HomeMy WebLinkAbout7800 Frying Pan Rd - 246908202009INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Eagle County Department of Environmental Health PERMIT
P.O. Box 850 - 550 Broadway
Eagle, Colorado 81631
Telephone: 328-7311 or 949-5257 or 927-3823
YELLOW COPY OF PERMIT MUST PLEASE CALL FOR FINAL INSPECTION BEFORE
BE POSTED AT INSTALLATION SITE COVERING ANY PORTION OF INSTALLED SYSTEM
Owner:
Address:
System Location:
Telephone:
Licensed Installer: License Number:
Conditional installation approval is hereby granted for the following:
Minimum requirements: Gallon Septic Tank or Aerated Treatment unit
Absorption area of dispersal area computed as follows:
Percolation rate: Inch in Minutes
Absorption area per bedroom Sq. Ft.
Number of Bedrooms X Sq. Ft. minimum requirement per bedroom -
equals Total Sq. Ft. minimum requirement
Special Requirements: Ta k - ,consin
Date: Environmental Health Officer:gi (t r(,X
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:
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: SQ. FT.
INSTALLED SEPTIC TANK: GALLONS; DEGREES; FEET
DESIGN ENGINEER OF SYSTEM:
INSTALLER OF SYSTEM:
PHONE:
SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR
AERATED ACCESS PORTS ABOVE GRADE: YES NO
PROPER MATERIALS AND ASSEMBLY: YES NO
COMPLIANCE WITH PERMIT REQUIREMENTS: YES NO
COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES NO
COMMENTS:
(Any item checked NO requires correction before final approval of system is made. Arrange a re -inspection when
work is completed.)
DATE (Final Approval) ENVIRONMENTAL HEALTH OFFICER:
DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER:
RETAIN WITH RECEIPT RECORDS PERMIT
Name of Applicant:
Amount Paid: Receipt Number:
Name of Owner:
Date
Cashier:
White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner
PaT ICA7,71, FORr.. AL :;r':.1 Tic,^c:�I. ter.^•.T—
ENVIRO."'ENTAL i:EAL111 OFF:CC - EAGLE
P.O. 30:: 350
I / Eagle, Color;ido 81631 No.
P=-!IT `�PM.ICATION FEE: 5150,.00 328-731 i PFnC0L1TION TEST 50. n0
NAME OF OId`ER: Lt�� ' 74S � �N. Cl-i � C,j �ANL �`,I
ADDRESS: _?FZ/0 /�t� ��tJ PIIO::E:Z ' � �` 0.3
NAME OF APPLICANT (if different from owner) :
ADDRESS: 37�� IIS tzJ � x�D � PHONE: G%�S�-�0�
DESIG;1 ENGINEER OF /SYSTDI (i�fj applicable) : �Y\N �Ze -2-01,7C( f7 l�
ADDRESS: � l Z �r�'�N� mot' SyiIC_ , I Z C�'o wcte(n-- PHO::E: �rS = /Joe/
IINS ALI--MON OF SYSTEM:
` Licensed Installer (see attached list): YES NO
ADDRESS:
- PHONE:
PER_`fIT APPLICATION IS FOR: New Installation Alteration ( ) Repair
LOCATION OF PROPOSED I`:DIVIDUAL SETJAGE DISPOSAL SYSTE_•i:
Street/Rural Address: 8 f- r�IC,Plf1
Lot Size: / , 3/
Legal Description:
BUILDING OR SERVICE TYPE (check apolicable cate^_orv)
(P<) Residential - Single Family
( ) Residential - Duplex
( ) Residential - Tr_Dle:c
NUMBER OF PERSONS: 2 irtDRAcS
WASTE TYPES (check apolicable cate^_ories):
( ) Coy iercial or Institutional
( ) Non -Domestic Wastes
( ) Garbage Disposal
( ) Automatic Washer
( ) Other
HYPE OF I*:DIVTDUAL SET -AGE DISPOSAL SYS=-1 PROPOSED:
( Septic Tank ( ) Coc:posting Toilet
( ) Vault Privy ( ) Greywater
( ) Pit Privy ( ) Aeration Plant
( ) Other -
( ) Residential - Quadplev
( ) Co=ercial (state usage)
MMER OF BEDROOMS: %
(�) Dwelling
( ) Transient Use
( ) Dish:casher
( ) Spa Tub
( } Incineration Toilet
( ) Chemical Toilet
( ) Recycling, Potable Use
( ) Recycling, Other Use
WILL EFFLUENT BE DISCHA_TRGED DIRECTLY INTO I?ATr-RS OF THE STATE: YES
( )
,:0
IS SYST'•1 DESIGNED FOR LESS T'dAN 2,000 GALLONS PER DAY: YES
C7C)
NO ( )
WASTEi.!ATER FLO.4 REDUCTION PLAN: �£c�t�iC'£!7 �, YES
( )
NO ( )
(I 5 yes , see attached ccas.te L�2te Sec'to .-LedLLC ttc;t me dtcds )
NOTE: The BnvZ'Lo;unei7.taC" Heae-t"L 03' .ices mau teduce .the-'Leoui,t.d
ab.so,tptii.c;t
a,tea upon
appnUVQr? U0 ai2 adeGuat LL'aS•%4CatZ.•t 6'Zow ,'LaductCou p'a;?.
