HomeMy WebLinkAboutBlk 11, Lot 7,8 - 285 Main St - 219723411006INDIVIDUAL 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. 1151
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 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: 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 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:
Incomplete Applications Will NOT Be Accepted
(Site Plan MUST be attached)
ISDS Permit # / % � 90
Building Permit #
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY
P. O. BOX 179
EAGLE, CO 81631
_.328 8755/927-3823 (Basalt)
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* EAPPLICATION FEE $150.00\1 PERCOLATION TEST FEE 0
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
PROPERTY OWNER:
MAILING ADDRESS:
APPLICANT/CONTACT PERSON: �SG1m�� PHONE:
LICENSED SYSTEMS CONTRACTOR: o o ox o F11-7 Al Al /)-YI-PHONE :
COMPANY/DBA: RCOJ 114-1"14/6 ADDRESS: ( 06v-SG
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PERMIT APPLICATION IS FOR: ) NEW INSTALLATION ( ) ALTERATIO14 ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL //SYSTEM:
Legal Description: 87-
Tax Parcel Number: �� 12,2_ ? 3 -)- //- G� 2 Lot Size: 6-d X /:2-S
Physical Addrer- . A-zln �, 3�� F/ia"--,
BUILDING TYPE: ((.:.::�ck applicable category)
Residential,:3in.gle Family Number of Bedrooms_
( ) Residential/Multi-Family* Number of Bedrooms
( } Commercial/Industrial* Type
TYPE OF WATER SUPPLY: (Check applicable category)
( ) Well (X�, Spring ( ) Surface
( ) Public Name of Supplier: Fu4- ( 0✓ltl
*These systems require design by a Registered Professional Engineer
SIGNATURE
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AMOUNT PAID:
TIME LOG: TRAVEL:
Y _ Date :
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RECEIPT #: G- DATE:
CHECK ?{ : CASHIER:
PERC: FINAL:
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COMNILINID DEVELOPMENT
PEPARTMENT
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EAGLE COUNTY, COLORADO
Dear I.S.D.S. Applicant:
500 RROAMVA�
P.O. PDX 179
EAGLE. COLORADO : 163 1
FAX (303)
Your application for an Individual Sewage Disposal System
(ISDS) Permit for
has been received.
Issuance of your permit is on hold until the following
materials or fee(s) are submitted.
Payment of $150.00 Application Fee
Payment of $125.00 Percolation Test Fee
1" Site Plan
Licensed System Contractor (See attached list)
Engineer Design
Other:
If you have any questions please call, 328-8755. When
calling or submitting information please reference your ISDS
application # //
Please submit information to:
Eagle County
Environmental Health Division
P.O. Box 179
500 Broadway
Eagle, CO 81631
ISDSHOLD.LET
ISDSDSK BH392
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