HomeMy WebLinkAbout12 McCoy Rd - 168906100015EAGLE %_ _, JNTY DEPARTMENT OF ENVIRONM, SAL HEALTH
PERMIT MUST BE POSTED ON LOCATION Box W,x 6th & Broadway PLEASE CALL FOR FINAL INSPECTION
Eagle, eoforado 81631 BEFORE COVERING ANY PART OF
INSTALLED SYSTEM
PERMIT NU 440 (this does not constitute
a building or use permit)
Owner MC COY COMMUNITY CHURCH (Agent: Rob Carl)
System Location McCoy on Main Street
Licensed Contractor Owners will be responsible for installation of system
* Conditional Construction approval is hereby granted fora 750 gallon
xxx Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Perc rate Qa 7 inches in estimated minutes 400 sq. ft.
absorption area per be&Ram
#-a 4edFocfl+s--------*--------sq.-ft:-Fflii�-Fegtr4ef fteet
May we suggest
Date June 13, 1980 Inspector Erik W. Edeen
FINAL APPROVAL OF SYSTEM:
MINIMUM REQUIREMENTS:
750 gallon tank;
8'x8'x8' dry wellgroe
400 sq. ft. leach field
No system shall be deemed to be in compliance with the Sewage Disposal Lawsuntil the assembled system
is approved "or to covering any part. _
tic Tank cleanout to within 12" of final ade or aerated access ports above grade. \
Proper materials and assembly. z!
Adequate absorption (or dispersal) area.
Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/re uirements.
Date Inspector
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, 3.21frequires 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
PLEASE RETURN THIS PORTION WITH YOUR SITE PLAN AND FEES
7� 328-7311 949-5257 927-3823
ENVIRONMENTAL HEALTH
BOX 850
EAGLE, COLORADO 81631
PERMIT FEE _ $75 PERCOLATION TEST FEE _ $50
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
NO.
NAME OF OWNER: ( V r_ C_ oAA A&V hI d 14
ADDRESS: MCCc:)y ,, C-C-71) PHONE:
NAME OF APPLICANT (IF DIFFERENT FROM OWNER):'__O,
ADDRESS: �� 4 % 6-r CCU PHONE: ~32-F-3-
DESIGN ENGINEER OF SYSTEM (IF APPLICABLE):
ADDRESS: PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
ADDRESS: �,,,.,rR,. u PHONE:
PERMIT APPLICATION IS FOR: >< New Installation ( ) Alteration ( ) Repair
LOCATION OF PROPOSED FACILITY: County 4E Itge 1- Lot Size
City or Town, if within City or Town Limits A&C COY
LEGAL DESCRIPTION:
STREET (RURAL) ADDRESS:
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY? Yes ( ) No
BUILDING OR SERVICE TYPE: (Check applicable category)
( ) Residential - Single-family dwelling ( ) Residential - Triplex
( ) Residential - Duplex ( ) Residential - Quadplex
( ) Commercial - State usage V C.4'w SO %Ab4-0 Mac r r a..r vjipo w,
# Persons # Bedrooms
WASTE TYPES: (Check all applicable)
( ) Commercial or Institutional ( ) Dwelling ( ) Garbage Grinder
( ) Non -domestic wastes ( ) Transient Use ( ) Dishwasher
( ) Other `0MM1JN!-rY C1,4 u rzt.N ( ) Automatic Masher
t
SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( ) Spring (X) Creek or Stream
Give depth of all wells within 200 feet of the system: NON E
If supplied by community water, give name of supplier:
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( ) Septic Tank ( ) Aeration Plant ( ) Chemical Toilet
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, Potable Use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, Other Use
( ) Greywater (-) Other SC-6p66C---
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO 14ATERS OF THE STATE? ( ) Yes (><) No
Signature
Date
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER
GROUND CONDITIONS: Percent Ground Slope:
Depth to Bedrock (per 8' Profile Hole): Depth to Groundwater Table:
SOIL PERCOLATION TEST RESULTS: Minutes per inch in Hole No. 1
Minutes per inch in Hole No. 2
Minutes per inch in Hole No. 3
FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Above Ground Dispersal ( ) Sand Filter
( ) Underground Dispersal ( ) 'Wastewater Pond
( ) Other
REPAIR PERMIT APPLICATION
FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEMS
A permit fee of $75. shall be charged for alteration, enlargement, or any repair
involving alteration of an existing sewage disposal system. This fee is authorized
by Eagle County Individual Sewage Disposal System Regulations adopted and effective
March 27, 1980.
For minor repairs of less than $100 for maintenance of the individual sewage
disposal system, no fee shall be required.
A percolation test fee of $50 shall be charged for all new leach fields on repair
permits. Percolation testing may be waived at the discretion of the Environmental
Health Officer on certain repair cases where prompt action must be taken to prevent
a ,health hazard.
IF PRESENT SYSTEM IS PRE-EXISTING, NON -CONFORMING, A NEW SYSTEM SHALL BE INSTALLED,
COMPLYING WITH ALL CURRENT REGULATIONS. IF A NEW SYSTEM IS REQUIRED, ALL FEES ARE
APPLICABLE.
DESCRIPTION OF PROBLEM/MALFUNCTION:
TYPE AND SIZE OF SYSTEM PRESENTLY IN USE:
DATE PRESENT SYSTEM WAS INSTALLED
PERMIT NUMBER FOR ORIGINAL SYSTEM, IF A PERMIT WAS ISSUED BY THIS DEPARTMENT:
SITE PLAN BELOW SHOWING PRESENT SYSTEM COMPONENTS:
W7-T
OWNER OF SYSTEM:
ADDRESS:
APPLICANT:
ADDRESS:_
DATE:
EAGLE COUNTY ENVIRONIENTAL HEALTH
ROUTE FORM
NA14E 07
DATE REFERRED i APPLICATION NO.
LOCATION
Please review the attached application and return it and this completed form
to the Environmental Health Office.
AI�I�INC�i Complies with: Yes N Reviewed By
Subdivision Regulations
n
Zo ing Regulations
Recommend Approval
Comments:
BUILDING: Set Backs
Site
A-s-
Other
Recommend Approval
Comments:
ENGINEER; ( necessary)
Roads
Grading
Drainage
Recommend Approval
Comments 6 - 9- SD -e_
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SCHOOL
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0440 Ma-3rr-Strzz-!t- - McCoy LL,, _
JOB NAME _ Macox COMMUNITY CHURCH �C-i�me(k � n�� `t�L1 �c- � ;1Q'( (� " �� JOB NO.
Parcel # 1689-061-00-00.0-Wj >
.00'J68 LOCATION _..
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
L�\A' c;`/Ik`Cti rfdlc4C� To�' tS ��
PERMIT # 440
OWNER: McCoy Community Church
LOCATION: Mu ; ,,-�- McCoy R(Ak
INSTALLER: Owner
SIZE OF TANK:, 750 gallons
DWELLING: Church
PERC RATE: one inch/20 minutes (400 sq.ft.)
Finalized: 10-01-80 By: Erik Edeen
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
d08 FOLDER Product 276
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