SOURCE AND TYPE OF G:ATER SUPPLY: (� Well ( ) Sprin-
g
(
)
Creek/Stream
Give depth of all wells within 200 feet of system:
If supplied by unity T er, give name of supplier:
SIGNATURE----
X
----------------------DATE---�
INFOR,t{ATION BELOW T BE FILLED OUT BY ENVIRO,U.'.IEb.rFAL HEALTH OFFICER:
----
-
GROUND CONDITIONS: Peneent G.tound S�.ope
Depth .to Bedto ch (pet 8' Pno S.tee Ho.2e )
Dep.dL .to GrtotL;iC' c,-L'et TabZe
SOIL PERCOLATION TEST RESULTS: A.u;tLt'cS pen-(-;Le;t .cn HoTe rl
ikt- ntLtcs pert inch .to HoEe #2
i•ii;cwtuS pZ%� i'[C'L .iv Ho-LZ, #3
FINAL DISPOSAL BY:
( ) Abso.tp,tLo;'l Tne;toh, Bed o."L P.L-t ( ) Evapott'ta;tsp.i ta.tio;t
( ) Above Grtcu;td D.i,spe'LsaL' ( ) Said F,ittet
( ) U;tdetgnound DZspe-'LsaE ( ) (Vas.tctt'a.tz t Pond
t ) O.theL
Amo=t PaEd: �� Re//c__e��cPt�
��Nunbc-t 1j1313
------------------- CyU%—
/
----- 7----------------
NOTE: Site Plan must be attached to*application.
(Env. Health Department - Rev. 4-07-83)
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Legal Description: Lot 1, Block 1, Peachblow Subdivision, County of Eagle,
State of Colorado.
Pee cvkvL S kyy e
?8i-lo F'Y
,33 c)-s , Co b ^r _
BY• LINES IN SPACE
SYDNEY L/NC/COME (L.S. /4///)
BOX 121 CARBONDALE COLO. 303-963-3852
2 jujtp i 9 8`7 I SCALE:I"= q0'
INSPECTOR'S DAILY RECORD
OF WORK PROGRESS
( Foe subm➢ttyl to Rasidettt Project flop. to compile Daily Construction Report DAY
Project TRW ' Ti w)`rV`7 k75&,5! PfOj a Rio. F7, 1' ZJEZ,:�C WEATHER
Fttt�wte lu�1�5��71 �"� TEMP.
wlNo
HUMIDITY
t;.o
o
o
esw
r.+
n.w. Mo. . .
CONTRACTOR'S WORK FORCE (Indicate classification. indudirq Subcontractor Person")
EQUIPMENT IN USE OR IDLED (Identity which)
MATERIALS OR EQUIPMENT DELIVERED
NON -CONFORMING MATERIALS OR WORK (Describe reason for no ►s onforrnance)
{ I FIELD PROBLEMS (which could result in delay or claim)
QUANTITIES OF PAY ITEMS PLACED
SUMMARY OF CONSTRUCTION ACTIVITIES
FOLLOWUP INSPECTIONS OF PREVIOUSLY REPORTED DEFICIENCIES _
DISTRIBUTION 1. Field Office
2.lnspecto.
Wiley -Fisk Forma 6
Inspector _
r INSPECTOR'S DAILY RECORD
OF WORK PROGRESS
g-1 S
( For submittel feo Resident Rap. to compile Deity Constrrctkm Report DAY . .
project Title 1 hl Li 7 �.% pn*at No. � WEATHER
p� TEMP.
