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HomeMy WebLinkAbout1625 Derby Mesa Loop - 168509100046EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH PLEAS'CEALL,P&OR FINAL P. 0. Box 850 - 550 Broadway INSPECTION BEFORE COVERINC Eagle, Colorado 81631 ANY PORTION OF INSTALLED SYSTEM 328-7311 or 949-5257 or 927-3823 OWNER: John T. Benton PERMIT NO. N2 626 PERMIT MUST BE POSTED AT INSTALLATION SITE ADDRESS: 1625 Derby Mesa Loop SYSTEM LOCATION: 1625 Derby Mesa Loop - Burns, Colorado LICENSED INSTALLER: Owner LICENSE NUMBER: "CONDITIONAL INSTALLATION APPROVAL is hereby granted for the following: MINIMUM REQUIREMENTS: 1,nnn_ gallon septic tank or aerated treatment unit. Absorption area or dispersal area computed as follows: PERCOLATION RATE: . ona inch in 1p minutes. Absorption Area per Bedroom 200 sq. ft. No. of Bedrooms 2 x 200 sq. ft. minimum requirement per bedroom 600 dotal sq. ft. minimum requirement. SPECIAL REQUIREMENTS: Existing farm house - repair system DATE: 6/29/83 INSPECTOR: Erik Edeen "CONDITIONS: 1. All installation must comply with all requirements of the 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 building and zoning 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 installed system is approved prior to covering any part. Installed Absorption or Dispersal Area: sq. ft. Installed Septic Tank: Design Engineer of System: Installer of System: gallons. Degrees: Septic tank cleanout to within 12" of final grade or aerated access ports above grade? Yes No Proper materials and assembly? Yes No Feet: Phone: Compliance with permit requirements? Yes No Compliance with County/State regulations 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: INSPECTOR: RE -INSPECTION DATE: INSPECTOR: APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTYy P.O. Box 850 Eagle, Colorado 81631 No. PERMIT APPLICATION FEE: $150.00 328-7311 PERCOLATION TEST FEE: $50.00 NAMEvOF OWNER: John T. Benton ADDRESS: 1625 n-3rby Mesa Loon PHONE: 6�i_4q�4 NAME OF.'.'APPLICANT (if different from owner): ADDRESS: DESIGN ENGINEER OF SYSTEM (if applicable): ADDRESS: PHONE: PHONE: PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: —Owner _ Licensed Installer (see attached list): YES _ NO X ADDRESS: PHONE: PERMIT APPLICATION IS FOR: (X) New Installation ( ) Alteration ( ) Repair LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Street/Rural Address: 1625 Derby Mesa Loop Lot Size: 44XI[7C 44.24 A. Legal Description: X1 y PT 41 4 9-2-85 Lots 2-2 BUILDING OR SERVICE TYPE (check applicable category): (X) Residential - Single Family ( ) Residential - Quadplex ( ) Residential - Duplex ( ) Commercial (state usage). _ ( ) Residential - Triplex NUMBER OF PERSONS: 2 NUMBER OF BEDROOMS: 2 WASTE TYPES (check applicable categories): ( ) Commercial or Institutional (X ) Dwelling ( ) Non -Domestic Wastes ( ) Transient Use (X) Garbage Disposal (X ) Dishwasher (X) Automatic Washer ( ) Spa Tub ( ) Other TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (X) Septic Tank ( ) Composting Toilet ( ) Incineration Toilet ( ) Vault Privy ( ) Greywater ( ) Chemical Toilet ( ) Pit Privy ( Aeration Plant ( ) Recycling, Potable Use ( ) Other <Y G' c ( ) Recycling, Other Use WILL EFFLUENT BE DISCHARGE DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO (X ) IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES (X ) NO ( ) WASTEWATER FLOW REDUCTION PLAN: YES ( ) NO ( ) (I4 yeas, see attached wa6tewateA 4tow Reduction methods ) NOTE: The Envitonmenta2 Hea,P h 044tceA may Reduce the Aequ,iAed abzonpti.on anea upon appnova2 o4 an adequate wastewateA 4tow Aeducti.on plan. SOURCE AND TYPE OF WATER SUPPLY: ( ) Well (X ) Spring ( ) Creek/Stream Give depth of all wells within 200 feet of system: If supplied by community water, give name of supplier -- SIGNATURE: DATE: - - - - - - - - - - - - - - - INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER: GROUND CONDITIONS: PeAcent GAound Slope 26 Depth to Bednock (pen 8' PAo4ite Hote) ��— Depth to GAoundwateA Table SOIL PERCOLATION TEST RESULTS:. Mtnute/s pets tich in Hole 1 Minutes pen inch to Hole # 2 Minutm pets inch to HoZe # 3 FINAL DISPOSAL BY: ( ) Abzotcpti.on TAench, Bed on Pit ( ) Evapottcamsp,vAa ion ( ) Above Gnound DispeAsat ( ) Sand FitteA ( ) UndeAgnound Dfzpetu6a2 ( ) waste_wateA Pond ( ) Othe/t Amount Paid: :Z"') 0 . D Receipt NumbeA (� Date: - ------------------------------------------------- NOTE: Site Plan must be attached to application. ' 07-83) Neal th Department - Rev. 4- EAGLE COUNTY ENVIRONMENTAL HEALTH FILE 1 offing - Name Ion" 1 Date Routed %& Application Nb. Loc ion Please review the attached Individual Sewage Disposal System Permit Application and return it with this completed form to the Environmental Health Office._ PLANNING: Complies with - .. YES NO REVIFWE Y DATE Subdivision Regulations: Zoning Regulations: Recommend Approval: E ....... COMMENTS BUILDING: Complies with - Building Permit Applied For: Building Permit Issued:#_�3$i� Recommend Approval: COMMENTS: YES1REVIEWED BYi� �6L�r�iiiv mil/ ENGINEER: Complies.with - Roads: Grading: Drainage: Recommend Approval: YES NO REVIEWED BY DATE COMMENTS: ENVIRONIMENTAL HEALTH: Complies with - Floodplain Permit Necessary: I.S.D.S. Regs. Compliance: Recommend Approval: YES NO REVIEWED BY DATE COMMENTS: TN / ef ITEM CORRECTED NO. REMARKS BY Complies with the Control of Smoking Legislation Yes No z� .0 a 9G'G r . -4 YAP S `a y INSPECTED BY:; NAME RECEIVED BY: NAME TITLE TITLE COLORADO DEPARTMENT OF HEALTH GENERAL SANITATION SURVEY REPORT FOOD AND DRUG FIRM NAME LOCATION OWNER ADDRESS MANAGER COUNTY INSPECTION OF YOUR ESTABLISHMENT TYPE AT THE ABOVE LOCATION REVEALED THE FOLLOWING DEFICIENCIES: 1. PREMISES: DUST CLEAN OTHER 2. WATER SUPPLY: ADEQUATE SAFE TYPE 3. TOILET -LAVATORY:. FACILITIES GOOD REPAIR CLEAN ' ASTE DISPOSAL: CEW A jGr TYPE REFUSE PRODUCT WASTE G. VECTOR CONTROL: RODENTS INSECTS VERMIN PROOF 6. BUILDING: CONSTRUCTION _ MAINTENANCE CLEAN 7. EQUIPMENT: ADEQUATE _ GOOD REPAIR CLEAN STORAGE 8. CONTAINERS -UTENSILS: CLEAN SANITIZED _ STORAGE 9. REFRIGERATION: CLEAN TEMPERATURE _ THERMOMETER STORAGE DRAINAGE 10. FOOD: OPERATION _ STORAGE TRANSPORTING NON-FOOD HANDLING OTHER 11. MISCELLANEOUS: ANIMALS DRESSING Room - PERSONNEL HAZARDS OTHER UNSATISFACTORY - ExPLAIN IN REMARKS SECTION REMARKS: -y la el ( d, )ATE: - —r � RECEIVED BY: 'S:MFD 55 (1-71-50) SANITARIAN: PERCOLATION TEST FEE: S5n OWNER: I.S.D.S. APP. LEGAL DESCRIPTION: RURAL ADDRESS: TYPE OF D14ELLING: DATE OF PERCOLATION TEST: Z 2— TYPE OF SOIL: TEST HOLES PRESOAKED? Yes No v OF BEDROOMS: 22, � ► (INCHESOF I FALL,.., �����i®mil 1��►©Csi PERCOLATION RATE: Q /22 RECOMMENDED MINIMUM SEPTIC TANK SIZE: %Q CA RECOMMENDED MINIMUM LEACH FIELD SIZE: G o / RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: Site has been reviewed.and tested for percolation rate. �c Da e Environmental eat icer COMMENTS: Z C_' (-) / o2N a 3 0626 en o 1625 Derby Mesa NN Loop Joe .NI JOB LOCATION BILL TO _. DATE STARTED DATE COMPLETED DATE BILLED 0 8 a,, �L 41 20i5 n C0 WnS s 2 5 JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL �� — — -- ----- __ r 3, PERMIT NO. 626 OWNER: Co 1625 Derby Mesa Loop - Burns, CO 80426 LOCATION:051625 Derby Mesa Loop - Burns INSTALLER: Owner SIZE OF TANK: 1,250 gallons (Degrees: _ DWELLING: Farm House - 2 bedroms- 200 sq.ft Feet: 34) PERC RATE: one inch/10 minutes (600 sq.ft.) comments: Settle fill under inlet pipe before final I backfi 11 t� V 16 -� I� ()qc F i n � l � -� ,. ,,I . TOTAL LABOR INSURANCE SALES TAX MISC. COSTS TOTAL JOB COST GROSS PROFIT LESS OVERHEAD COSTS % OF SELLING PRICE NET PROFITL�l .JOB FOLDER Produ By: Erik E d e e n .Printed In u.s Aa 0 0 `°` e