HomeMy WebLinkAbout505 Mosher Ln - 210923401002INDIVIDUAL 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. 942
Please call for final inspection before covering any portion of installed system.
OWNER: Doyle & Patricia Johnson PHONE: 328-5266
MAILING ADDRESS: P _ n - Roo 03, Facile. rn 81611
AGENT: PHONE:
SYSTEM LOCATION: 0505 Mosher Lane, Lot 2, Ladybelle View 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:
SQUARE FEET OF SEEPAGE BED / SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS:/ �� '� A l, < �/
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.
INSTALLED ABSORPTION OR DISPERSAL AREA: SQUARE FEET.
INSTALLED SEPTIC TANK: GALLONS 9,0L DEGREES 2FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALSAND ASSEMBLY S NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: YES 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: 0DATE: s
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
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number:
P. 0. BOX 179
EAGLE, COLORADO 81631 ;..
949-5257 Vail �.- 328-7311 Eagle 927-3823 Basa111
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEES
NAME OF OWNER:
MAILING ADDRESS:,
NAME OF APPLICANT (If different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
LICENSED INSTALLER: ( ) YES (K) NO
ADDRESS: On �; c�-1 4103 O� - W-/tp'
3330
$125.00
PHONE: (n_
PHONE:
PHONE:
l- h.:3-y)-,v
PHONE:
PERMIT APPLICATION IS FOR: (-K) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address: ear- Gr4�e
Parcel Number: Lot Size: 3
Legal Description: �!. D Ls9dc4 b,Af 0 etj
BUILDING OR SERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: - NUMBER OF BEDROOMS: 3
WASTE TYPES Check applicable categories):
Commercial or Institutional Dwelling
( ) Non -Domestic Wastes ( ) Transient Use
( ) Garbage Disposal 1 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 ( ) Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system:
If supplied by community water, give name of supplier: 7,,,•ti
SIGNATURE: CS' DATE: 17A
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: -%_S RECEIPT NUMBERC DATE
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
(Environmental Health Dept. - Rev. 4/88)
CC 3 3 3o
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1(39-254-Gl G02
y June 9, 1994
Mr. Ray Merry
Community Development
Eagle County
P.O. Box 850
Eagle, CO 81631
Dear Mr. Merry:
Upon completion of the addition to my residence on 0505 Mosher Lane,
d.t will remain a 3-bedroom home.
Thank you.
Sincerely,
Bryon K. McGinnis
0505 Mosher Lane
P.O. Box 71
Eagle, CO 81631
ROUTE FORM
YES NO REVIEWED BY DATE
YES
NO
REVIEWED BY
DATE
EAGLE CO TY ENVIRONMENTAL.HEALTH OFFICE
Name
Date'Routed pplication
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 REYIIEWED 5Y DATE
Subdivision Regulations: e-l", 34
&1
Zoning Regulations:
Recommend Approval:
COMMENTS: 4'1.1%q - 6Lz.. al;�.,J 62 , �k. h 44o v s41,,, _
BUILDING:
Complies with - YES NO REVIEWED BY DATE
Building Permit Applied For:
Buildina Permit Issued:
Recommend Approval:
COMMENTS: �c �.��� �'et✓�.5.�/fc%'���"
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:
PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE:
$125.00
ISDS APPLICATION NO.
OWNER:
Do
C4 /f
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LEGAL DESCRIPTION:
RURAL ADDRESS:
TYPE OF DWELLING: NUMBER OF BEDROOMS:
DATE OF, PERCOLATION TEST: � TYPE OF SOIL: 1—Gk
�-
TEST HOLES PRE-SOAKED: YES NO
2-
TIME
( WATER DEPTH
INCHES OF FALL
RATE
11
2
3
1
2
3
1
2
3
1
2
3
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PERCOLATION RATE:
RECOMMENDED
MINIMUM SEPTIC TANK SIZE: C7
() Q
RECOMMENDED
MINIMUM LEACH FIELD SIZE:
RECOMMENDED
MINIMUM SQUARE FOOTAGE PER BEDROOM:
�y
SITE HAS BEEN REV IE,lED AND TESTED FOR PERCOLATION RATE.
f
Environmental Health Officer Date
COMMENTS: zr, l /,l ( G/)�11-�� J ra t ram. f Lt
11
Rev. 5/31/84
Count
le
.Envlronmental9Health Department
P. O. Box 179
Eagle, Colorado 81631
328-7311 Eagle area Installers - New
949-5257 Vail area Installers - Renewal
927-3823 Basalt area Cleaners - New
Cleaners Renewal
APPLICATION TO CONDUCT BUSINESS
AS A
SEWAGE DISPOSAL SYSTEMS INSTALLER/CLEANER
To obtain an Eagle County License, please answer all items fully
and attach proper remittance. Make check payable to Eagle County
Treasurer. Send check and application to: Eagle County Department
of Community Development, P. 0. Box 179, Eagle, Colorado, 81631.
1. Indicate type of ownership: Individual
Co -Partnership or Company
Corporation
Other (specify)
2. License to be issued in name(s) of:
a
(Full name(s) of ownership
3. Trade Name: Pd'iOJe- TPJ5_f0-NC1+ 6nJ
4. Business Location:
Phone Number: a Ado/
5. Mailing Address: �.(�,P�04 14C3 e'E'Azzte ob F-1&31
6. Date You Started Business:
7. If seasonal, show months in which business will be operated:
8. Name and address of person taking license examination:
9. LICENSE FEES: INSTALLERS - NEW .$ 25.00
INSTALLERS - RENEWAL $ 10.00
CLEANERS - NEW $ 25.00
CLEANERS - RENEWAL $ 10.00
I do hereby certify that I will comply with all reauirements of
the Eagle County Individual Sewage Disposal Regulations and that
I will comply with all orders given me by authorized inspectors
of the Eagle County Environmental Health Office.
I do hereby agree that in the event the Individual Sewage Disposal
Regulations are not complied with, I and/or my employees will
discontinue installation/cleaning (whichever is applicable) of
sewage disposal systems and forfeit my license at the discretion
of the Eagle County Board of Health.
Signature: Date:
***************** *******************************
License Number: Date Issued:
Receipt Number: Check Number:
Issued By:
EAGLE COUNTY
BUILDING DIVISION
P. O. Box 179
Phone: 328.7311
DATE:
INSPECTION REQU
JOB
NAME:
TIME
RECEIVED: El PM, I CALLER: — U
BUIL,PING PERMIT NO.
❑ OTHER: LOCATION:
❑ PARTIAL
Ready for Inspection: ❑ MONDAY ❑ TUESDAY ❑ WEDNESDAY ❑ THURSDAY ❑ FRIDAY ❑ AM ❑ PM
COMMENTS:
APPROVED
DISAPPROVED REINSPECT
❑ Upon the Following Corrections:
W
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DATE: TIME:
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INSPECTOR
942
JOB NAN Doyle
le & Patricia Johnson 9
0505 Mosher Lane, Lot 2
r7=110N
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
L& Pei L
D� v ,p vy 101D` Z,
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
.JOB FOLDER Product 278 ®® NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 Printed in USA
JOB FOLDER