FtrlttJfrt WIND
Contrscoor � -Type of Work HUMIDITY
CONTRACTOR'S WORK FORCE (Ind.cata ciatsilicetiana, inclydirq Subcontractor persor►nal l
EQUIPMENT IN USE OR IDLED (Identify which)
MATERIALS OR EQUIPMENT DELIVERED
NON -CONFORMING MATERIALS OR WORK (Describe reason for nonconformance)
FIELD PROBLEMS (which could result in delay or claim)
QUANTITIES OF PAY ITEMS PLACED
SUMMARY OF CONSTRUCTION ACTIVITIE
FOLLOWUP INSPECTIONS OF PREVIOUSLY REPORTEE) DEFICIENCIES
mWiNAM
e
DISTRIBUTION 1. Field Office
2.Inspector
wilav-Fkk Fever "
Inspector —
INSPECTOR'S DAILY RECORD
OF WORK PROGRESS
DAY
1
For submittal to P � . to oompila Deity Cottstrvction RaPat S
Project Tkkrif �I �� —�
Fwi tt.
SST � �I�.► �
®&'%
®®
®®
CONTRACTOR'S WORK FORCE (Ind'icate ctasaidkmion s. inciudkV Subcontractor personnel)
EQUIPMENT IN USE OR IDLED (identify which)
MATERIALS OR EOU"4AENT DELIVERED
NON-OONFORMING MATERIALS OR WORK (Describe reason for nontonformence)
FIELD PROBLEMS (which could result in delay or claim)
QUANTITIES OF PAY ITEMS PLACED
SUMMARY OF CONSTRUCTION ACTIVITi
FOLLOWUP INSPECTIONS OF PREVIOUSLY REPORTED DEFICIENCIES
DISTRIBUTION
Wilev-Fisk Form"
1. Field Office
2.Inspector
Inspector
SCHMUESER GORDON MEYER, INC.
1512 Grand Avenue Suite 212
GLENWOOD SPRINGS, COLORADO 81601
[LIEUTEQ OF UQQ MOMOV L
(303) 945-1004
TO
i
WE ARE SENDING YOU Attached ❑ Under separate cover via_
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order
DATE
JOB N��
ATTENTION
RE:
following items:
❑ Samples ❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
O
THESE ARE TRANSMITTED as checked
❑ For approval
❑ For your use
❑ As requested
❑ For review and comment
❑ FOR BIDS DUE
REMARKS
below:
❑ Approved as submitted ❑ Resubmit copies for approval
❑ Approved as noted ❑ Submit copies for distribution
❑ Returned for corrections ❑ Return corrected prints
❑
19 ❑ PRINTS RETURNED AFTER LOAN TO US
COPY TO
PRODUCT 240-3 n e ice., croron, mass. 0 147 1.
SIGNED:
If enclosures are not as noted, kindly notify us at o e
L1 V\..JL 1
Peachblow Sub 7840 Frying Pan
JOB NAN Rd
- = JOB NO-90(
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
OF SELLING PRICE
NET PROFIT
JOB FOLDER Product 278 J�® NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 Printed in U.S.A.
JOB FOLDER
U AEUTRAL LP
111 m GENERAL IMI'FS
/S AAP Ck'4C•Ur Mr Yw l6 AAA C UT
BREAKER fC7VP J EAKER PIMA'
' ALARM 016-1 C0M%C70q c� 1. All materials, installation practices, setbacks, etc. shall oonform
ro fWA A"AW CVWrR iL to Eagle County Individual Sewage System Regulations.
0AVRCROLM &PCP CABLE
EirrA<R ROIn�o OR fur .A, WWV 2. On Feeder, Manifold and Lateral lines, provide sufficient slope to-
_ *VCAACL£PA;Gr l^"M + wards their inlets to allow the piping to drain.
ALARM ECOr + s4cK fLA4r SwrtGv
LOCATED ql
7066.4t 3. Sand shall be medium texture sand.
L rc��rcic AV CMR WW1 GAO. w s avrR sn CVAVLCWR > 25$ 0.25 - 2.0 mm
cow M FLAP < 30-35% 0.05 - 0.25 mm
G" SrxANArLEr > 5-10% 0.002 - 0.05 mm
OV4-t C10MOIC70R CAaL£ n* ALARM COwrAM �- m ALAEN no4r
�Q AROMA The Engineer may require that a graduation analysis be performed to
WIRING CONN MONS FOR ALARM BOX 8 AWS-/ LEVEL CONTROL certify that the material proposed meets this specification.
