HomeMy WebLinkAbout6554 Bellyache Ridge Rd - 210704201005INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
P.O. Box 179 - 550 Broadway • Eagle, Colorado 81631
Telephone: 328-7311 or 949-5257 or 927-3823
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 9 3 9
Please call for final inspection before covering any portion of installed system.
OWNER: Richard J Haffner 926-3402
PHONE:
MAILING ADDRESS: BOX 2- Wolcott. CO 81655
AGENT: ,�PHONE:
SYSTEM LOCATION: of 5, Bellyache II Subdivision
LICENSED INSTALLER: sel f LICENSE NO.
DESIGN ENGINEER OF SYSTEM:
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
1000 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS: Ir
SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS:
ENVIRONMENTAL HEALTH OFFICER: DATE:
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 Ill, 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: (TO BE COMPLETED BY INSPECTOR):
NO SYSTEM SHALL BE DEEMED TO BE IN COMLIANCE WITH THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS UNTIL THE SYSTEM IS APPROVED
PRIOR TO COVERING ANY PORTION OF THE SYSTEM. tS e
INSTALLED ABSORPTION OR DISPERSAL AREA: SQUARE FEET.
INSTALLED SEPTIC TANK'/_fr-.?SLGALLONSDEGREES2 t!�L FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALS AND ASSEMBLY YES. NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: NO
ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS COMPLETED.
COMMENTS:
ENVIRONMENTAL HEALTH OFFICER: DATE:
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT 'I
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY No. 32,u2
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail 328-7311 Eagle 927-3823 Basalt
PERMIT APPLICATION FEE $150.00 I PERCOLATION TEST FEE $125.00
NAME OF OWNER:
E lL b
MAILING ADDRESS:
_W—_� Z LOOP Q
_ /�� PHONE:
NAME OF APPLICANT
if different from owner):
ADDRESS:
PHONE:
DESIGN ENGINEER OF
SYSTEM (If applicable):
ADDRESS:
GjE
PHONE:
5y��
PERSON RESPONSIBLE
FOR INSTALLATION OF SYSTEM:
LICENSED INSTALLERL>• A ,��YES ( ) NO
ADDRESS:
PHONE:
PERMIT APPLICATION IS FOR: (�< NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address: _J_\y (1��(
Parcel Number: 0010' Lot Size: 5- 4"IZ-D
Legal Description:3�uy Cl SL�r33��v1Sie�� , z�
BUILDING OR SERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ). Residential- Triplex
NUMBER OF PERSONS: NUMBER OF BEDROOMS: v
WASTE TYPES Check applicable categories):
Commercial or Institutional (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 K)NO
NO
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: (><) YES
WATER CONSERVATION PLAN: (_ ) YES (>,�J' 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: (,X Well ( ) Spring ( ) Cree Stream
Give depth of all wells within 200 feet of system:
If sup" ed b comm nity water, give name of supplier:
SIGANTURE: 11 1DATE:
INFORMATION BELOW TO BEJFILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope
Depth to Bedrock (Per 8' profile hole)
Depth to Groundwate table
SOIL PERCOLATION TEST RESULTS:` Minutes per inch in Hole #1
0 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
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AMOUNT PAID: o"?7S RECEIPT NUMBER DATE:
NOTE: SITE PLAN MUST BE ATTACHED030 APPLICATION. _
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(Environmental, Health Dept. - Rev. 4/88)
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ROUTE FORM �
EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE
b �/(Name)
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Da a Rou ed P -Z :!i�. ,f s 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 REV41EWED U,,f DATE
Subdivision Regulations:
Zoning Regulations:
Recommend Approval:,
COMMENTS:
BUILDING: Complies with - Y S NO REVIEWED BY DATE
Building Permit Applied For:
Buildina Permit Issued:
Recommend Approval:
COMMENTS:
ENGINEER: Complies with - YES NO REVIEWED BY DATE
Roads:
Grading:
Drainage:
Recommend Approval:
COMMENTS:
ENVIRONMENTAL HEALTH: Complies with -
Floodplain Permit Necessary:
I.S.D.S. Regs. Compliance:
Recommend Approval:
COMMENTS:
FEE:
$125.00
PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
OWNER: 11' i�l2 �� �_S , �Cf6t
LEGAL DESCRIPTION:
RURAL ADDRESS:
i
ISDS APPLICATION N0 �'�?
S� `17
TYPE OF DWELLING: /J�/Ti�1 �P� NUMBER OF BEDROOMS: /C i
DATE OF PERCOLATION TEST: —` `— TYPE OF SOIL:
TEST HOLES PRE-SOAKED: YES
NO
TIME
WATER DEPTH
INCHES OF FALL
RATE
1
2
3
1
2
1
2
3
1
2
3
2_.
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2 ��
2
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3
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PERCOLATION RATE: % �/-
RECOMMENDED MINIMUM SEPTIC TANK SIZE: 000
RECOMMENDED MINIMUM LEACH FIELD SIZE:
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:
SITE HAS BEEN REVIEWED ND TESTED FOR PERCOLATION RATE.
G
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Environmental Heal Officer Date
COMMENTS:
Rev. 5/31/84
37
y.;;tt tiarrner Lot 5 Bellyache
II Sub 2107-04-002-005 tJ/J
JOB NAME JOB NO.
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
PERMIT #: 939
OWNER: RICHARD J HAFFNER
LOCATION: Lot 5, Bellyache II Subdivision
INSTALLER: owner
SIZE OF TANK: 1000 gal.
DWELLING: one bedroom
PERC RATE: 10 MPI
ABSORPTION AREA: 120 sq. ft.
FINALIZED: 09-05-89 BY: EE
PARCEL #: 2107-04-002-005
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
OLDER
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