HomeMy WebLinkAbout2881 Derby Mesa Loop - 168505400042EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
PLEASE CALL FOR FINAL P. 0. Box 850 - 550 Broadway PERMIT MUST BE POSTED
INSPECTION BEFORE COVERING Eagle, Colorado 81631 AT INSTALLATION SITE
ANY PORTION OF INSTALLED SYSTEM
328-7311 or 949-5257 or 927-3823 PERMIT NO. N c - 69
OWNER: William Schlegel ADDRESS: P.O. Box 21, Burns, CO
SYSTEM LOCATION: 2881 Derby Mesa Loop
LICENSED INSTALLER: LICENSE NUMBER:
**CONDITIONAL INSTALLATION APPROVAL is hereby granted for the following:
MINIMUM REQUIREMENTS: 1000 gallon septic tank or N/A aerated treatment unit.
Absorption area or dispersal area computed as follows:
PERCOLATION RATE: 1 inch in 20 minutes.
Absorption Area per Bedroom 266. sq. ft.
No. of Bedrooms 3 x 266 sq. ft. minimum requirement per bedroom
= 800 total sq. ft. minimum requirement.
SPECIAL REQUIREMENTS: Maintain 50 feet separation between drain field and
irrigation ditch.
i
DATE: May 21, 1985 INSPECTOR: Sid Fox
**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: t00 gallons. Degrees: Feet:
Design Engineer of System: titN
Installer of System: C ui Ou- Phone:
Septic tank cleanout to within 12" of final rade or
aerated access ports above grade? Yes +d' No 0%
-- 5
Proper materials and assembly. Yes Njo
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: tiG.
RE -INSPECTION DATE: INSPECTOR:
RETAIN WITH RECEIPT RECORDS c
CHARGES
Percolation Test = $50.00
Permit Fee (includes final inspection) _
ALL CHECKS OR MONEY ORDERS ARE TO BE
MADE PAYABLE TO: EAGLE COUNTY
PERMIT NU. N_ 697
Name of Applicant: William Schlegel
Name of Owner: Same
Amount Paid: $200.00
Receipt Number: C0317
Cashier: Gail Parker
White and Pink Copies - Environmental Health Department Green Copy - Applicant/Owner
�t
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
PERMIT APPLICATION FEE:
NAME OF OUNER:
ENVIRON`•IENTAL HEALTH OFFICE - EAGLE COUNTY
P.O. Box 850
Eagle, Colorado 81631 No. IDC�`jt'd
$150.00 328-7311 PERCOLATION TEST FEE: $50.00
ADDRESS: ,C ��✓cam PHONE: IC'5'3 7q 3 15:2
NAME OF APPLICANT (if different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (if applicable):
ADDRESS:
PHONE:
PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
Licensed Installer (see attached list): YES NO 1-
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: (� New Installation ( ) Alteration ( ) Repair
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Street/Rural Address:
Lot Size:
Legal Description: 2) A—"r4srn— i�o—m
BUILDING OR SERVICE TYPE (check applicable category):
(e<) Residential - Single Family
( ) Residential - Duplex
( ) Residential - Triplex
NUMBER OF PERSONS:
WASTE TYPES (check applicable categories):
( ) Commercial or Institutional
( ) Non -Domestic Wastes
( ) Garbage Disposal
(?i') Automatic Washer
( ) Other
TYPE OF,INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(
Septic Tank
(
) Composting Toilet
(
)
Vault Privy
(
) Greywater
(
)
Pit Privy
(
) Aeration Plant
(
)
Other
( ) Residential _ Quadplex
( ) Commercial (state usage)
NUMBER OF BEDROOMS:
( ) Dwelling
Transient Use
( v�� Dishwasher
( ) Spa Tub
( ) Incineration Toilet
( ) Chemical Toilet
( ) Recycling, Potable Use
( ) Recycling, Other Use
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES NO ( )
WASTEWATER FLOW REDUCTION PLAN: YES ( ) NO (�
(I6 Ve/s , zee attached wastewater 6tow neduc ti.on methods J
NOTE: The Envi onmentat Health Oj4icen may neduee the )LeguiAed ab�sonption area upon
appnovaZ o6 an adequate wa6tewaten 4.2ow teducti.on plan.
SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system:
If supplied by community water, give name,,pf supRlier:
SIGNATURE: 'z1 �! ZDATE:
- - - - - - - - -
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Peneent G&ound Stope 3 °'/O
Depth to Bedrock (pen 8' Pno4ite Hole) i
Depth to G1Loundwaten TabZe f
SOIL PERCOLATION TEST RESULTS: inute./s pen inch tin Ho.2e 1
M.inu te/s pen inch to Hole # 2
Minutes pen .inch. to Hote # 3
FINAL DISPOSAL By:
( ) Ab�sonption Trench, Bed on Pit
( ) Above Ground Dizpeua2
( ) Undetgnound D.i speuae
( ) Othe&
Amount Paid:
Receipt Nwmben
( ) EvapotAa.nsp Cation
( J Sand FiQ,teA
( J [Vas tavaten Pond
Date:
NOTE: Site Plan must be attached to application.
(Env. Health Department - Rev. 4-07-83)
PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE: $50.00 ISDS APPLICATION NO. Ds I.'
OWNER:
LEGAL DESCRIPTION:
RURAL ADDRESS: ( L e C
TYPE OF DWELLING: �f NUMBER OF BEDROOMS:
DATE OF PERCOLATION TEST: _ 2 % r TYPE OF SOIL:
TEST HOLES PRE-SOAKED: YES NO
TIME
WATER DEPTH
INCHES OF FALL
RATE
l r
2
3:
1
2
3 Ij
1
2
3
1
2
3
2
i
PERCOLATION RATE: o vy, �� •�
RECOMMENDED MINIMUM SEPTIC TANK SIZE:goo
RECOMMENDED MINIMUM LEACH FIELD SIZE: 1
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:
SITE HAS BEEN REVIEWED AND TESTED FOR PERCOLATION RATE.
Environ t Heal h f ce Dates-7
COMMENTS: � nG 0-t i N So
Pir►A--in� C���.
Rev. 5/31/84
h
a
/buki fK��
)� ?�ejn-
n
JOB NAME,
�9-8 1 -De
m
JOB FOLDER Product.278 ®® NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 JOB FOLDER Printed in U.S.A.