400,922 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:1-" hw,5t&, 4,t+ PA44kt5 MAILING ADDRESS: P•© • f j�[ � , E=AUGURS PHONE: JZ& `3-S06 APPLICANT/CONTACT PERSON: l` 4CX1ti PHONE: qZ6 - 3S LICENSED SYSTEMS CONTRACTOR: E- OAUaf►tL9 96T t9� EP ADDRESS: PHONE PERMIT APPLICATION IS FOR: ()6 NEW INSTALLATION ( ) ALTERATION ( ) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOS SYSTE :- Legal Description: oe� A�- Parcel Number:AL p 030 Z Ut siz Physical Address: P"r 1 1-, ,._.r,, BUILDING TYPE: - -- (Check ( Residential / ( } Residential / ( } Commercial / HOT TUB WATER CONSERVATION PLAN: TYPE OF WATER SUPPLY: Give depth of all applicable category) Q Single Family Number,of Bedrooms Multi -Family* Number of Bedrooms Industrial* Type Yes ( j. No Yes ( j No ( ) Well( ) -Spring ( ) surface (•) Public (><) Name of Supplier: 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 AMOUNT PAID: �� Ou RECEIPT# CHECK # TIME LOG Travel Perc Final DATE: DATE 7 CASHIER:/,� A a /070 /,5 i 4T i,,, C�nke�bre�,� �esroi , � �s NdT mao+e apt/«.�aH ' kn t� ,t { Ilbe �v� U-3-500 ." t�. A: 'Sr t: 6 vF� A' _r if. YS, vF Y1 t j &'alvt t`ller_ -, 3� &,- i'tc-h ENVIRONMENTAL HEALTH ROUTING # 't ? L7 APPROVED* WATER py'� SEWAGE DISPOSAL I? v4-r 2 DISAPPROVED ISDS APPLICATION # ISDS PERMIT # The following are required to be submitted prior to a building permit being issued. Applicant contacted on 4•3 COMMENTS: �"a l � tv -fir(/` s /'1 at _ C(�7^�l <` lie, NG� kA r'-l / rr" f vee - 6�o Z �"Q 7'Zt r`� S Y' y`' -►-�, �'e .0 ✓`r� Signed °T Date ,O ' 7� *This approval applies to the building permit issuance only. The applicant must be aware that where an ISDS permit is required, the final inspection on the septic system must be completed prior to occupancy. In addition, the applicant must understand that certain site characteristics may require the ISDS be designed by a Registered Professional Engineer. t-g3-5 qRlecell G 300 ' ta m //)mse- -6 max, 4-t� /�er �l 44,1,t— 4�aay 1070-91 TxPrcl#2107-121-03-002 C JOB NAME _ Lot 35, Tract C � I� �C��(V��(r�� � *,t 2 Kensington Land Investment +� ` J.06 JOB FOLDER Prpduct.27a Q® NEW ENGLAND BUSINESS SERVICE, INC.. GROTON, MA 01471 Printed in U.S.A. JOB FOLDER