4. The amount of fill outside of the sand area may vary frcrn what is
shown in Section A -A to allow the homeowner to blend the mound in
with the landscaping plan.
OV WELL
e t • LhOIFRCROLAV CABLR nW ALLOW earrRA C 48LE CW rowER l Sm 00 � 5. The Contractor and Owner shall take whatever measures are necessary
`v ALARM AAo ��' A ALARM CDVrAUt ' 4 w aLE3 rn ft-WVE PUW �£;e to assure that (a) the dosing tank, septic tank and sewer lines are
ca r'p"B°x ft , ro� wrar►� completely water -tight to prevent infiltration of groundwater into
_ P"°'r the system, and (b) the system is to be installed to prevent f reez-
�"^ti .�ca►� f ter. AiMK AAx3SLOPE MN ing of all pressure and gravity sewer lines.
A. e4CYC ry MAK
WASTE LAC FROM MOWr e4 £ 6. The County Engineer shall be notified when construction commences
QQ J '063.8 S W hOLW VENT 41 PM � c�� so that the system can be inspected at regular intervals to assure
conformance with these plans.
O + W d AA1K ADOO G4LLCW aETWEDY MAP DRLL �GW hqL£
Q. RES/DENCE- , d£P7�TAAIr USA Na,7i Or PPE 7. If the last hole based 30 inch spacing, is al to or eater
i+rxaE r Z4W ALZRr i A Rw � ng . greater
than 15 inches from the end of the lateral
Sr ELzrm SYSrEwv
ioao GAL. Lnwc. ► S.
SrsrbM ftwr er ..Put another hole in the
SEPTIC TANK end cap of the pipe or close to it.
/000 GAL. CONC .
' ' ' SWJS LA2ER N SL6-
aasuvG TANK I 4„PE J Q ,�_ �Lvvr 8. Stone shall be 3/4" - 2 1/2" crushed rock.
�Q• L �- n
V iFr, r `� /000 SALLOW Cowes Serra• The area disturbed
MAK�AW0 �w>att 4-cw hac£ Vcavcft"£a01 9. by construction shall be reseeded with native
2- SCH. 40 PVC I / 8-ABOVE 3ZWfi0r7aM grasses to prevent erosion.
'f 70633 + TYPICAL INSTALL ION OF TANKS finished grade.
PUMP 8 CONTROLS. 10. Use risers as needed to bring septic tank access hatch within 6" of
l►i / 11. Cast iron pipe or pipe of equal strength or other pipe properly
Wrscowsuv / supported to prevent failure by settling shall extend from septic
A AMA V MEF �1�P / and dosing tanks for a distance of at least five (5) feet from the
}�� /. /
30" inlet and outlet ends.
/ 0 tYP• DESIGN CRITERIA
io / / r SCH 4 PVC
Mrnt / LATERAL (TYPE
/ roez o� jy - HOLES LOCATED
s.
DOWNW4RD 1. 71wo bedrocrtis (4 persons) = 8 persons total
ELEVAT/ON OF BED PROVIDED BY OWNER. CAP Two baths @ 14.7 gal/person day = 2(14.7)(4) = 117.60
Two water closets @ 24.8 gal/person/day = 2(24.8)(4) = 198.40
(TYP) Z",�""� Two lavatories @ 8.4 gal/person/day = 2( 8.4)(4) = 67.20
1 EACHSL0W ROAD z� 50t p LTEE383.20 gpd
MAC 2~ TEE 1" TEE 3 R£ 0 = 383.2 gpd
on1
SITE 2" 90• FITTWO
PLAN B5H DOWN (2 REOD) 2. Absorption Area = (sand)
-
WIJ COI SI Y MOUND 430 B£ND 1.5 ( 0 avg) = A, L.R. = Loading Rate (1.2 for sand)
- L.R.
SCALE.• /" = 40'
2" SCH 40 P.V.O f J'EDf*R A = 1.5 (383.2) 479.0 ft2
LAVE FROM PC/MP 1.2
T YP/CAL LATERAL 479 -1.2 (low water use fixtures) _ 399.17 ft2
S TA L L A TION DE TAIL Basal Absorption Area = 400 16 =320 ft2
5
At T'S' Use rock area of 10' x 40' to provide 400 ft2 of Sand Absorption
Area.
