HomeMy WebLinkAbout24434 Colorado River Rd - 000000000000i
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Eagle County Department of Environmental Health PERMIT N® 0869
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:_ Frank Benton Telephone: 653-4374
Address: Rurnc, r.n Rn426
System Location: 24434 Colorado River Road
Licensed Installer: Owner License Number:
Conditional installation approval is hereby granted for the following:
Minimum requirements: 1500 Gallon Septic Tank or Aerated Treatment unit
Absorption area of dispersal area computed as follows:
Percolation rate:_ Inch in —10 Minutes — Y- -(e;471
Absorption area per bedroom 160 Sq. Ft.
�
Number of Bedrooms 5 X Sq. Ft. minimum requirement per bedroom -
equals Total Sq. Ft. minimum requirement
Special Requirements:
Date: A,.Ua- Ph 1922 Environmental Health Officer: Erik Edeen
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 buildin -'
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.
INSTALLED ABSORPTION OR DISPERSAL AREA: SQ. FT. nn �� l
INSTALLED SEPTIC TANK: �s� GALLONS; DEGREES J(2 FEET l ✓�auS�
DESIGN ENGINEER OF SYSTW:
INSTALLER OF SYSTEM: ' G`/ G `�ii , PHONE: Cl) �_ 7
SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR
AERATED ACCESS PORTS ABOVE GRADE: YES X NO
PROPER MATERIALS AND ASSEMBLY: YES NO
COMPLIANCE WITH PERMIT REQUIREMENTS: YES NO
COMPLIANCE WITH COUNTY / STATE REGULATION RE UIREMENTS: YES O
COMMENTS: ��� �� Z- G o, &-v 2�
(Any item checked NO requires correction before final approval of system is made. Arrange a re-' spection when
work is completed.) G
DATE (Final Approval) F{ r� ENVIRONMENTAL HEALTH OFFICER:
DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER:
RETAIN WITH RECEIPT RECORDS PERMIT
Name of Applicant: John enton Name of Owner: John Benton
Amount Paid: $275.00 Receipt Number: 341 Date: R-29-RR Cashier: April
Check #14426
White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY
REPAIR
P. 0. BOX 179
EAGLE, COLORADO 81631 No.
949-5257 Vail
328-7311 Eagle
321C
927-3823 Basalt
,jF RMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00
NAME OF OWNER:
MAILING ADDRESS:
MR BWON LAND AND LNEST08K IL
NAME OF APPLICANT (If different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS:
Z_G PHONE:
PHONE:
PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
LICENSED INSTALLER: ( ) YES (c) NO
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: (� ) NE14 INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUA SEWAGE DISPOSAL SYSTEM:
Physical Address: �24 qJV ("92'9. ejye-"&
Parcel Number: Lot Size:
Legal Description: ;e7 a. Sao
BUILDING OR SERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential.,- Duplex ( ) Commercial (Type)
( Residential - Triplex
NUMBER OF PERSONS: NUMBER OF BEDROOMS:
WASTE TYPES Check applicable categories):
Commercial or Institutional O Dwelling
( ) Non -Domestic Wastes ( ) 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: (K 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 UPPLY: ( ) Well O Spring ( ) Creek/Stream
Give depth of all #ells within 20 feet of system:
If supplied by/7co unity water, give name of supplier:
SIGANTURE:
DATE:
INFORMATION BELOVTO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope
SOIL
Depth to Bedrock (Per 8' profile hole)l/
Depth to Groundwater table
PERCOLATION TEST RESULTS: �"l/,�— Minutes per inch in Hole #1
Minutes per inch in Hole #2
Minutes per inch in Hole #3
FINAL DISPOSAL BY:
11'�) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( T Above Ground Dispersal ( ) Sand Filter
( ) Under Ground Dispersal ( ) Wastewater Pond
( ) Other
AMOUNT PAID: $275.00 RECEIPT NUMBER
NOTE: SI4TE PLAN`MUST BE ATTACHED TO APPLICATION.
w0ell
(Environmental Health Dept. - Rev. 4/88)
a
FEE: $125.00
PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
ISDS APPLICATION NO.3 2'1
OWNER: �%r i� �' , '7% %� \ /�z ut% Q)
LEGAL DESCRIPTION:
RURAL ADDRESS: f
TYPE OF DWELLING: NUMBER OF BEDROOMS:��
DATE OF PERCOLATION TEST:
- s TYPE OF
SOIL:�zl
TEST HOLES PRE-SOAKED:
YES
NO
TIME
WATER DEPTH
INCHES OF FALL
RATE
1
2
3
1
2
3
1
2
3
1
2
3
Ali-
lo
PERCOLATION RATE:
RECOMMENDED MINIMUM SEPTIC TANK SIZE:
RECOMMENDED MINIMUM LEACH FIELD SIZE:
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: % I
SITE HAS BEEN REVIEWED AND TESTED FOR PERCOLATION RATE.
Environmental Health Officer Date
COMMENTS:
Rev. 5/31/84
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 Q0 NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 JOB FOLDER
re
Printed K U.S.A.
51
PON* All