HomeMy WebLinkAbout875 Pilgrim Dr - 210724102013 - 1421-94ISINDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION
P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631
Telephone: 328-8755
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 1421
Please call for final inspection before covering any portion of installed system.
OWNER: Jan Helene c/o Hanifen Imhoff PHONE:
MAILING ADDRESS: 1125 17th St. City: Denver Slade: CO Zip; 80217
APPLICANT: Daryl L. R.A. Nelson PHONE: 949-5152
SYSTEMLOCATION: Lot 11 A BBk Subdivision TAX PARCEL NUMBER: 2107-241-02-013
LICENSED INSTALLER: John Seipel LICENSE NO: 23-94
DESIGN ENGINEER OF SYSTEM:
INSTALLATION HEREBY GRANTED FOR THE FOLLOWING:
2250 1250, + 1000 or 2 x 1250 knock baffle out of firdt tank
GALLON SEPTIC TANK
ABSORPTION AREA REQUIREMENTS:
1609
SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Rake trench bottoms if there is any smearing Of clays Install inspection
portals at the end of each trench and a cleanout between the house and the tank
Call the county with any Ruestiqns and for a final inspection.
ENVIRONMENTAL HEALTH APPROVAL: 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. 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. CHAPTER IV, SECTION 4.03.29 REQUIRES ANY, PERSON WHO CONSTRUCTS, ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED.
FINAL APPROVAL OF SYSTEM: (TO BE COMPLETED BY INSPECTOR):
NO SYSTEM SHALL BE DEEMED TO BE IN COMPLIANCE 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: 1609 SQUAREFEET. via 43 infitrator units
INSTALLED SEPTICTANK:1250+1000 GALLON 270� DEGREES 31' 10" FEETFROM east side of house
SEPTIC TANK ACCESS TO WITHIN 8" OF FINAL GRADE AND
PROPER MATERIAL AND ASSEMBLY _X YES —NO
COMPLIANCE WITH COUNTY! STATE REQUIREMENTS: X YES NO
ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS CORRECTED.
COMMENTS:
ENVIRONMENTAL HEALTH APPROVAL: DATE:T� -1
ENVIRONMENTAL HEALTH APPROVAL: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS
APPLICANT / AGENT:
OWNER:
PERMIT FEE PERCOLATION TEST FEE RECEIPT # CHECK #
Incomplete Applications Will NOT Be Accepted
(Site Plan MUST be attached)
a
ISDS Permit # 114 �—
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)
**************************************************************************
* PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $200.00
* *
* MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY.TREASURER"
**************************************************************************
PROPERTY OWNER: JAh) A 1LrV 70 mfvlFrf INNOF
MAILING ADDRESS: S L��NUr;tZ _ Cu �na1 PHONE:
APPLICANT/CONTACT PERSON: bAam L / kA. 0EU0fu ��^ PHONE: QK9 D3- -
LICENSED SYSTEMS CONTRACTOR: JON� MPLI-L . 0� PHONE:
COMPANY /DBA: ADDRESS: 60,4wtK U1Dy AyDN Ca 1/00-0
PERMIT APPLICATION IS FOR: (,iQ NEW INSTALLATION ( ) ALTERATION () REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description: L6T �am)I/lS1YJN
Tax Parcel Number: �)C7 �a d�3 Lot Size: 11,2, ACRL�S
Physical Address:
BUILDING TYPE: (Check applicable category)
(► Residential/Single Family
( ) Residential/Multi-Family*
( ) Commercial/Industrial*
TYPE OF WATER SUPPLY: (Check applicable category)
(A) Well ( ) Spring ( ) Surface
( ) Public Name of Supplier:
Number
Number
Type _
of Bedrooms
of Bedrooms
*These systems require design by a Registered Professional Engineer.
