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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 co AMOUNT PAID: o"?7S RECEIPT NUMBER DATE: NOTE: SITE PLAN MUST BE ATTACHED030 APPLICATION. _ oao (Environmental, Health Dept. - Rev. 4/88) oor 0-1 O z 0 LlJ�^J Dies F-I Lli Ld ao ROUTE FORM � EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE b �/(Name) _ `7 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_. ', G`7 2-3�z jZ x 2 �� 2 Z `,Z L .;ZS 3 / r z ( f Z S 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 c5yF_ 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 Printed in U.S.A.