HomeMy WebLinkAbout264 Green Mountain Dr - 210904203004INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Eagle County Department of Environmental Health PERMIT N2 0848
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: William W. Gray Telephone: 328-2360
Address: P. 0. Box 673 Eagle CO 81631
System Location: Upper Kai bab Filing #2 Lot 30
L-ircn=d.Installer: Longs Excavation License Number: -
Conditional installation approval is hereby.granted for the following:
Minimum requirements: 1250 Gallon Septic Tank or Aerated Treatment unit
Absorption area of dispersal area computed as follows: US L b O W
Percolation rate:_Inch in 22.5 Minutes 2Aue-(
Absorption area per bedroom- 225 Sq. Ft.
Number of Bedrooms_ X 225 Sq. Ft. minimum requirement per bedroom -
equals Total Sq. Ft. minimum requirement
Special Re uirejnents: Use 10" SB2 - 1 foot = 3 sq. ft. of trench bottom.
/ ('0 4wo CKRv"O- 1
Use t*e--W' trenches with 10" SB2 ,NScAie Pe0l Ax-t,4 A K kg; -
Date: 6-17-88 Environmental Health Officer: �' Sid Fox t
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 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 system is approved prior to covering any portion of the system.
AREA: ` /
INSTALLED ABSORPTION OR DISPERSAL60 S�� l
/SQ. FT.
INSTALLED SEPTIC TANK: GALLONS; _l 1Ub DEGREES;_ FEET Z Cr�
DESIGN ENGINEER OF SYSTEM:
.INSTALLER OF S
SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR
AERATED ACCESS PORTS ABOVE GRADE:
PROPER MATERIALS AND ASSEMBLY:
COMPLIANCE WITH PERMIT REQUIREMENTS:
PHONE: J7Q Q6
yyl — yes
YES,X� NO
YES NO
YES NO
COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES NO
COMMENTS: ' �1--e % se
(Any item checked NO requWcection before final approval of system is made. Arra ge a r -inspection when
work is completed.)DATE (Final Approval) RONMENTAL HEALTH OFFICER:
DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER:
RETAIN WITH RECEIPT RECORDS PERMIT
Name of Applicant: -- William Gray Name of Owner:
William Gray
Amount Paid: $275.00 Receipt Number: 4992 Date: 6-10-88 Cashier: Jq
Check # 1386
White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY No.:
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail 328-7311 Eagle 927-3823 Basalt
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00
MAILING ADDRESS:
NAME OF APPLICANT (If different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS:
�} PERSON RESPONSIBLE FOR INSTALLATI OF SYSTEM:
` INSTALLER: ( S
ADDRESS: ��� _ o- ay� [ion
PHONE:
p PHONE:
NO
PHONE:
PERMIT APPLICATION IS FOR: ( NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address:
Parcel Number: Lot Size; )Z•
Legal Description: Y,6 T 3a- 0(ppJPc2. KA—T6W6 t c kyir
BUILDING OR VICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential"- Triplex
NUMBER OF PERSONS: ? NUMBER OF BEDROOMS: tz-/
WASTE TYPES Check applicable categories):
Commercial or Institutional ( Dwelling
( ) Non -Domestic Wastes ( ) Transient Use
().G�bage Disposal ( ) Dishwasher
�j Automatic Washer ( ) Spa Tub
( ) Other (Specify):
TYPE OF IN DUAL 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: ( ) ( 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 ( ) Spring ( )
Give depth of all wells within 200 feet of system:
If suppl' d b o munity water, ve name of supplier:
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OnFFFICER:
GROHNO CONDITIONS: Percent ground slope / ®
Depth to Bedrock (Per 8' profile hole
Depth to Groundwater table 7 c6'
TEST RESULTS: j �' Minutes per inch in Hole #1
a b Minutes per inch in Hole #2
Minutes per inch in Hole #3
SOIL PERCOLATION
Creek/Stream '/6CJ l?
FINAL DISPOSAL BY:
{ Absorption Trench, Bed or
( Above Ground Dispersal
{ ) Under Ground Dispersal
{ ) Other VI—✓-'
AMOUNT PAID: Q2s ®Z) RECEIPT
Pit ( ) Evapotranspiration
Sand Filter
( ) Wastewater Pond
13��
NUMBER -.44c? DATE: L --fc)—FF
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
(Environmental Health Dept. - Rev. 4/88)
PERCOLATION 1-EST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE: 550.00
ISDS APPLICATIO. �Ju.
OWNER:
LEGAL DESCRIPTION: -I- �® _ PP KA=I\q
RURAL ADDRESS:
TYPE OF DWELLING: �iN �e NUMBER OF BEDRO^ui•1S:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * �k
DATE OF PERCOLATION TEST: (�-I(A-S TYPE OF SOIL:i` %btvr�t
TEST HOLES PRE-SOAKED: YES � NO
TIi^E II i 2 WATERRATE
DEPTH II INCHES OF FALL JI
1 i l 3
2 3 it 1 i 2
PERCOLATION RATE:
RECOMMENDED MINIMUM SEPTIC TANK SIZE: W50 6pf\10 JU
RECOMMENDED MINIMUM LEACH FIELD SIZE:
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:
SITE HAS BEEN REVIE!•JED AND TESTED FOR PERCOLATION RATE.
Environmental Health Officer
COMMENTS: to
Rev. 5/31/84
404
Date
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30
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848 Grey Lot 30 Filing 2 a10g0ga03o0q
Upper Kaibab
JOB NAME _ JOB NO. 4d
JOB LOCATION
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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
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