CONTRACTOR/OWNER NOTE;
THE PERC RATE IN NATURAL SOIL MUST BE VERIFIED
DOSING TANK
" Z" SCH. 40 PVC, SLOPE
TO DRAIN BACK TO PRIOR TO ANY CONSTRUCTION, IF ANY RESULT GREATER
/4 THAN 16 MPI IS OBTAINED, CONTACT ENGINEER IMMEDIATELY.
M
ivt P 21 3' 3' 2' /• 2
I ( I 6" TOPSOIL
SLOPE TO
DRAIN
�0 SEE NOTE #4 ' -
EDGE OF SAND �j� ` PLACE 4" OF S W
ABOVE ROC7C � NATIVE N BACKF/LL
EDGE OF ROCK
a I I 2" SCH. 40 PVC CLEAN ROCK /
a• IMAN/FOLD LINE SAND ' EXISTING GRADE
�I _
N _
I III /.. SCH 40 PVC i 1�'
LATERAL (SEE DETAIL) \\y
I I � 8 MIL PVC LINER
ROUGHEN SURFACE 2" SCH 40 I SEE NOTE #2 BEFORE PLACING SAND TO DRAIN BACKC, S(READ ON 3 SIDES)
TO
LOPE
iV
I L DOSING TANK
in
/ 3' SECTION A -A
14` SCALE. /" = 2•
PLAN VIEW - -
WISCONSIN MOUND SCHMUESER GORDON MEYER INC.
ENGINEERS & SURVEYORS
/O' SCALE: G 1512 GRAND AVENUE, SUITE 212
/"� .oum'"'''�'x GLENWOOD SPRINGS, COLORADO 81601
i�"��,? - - -- - - -- 13031 945 - 1004
REVISIONS PERRY RESIDENCE EAGLE COUNTY
rr :� 207W J COLORADO
.. + •.�.+; NO. DESCRIPTION DATE BY CHK D.
• .+c,c
.`,�,64�•E~� WISCONSIN MOUND
- rr�trm;;i��u�;�:;;.v� .
B NO. TE I BY I S ALE APPR. BY I DRAWING0.
67128A 9.797 J.QA4 NOTED P c, 7f /
EAGLE 'JNTY DEPARTMENT OF ENVIRONN(r 'TAL HEALTH
Box 81 1 6th & Broadway °
Eagle, Colorado 81631
PERMIT NO 122 (this does not constitute
• a building or use permit)
Owner Ernest T. Smith
System Location peach Blow - Lot 1, Block 1
Licensed Contractor . Robert Nell & Keith Patterson
* Conditional Construction approval is hereby granted fora 1000 gallon
Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate inches in minutes sq. ft.
absorption area per bedroom
# of bedrooms 2 x 300 sq. ft. minimum requirement
600 s 7—
Date
May we suggest q. ft, of drainage field
5-17-76
Inspectora,
FINAL APPROVAL OF SYSTEM:
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
is approved prior to covering any part.
Date
Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
1� Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
X Adequate compliance with County and State regulations/requirements.
91 %l
Inspector A� -io•
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
* CONDITIONS:
1. All .installation must comply with all. requirements of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority granted in 25-10-104, CRS 1973 amended 25-1-614, CRS 1973
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 structures not approved by the building
and Zoning office 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, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal
system in a manner which involves a knowing and material variation from the terms or specifications con-
tained in the application of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or
hnth
HEALTH ENVIRONMENTAL
P.O. BOX 811 -r
PERMIT NO. EAGLE, COLORADO 81631 PERMIT FEE $25.00
-- APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT a `
05
Name of Owner:: �>�' f" %` Phone
Address of Owner: I =
Is facility .within boundaries of a city/town or sanitation district?°'}`
Distance to nearest sewer system:
Location of Proposed System: _
Legal Discription:
Type of Structure: Single Family Dwelling ( J-04her: No. Bedrooms
Water Supply: Private Well {.4< Location: Distance From leach field ` > L(
Size of. Lot: /! Public Water Supply; '
An appropriate. plat plan must accompany.site inspection for this application showing required information. (See
attached sheet) The individual sewage disposal- system will be constructed and installed in accordance with, the
reggulations governing individual sewage systems within Eagle County, and shall comply with House Bill 1553,CRS
66-14, 1973. Payment shall be made to the Eagle County Treasurer. Permit, upon approval of this application, may be
obtained at the Eagle County sanitarian's office.