SIGNATURE: Date:
***************************************************************************
AMOUNT PAID: 3 S-6. oc) RECEIPT # : % 3--a-2- DATE:
CHECK CASHIER: =-
dab R�L�
Community Development Department
(970)328-8730
Fax:(970) 328-7185
TDD: (970) 328-8797
EAGLE COUNTY, COLORADO
August 31, 1995
Jan Helene c/o Hanifen Imhoff
1125 17th Street
Denver, CO 80217
Eagle County Building
P.O. Box 179
500 Broadway
Eagle, Colorado 81631-0179
RE: Final of ISDS Permit No. 1421-94 Parcel #2107-241-02-013.
Property located at: 875 Pilgrim Downs, Lot#11A, BBK
Subdivision, Helene Residence.
Dear Ms. Helene,
This letter is to inform you that the above referenced ISDS
Permit has been inspected and finalized. Enclosed is a copy to
retain for your records. This permit does not indicate
compliance with any other Eagle County requirements. Also
enclosed is a brochure regarding the care of .your septic system.
Be aware that later changes to your building may require
appropriate alterations of your septic system.
If you have any questions regarding this permit, please contact
the Eagle County Environmental Health Division at 328-8755.
Sincerely,
Janet Kohl
Environmental Health Department
ENCL: Information Brochure
Final ISDS Permit
enclosures
COMMUNITY DEVELOPMENT
DEPARTMENT
(303)328-8730
EAGLE COUNTY, COLORADO
December 2, 1994
Jan Helene
c/o hanifen Imhoff
1125 17th St
Denver, CO 80217
Dear Applicant,
500 BROADWAY
P.O. BOX 179
EAGLE, COLORADO 81631
FAX: (303) 328-7185
The Environmental Health Division would like to notify you to
make a formal request to extend your Individual Sewage Disposal
System(ISDS) Permit #1421-94 into the 1995 construction year.
The Environmental Health Division discontinued percolation tests
on.November 15, 1994 and final inspections on December 2, 1994
due to climatic conditions.
ISDS permits are active for 120 days after the date of issue if
no Building Permit has been issued for the same property. If a
Building Permit has been issued for the same property the ISDS
will expire at the same time as the building permit.
If you still plan to apply for a Building Permit this year or in
the early months of 1995 you will need to have a percolation test
conducted before your Building Permit will be released. You will
have to contact a Registered Professional Engineering(RPE) firm
to conduct your percolation test.
If you have had your permit issued and have not had your final
inspection completed, but plan on constructing the system in the
next few weeks, please give our office a call and we will
evaluate your permit on a case by case situation.
Please give the Environmental Health office a call at 328-8755,
if you have any questions regarding your permit extension
process.
cc: ISDS Permit #1421-94 File
ISDS Final Inspection
Co pleteness Form
Tank is 2, d gal . Tank Material OnA 6?oil)
Tank is located I6 ft. .and ��lu degrees from
(permanent landmark)
A.
Tank is located ft. and'�egrees from
(permanent landmark)
Tank set level. Tank lids within 8" of finished grade.
Size of field ft,
TdtwffAology
Cleanout is installed in be ik and house(+ 1/100ft).
�There is a "T".that goes,cabwn ]4 inches in the inlet.and
outlet of the tank.
Inlet and outlet is sealed iwitl tar tape; rubber gasket
etc.
✓ Tank hastc m ar mkt he larger .,..compartment
closest to` : ire, hbus
-,-" Measure distance and relative direction to field.
L/ Depth of field'2( - A41 ft.
Soil interface raked.
Inspection;portals at the end of each trench.
}
Proper distance to setbacks.
Other
Inspection meets requirements.
Copy form to installer's fileif recommendations for
.improvement were suggested.
ACTION TAKEN:
Setbacks
Well . Potable House
Water Lines
Field
100
25
20
Tank
50
10
5
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EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER:
LEGAL DESCRIPTION: ,cA ,`-is 2'V �r
MAILING ADDRESS:
TYPE OF DWELLING: NUMBER OF BEDROOMS
TEST HOLES PRE-SOAKED: YES NO
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LESS OVERHEAD COSTS
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NET PROFIT
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