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HomeMy WebLinkAbout2108 Salt Creek Rd - 210730200023INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT Eagle County Department of Environmental Health PERMIT N2 0789 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: John Tolbert Telephone Address: Box 341, Eagle, CO System Location: 2108 Salt Creek Road Licensed Installer: Ted Reynolds License Number: Conditional installation approval is hereby granted for the following: 328-6687 Minimum requirements: 1000 Gallon Septic Tank or Aerated Treatment unit Absorption area of dispersal area computed as follows: Percolation rate:_1 Inch in __10— Minutes Absorption area per bedroom Sq. Ft. Number of Bedrooms2 .3_X 200 Sq. Ft. minimum requirement per bedroom - equals 600 Total Sq. Ft. minimum requirement Special Requirements: Maintain 4 feet above the water table. Mound system required to be located south end of driveway or west of storage shed. Also locate 50 feet from _Salt Creek. Date:Environmental Health Officer: 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 andcause 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. / S'� <, 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: PROPER MATERIALS AND ASSEMBLY: YES NO YES COMPLIANCE WITH PERMIT REQUIREMENTS: YES COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES COMMENTS: NO NO NO (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: John D. Tolbert Name of Owner: Same Amount Paid: 200.00 Receipt Number: 3229 Date: 6-10-87 Cashier: E. Hueni nk Check #792 White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner APP ICAT'^, FOR �I `. AL Sr-�:\(. Dic- �`LI .C- �r^.,f i?EALTii OFFICE - EAGLE COUNT:- P.O. 30:: ")50 Eagle, Colorado 81631 `:o. 3��d P=%IIT AP?i.ICATIM: FEE: S150.00 328-7311 PFRCOL\TIO`; TT-ST F= 550.00 NAME OF OW%ER: c� ©h r✓ n. o / `�F % ADDRESS: 3`/ % ,49�P �n �/�03� PHO::E: 3_2�' NAME OF APPLICL`;T (if different from owner) : ADDRESS: DESIGN ENGINEER OF SYSTDI (if applicable): PHONE: ADDRESS: PHO:E : I IivSiALLATION OF SYSTE`T: _1�� RQ �(�y � /'� S• L Licensed Installer (see attached list): YES- _ NO ADDRESS: — Gk�Sv,+a �� IL.� PHO:;E: PER`fIT APPLICATION IS FOR: (X) New Installation ( ) Alteration ( ) Repair LOCATION OF PROPOSED INDIVIDUAL SET.TAGE DISPOSAL SYSTL^_-T: Street/Rural Address: Lot Size:�� Legal Description: BUILDI::G OR SERVICE TYPE (check aoolicable cateacrv_)• (x) Residential - Single Family ( ) Residential - Quadolev ( ) Residential - Duplex ( ) Co=ercial (state usage) ( ) Residential - Tr_ole-x NUMBER OF PERSONS: i WASTE TYPES (check applicable cate^_ories): N17, -TBER OF RrT)Ron,-fq ( ) Co«:ercial or Institutional (�() Ihaelling ( ) Non -Domestic Wastes ( ) Transient Use ( ) Garbage Disposal ( ) Dishwasher (u) Automatic Washer ( ) Spa Tub ( ) Other -TYPE OF II1IDIVIDUAI.. SEWAGE DISPOSAL SYS i �-I PROPOSED: (7() Septic Tank ( ) Composting Toilet ( ) Incineration Toilet ( ) Vault Privy ( ) Grey -water ( ) Chemical Toilet ( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Potable Use ( ) Other ( ) Recycling, Other Use WILL EFFLUENT BE DISCHARGED DIRECTL`i INTO �-'A=S OF THE STATE: YES ( ) NO (x) IS SYSTEH DESIGNED FOR LESS T'dAN 2,000 GALLO`:S PER DAY: YES NO ( ) WASTEWATER FLOW REDUCTION PLA_V: YES (X) NO ) (IS yes, see attached u:as.tc.