HomeMy WebLinkAbout1240 LaGrow Rd - 000000000000INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Eagle County Department of Environmental Health PERMIT N® 0836
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: 1240 LaGrow Road
Telephone: 5 4-78 7
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: t M oL,lL Vn
v
Date: J` I (0 - ge 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 ABSO PTION OR DISPERSAL AREA: SQ. FT.
INSTALLED=�ANK: -1 GALLONS; DEGREES; T-� 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. Arra e a -' spection when
work is completed.) l�
DATE (Final Approval) ENVIRONMENTAL HEALTH OFFICER:
DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER:
RETAIN WITH RECEIPT RECORDS PERMIT
Name of Applicant: Phi 1 i g Bain Name of Owner: Philip Bain
Amount Paid: $150. 00 Receipt Number:_ 4832 Date: -- 5/5188 Cashier: _Earl enP
Check# 1328
White and Pink Copies - Environmental Healtb Department Yellow Copy - Applicant / Owner
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY No. 3f q
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail
PERMIT' APPLE
ION FEE $150
328-7311 Eagle
927-3823 Basalt
PERCOLATION TEST FEE $125.00
NAME OF OWNER: % lie �'f� ,�151/A �- 161 a Lg 6 rou) --
MAILING ADDRESS: U ,�D,� (p 4e�, PHONE: ��
NAME OF APPLICANT (If different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS:
PERSON RESPONSIBLE .FOR INSTALLATION OF SYSTEM:
LICENSED INSTALLER: ( ) YES ( )
ADDRESS:
PHONE:
PHONE:
NO
PHONE:
PERMIT APPLICATION IS FOR: X) NEW INSTALLATION ( ).ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address: 12Z/0 ED /tom
Parcel Number: 2111 -- Imo- 0 0 - 009�_ Lot Size:
Legal Description: I►3 7-
BUILDING OR SERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex O Commercial (Type) .�
( ) Residential"- Triplex
NUMBER OF PERSONS: NUMBER OF BEDROOMS:
-WASTE TYPES Check applicable categories):
Commercial or Institutional ( ) Dwelling
( ) Non -Domestic Wastes (X) Transient Use
( ) Garbage Disposal ( ) Dishwasher
( ) Automatic Washer ( ) Spa Tub
( ) Other (Specify):
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank Composting Toilet ( ) Incineration Toilet
(�) Vault Privy ( ) Greywater ( ) Chemical Toilet
( ' Pit Privy ( ) Aeration Plant ( Recycling, Portable Use
( ) Other ( ) 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
WATER CONSERVATION PLAN: ( YES NO
NOTE: The Environmental Health Office may reduce the required absorption area upon
approval of an adequate water conservation plan.
SOURCE AND TYPE OF WATER SUPPLY: ( ) Well (K) Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system:
If supplied by community water, give name of supplier:
SIGANTURE: �Z�W��// DATE:�c
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 #1
Minutes per inch in Hole #2
Minutes per inch in Hole #3
FINAL DISPOSAL BY:
( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Above Ground Dispersal ( ) Sand Filter
( ) Under Ground Dispersal ( ) Wastewater Pond
( ) Other
AMOUNT PAID: 160 ` = RECEIPT MBER DATE: 5 - 6 -0 0
f - /,5"
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
(Environmental Health Dept. - Rev. 4/88)
ROUTE FORM
EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE
.R. Phi ) ip Bql n
` Name
3197
Date Routed )240 ba CtroO Road Application No.
Location
Please review the attached Individual Sewage Disposal System Permit Application and
return it with this completed form the the Environmental Health Office.
PLANNING: Complies with - YES NO REVIEWED BY DATE
Subdivision Regulations:
Zoning Regulations:
Recommend Approval:.
COMMENTS:
BUILDING: Complies with -
Building Permit Applied For:
Building Permit Issued:
Recommend Approval:
COMMENTS:
ENGINEER: Complies with -
Roads:
Grading:
Drainage:
Recommend Approval:
COMMENTS:
ENVIRONMENTAL HEALTH: Complies with -
Floodplain Permit Necessary:
I.S.D.S. Regs..Compliance:
Recommend Approval:
COMMENTS:
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(ES NO REVIEWED BY DATE
YES NU KEVIEWED BY DATE
836 Bain 1240 LaGrow Roa
JOB NAME_ JOB NO.
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 ag?® NEW .ENGIAND BUSINESS SERVICE, INC., GROTCN, MA 01471 ��� ������ Printed iri U.SA.
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