1
Appointment for final` inspection must be madeprior-to.aco'nstruc,-ion ,by contacting the inspecting sanitarian. [Phone
328-7718 between 8:30 and 9s:00 AM.] Refer to p rmit,number. No approval will be given on any system without final
inspection.`
Name,. -address, and telephone of person res o si6le for desi ' of s st m:
p P p / Y
.,The undersigned acknowledges that the above information s tiue-and-that_fa]se., information will` mvalidate;`the
application or subsequent permit.,.
SIGNATURE OF APPLICANT,.. Date:
(This application becomes invalid 6 months from above date.)
HEALTH P►RTMENT USE ONLY -
Percolation Information: � b -- � Permit No.
Tank Capacity: ' . _ gal r(mil'hwum) /y Fee Receipt
Absorption Area: . - �'' -'Sq. ft. (mi i, u I) File:
REMARKS: i
APPLICATION IS: APPROVED ( DENIED
The above individual sewage disposal, system was installed by
AND HAS BEEN INSPECTED AND APPROVED BY A REPRESENTATIVE OF THE EAGLE COUNTY HEALTH:4DEPT.
Date: Sanitarian.
}
EAGLE COUNTY Eagle County OWTS Systems Cleaners Reporting Form
NOTE:Required to be submitted to Environmental Health within 10 days of cleanine an OWTS system
Systems Cleaner Company / i1441(3 '-�POILL License Number t.,, 6- y6
Email Address f7`� P %1`��c l ���./1 �� t11 Phone _ %� �7/ 0913
Service Technician I Y'%t UGr u NS d or, Phone 6?%0- 4/7/ " 62;Z
Tax Parcel # 21162a13 aoZ//.Qoq Address of Service
Person Requesting Service?'r—J& ) Brit• 440�*/ Nhone �770 '- �263i - 4 V f 4f
{I /`f Property Owner �,c i"ILi[� �Cti�a/(J� �d hone 6 NO
Septic System Permit Number Tank Size /�C•�C�y^l1/�L'n7ALi+
Date of service �- �� 'f �► Tank Material
Sewage Disposal Site
Y
General Condition and Functionality of the System �r'y_ i/tct �ii
Site sketch showing location of the septic tank access lids measured from at least 2 fixed points
(Photos Encouraged)
a
c�
Signed Date
7._ Z `�- 2 Oj6,
01 2-Lot 1 Block 1 Peachblow Subdvsn 11Cj
780.0\Frying Pan Rd
JOB NAME ; —
JOB NO. �22
JOB LOCATION
BILL TO
DATE STARTED
201 -
TE
• 2� I � Ca%,Sq �,��,F�y i ��� �� �
PERMIT # 122
OWNER: ;rnest mi '
LOCATION: Lot 1 - Block 1 - Peachblow Subdivision.
(one acre)
INSTALLER: Robert Nell & Keith Patterson
SIZE OF TANK: 1,000 gallons
DWELLING: single family - 2 bedrooms x 300
PERC RATE: not listed
(suggest 600 sq. ft. of drainage field - ET system)
Finalized: 9-76 By: Erik Edeen
u R�.
DATE
JOB COST SUMMARY
TOTAL SELLING PRICE
EAGLE COUNTY Eagle County OWTS Systems Cleaners Reporting Form
NOTE: Reauired to be submitted to Environmental Health within 10 days of cleanine an OWTS system
Systems Cleaner Company � Ty���� �xo License Number G6- /6
Email Address �fi�t'�� 6i1Lt1� Phone g7Ct 4/7/�- f913
Service Technician-Iraf1G�i Z:)CJ NS oi"t Phone 9/CI
Tax Parcel # 2116')13zo-zooq Address of Service
Person Requesting
�Service� Zl & */Phone '1
7Q "�,fg��'j �4
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Septic System Permit Number Tank Size
Date of service :2— Z& , Z�)) t, Tank Material L2LLJ1 IL -
Sewage Disposal Site
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General Condition and Functionality of the System
Recommended Repairs /G�'l�l�GtL i �604d /1`Cj ot, CC
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Site sketch showing location of the septic tank access lids measured from at least 2 fixed points
(Photos Encouraged)
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Signed ��---�--'" Date
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