=Lte-t S.ec•ty .tedu�ti.on me,tlzc'ds) NOTE: The EnvZtoi-unentae Heae-t;z 03' .ic&—L matt educe the .teotu,ted ab.sc%Lption area upon app,tovae oS an ade.0uat2 teas-i �L'at &t 3CCU1 teduCtcOii peaii. SOURCE AND TYPE OF tdATER SUPPLY: (X) Well ( ) Spr;ng - ( ) Give depth of all wells within 200 feet of system: Creek/Stream If supplied by community water, give name of supplier: SIGNATURE_ / �- �_J - �r���i%c-s/(- - - - - - - - - - - DATE: - -�� = S 7 - - - - - - - INFORtfATION BELOW TO BE PILLED OUT BY ENVIRON.'[EhiTAL HEALTH OFFICER: GROUND CONDITIONS: Percent G.touizd Stope 2- 3 r Dept'> to Bedtoch (pen 8' P.to S tee Ho ee) Depth .to Gtcoujidaca.tc t Tabte SOIL PERCOLATION TEST RESULTS: A ciuct'ca pe/t -cnciz in HoZe K 1 11- JnL-tcs peA inch to Ho.ee #2 '"kijuu.uS Pel, iiti_J't to HOZZ # 3 FINAL DISPOSAL BY: - ( ) Abso.tptLA TAencA, Bed o.t Pit ( ) Evapo,t'cansPiAa,tZon ( ) Above GActtitd D.Lspellsa.e ( ) Saad Fi_Uc-t ( ) Undetg,tound Dispelsae ( ) Was.tcccatct Pond Arnou;tL Paid: �QQ °=� ReccipL Ncunbc.t ig_ /9 / 9 DaL�: C'���J # �9,2 NOTE: Site Plan must be attached to'application. (Env. Health Department - Rev. 4-07-33) Ol.-MER . X LEGAL CES:..,i i-i0,+: Z a2Z RURAL ADDRESS: Zl (, TYPE OF DUELLING: cS�-,� �P 7L� --, � � �c2e���.,, 4 OF 8E")PM'?S: * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * DATE OF PERCOLATION TEST: 1K 7 TYPE OF SOIL: TEST HOLES PRESOAKED? Yes �_ No TIi'•?E WATER DEPTH INCHES OF FALL RATE 2 3P-f 1 2 - 3 I -1 2 3-- 1 2 oi 17 16 1/0 8 G-3b 12: z r Z3 / i I I PERCOLATION•! RATE: /0 /?"A RECOMMENDED MINIMUM SEPTIC TANK SIZE: r��U..� RECOMMENDED MINIMUM LEACH FIELD SIZE: RECOMMENDED MINIMIUM SQUARE FOOTAGE PER BEDROOM: Site has been reviewed and tested for percolation rate. Date Environmental Freaith Ofticer cu_-01-) 6 EAGLE COUNTY E`1VIRON1,MENTAL HEALTH OFFICE (-Name) Date Routed �1-2j App i i ca ion -14o _ Location Please revie,;r the attached Individual Se: -rage Disposal System Permit Application and return it with this completed form to the Environmental Health Office. PLANNING: Complies with - YES NO REVIEI!Er) RY nnTr Subdivision Regulations: 1� p Zoning Regulations: Recommend Approval: ✓' 6 2 BUILDING: Complies with - Building Permit Applied For: Building Permit Issued: Recommend Approval: COMMENTS: ENGINEER: Complies with - Roads: Grading: Drainage: Recommend Approval: COMMENTS: ENVIRON,' E11TAL HEALTH: Complies with - Floodplain Permit Necessary: I.S.D.S. Regs. Compliance: Reco,�.mend Approval: YES I NO I REVIE:IED BY DATE ke YES NO REVIE1.1ED BY DATE YES NO REVIE14ED BY DATE x CO3•,;,1E111 3 : /-7 4f,4 r- V r 0789 Tolbert 2108 Salt Creek JOB NAM, Rd G / I JOB NO. .00'JOB LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL T[lTA 1 .1 A CZr%M PERMIT #789 OWNER: JOHN TOLBERT LOCATION: 2108 Salt Creek Road INSTALLER: TED REYNOLDS SIZE OF TANK: 1000 gal. DWELLING: Res. Single Fam. - 3 bedroom PERC RATE: 1 INCH IN 10 MINUTES _ ABSORPTION AREA: 4V. Rrilr VA... JOB FOL 1� Printed in U.S,A.