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Home My WebLink About4541 Frying Pan Rd - 246702300021INDIVIDUAL 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 Repair Permi YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. P RMIT NO. .4 Please call for final inspection before covering any portion of installed system. OWNER: Ralph C. Pearce PHONE: 234-9380 MAILING ADDRESS: 3321 Vivian Ct., Wheatridge, CO 80033 AGENT: PHONE: SYSTEM LOCATION: 4541 Frying Pan Road LICENSED INSTALLER: Dreager Excavating LICENSE NO. 012-89-I DESIGN ENGINEER OF SYSTEM: INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING: 1250 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT. DISPERSAL AREA REQUIREMENTS: SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM. SPECIAL REQUIREMENTS: L IX 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: 4/14 SQUARE FEET. INSTALLED SEPTIC TANK'/? 6 L GALLONS DEGREES FEET SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: PROPER MATERIALS AND ASSEMBLY �Y 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: - DATE: ENVIRONMENTAL HEALTH OFFICER: DATE: (RE -INSPECTION IF NECESSARY) RETAIN WITH RECEIPT RECORDS PERMIT APPLICANTIAGENT: OWNER: AMOUNT PAID: RECEIPT #: CHECK #: CASHIER: fi ¢4 APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE P. 0. COUNTY Number: BOX 179 EAGLE, COLORADO > 1631' 949-5257 Vail 328-7311 E 1 927-3823 Basalt PERMIT APPLICATION FEE M0.00 ;:',..{ PERCOLATION TEST FEES125.00 NAME OF OWNER: ,�} ✓� 4.4��l,L ( " /.J��.Y.,i E. MAILING ADDRESS: �/�,,4,,! l�/r✓, e�a� C° �ONE:) NAME OF APPLICANT (If different from owner).: ADDRESS: PHONE: DESIGN ENGINEER OF SYSTEM (If applicable): ADDRESS: PHONE: or PERSON RESPONSIBLE FOR INSTAL F SYSTEM: 7r - �;--,.-C-� e�� 4cw, LICENSED INSTALLER: ( )YES NO ADDRESS HONE: �� 5'� 7T Q00 �(l /v'�,CS PERMIT APPLICATION IS FOR: ( ) NEW INSTALLATION ( ) ALTERATION (k) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM � Physical Address: Parcel Number: Lot Size: r� , Legal Description: BUILDING OR SERVICE TYPE (Check applicable category): UKT—Residential - Single Family(S,v,-A61n( ) Residential - Fourplex ( ) Residential - Duplex ll `( ) Commercial (Type) ( ) Residential - Triplex NUMBER OF PERSONS: NUMBER OF BEDROOMS: 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: X Septic Tank Composting Toilet ( ) Incineration Toilet ( ) Vault Privy ( ) Greywater ( ) Chemical Toilet ( ) Pit,.,Privy ( ) Aeration Plant ( ) Recycling, Portable Use ( ) Other ( ) Recycling, Other Use WILL-EFFLOENT BE nDISCHARGED 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 (,k NO NOTE: The Environmental Health Office may reduce the required absorption area upon approval of an adequate water conservation plan. SOURCE AND TYPE-_0_F WATER SUPPLY: (,K) Well ( ) Spring ( ) Creek/Stream Give depth of all wells w" in 200 feet of system: 44 J, f - If supplie c-mmu it ater, give name of supplier: SIGNATURE: DATE: INFORMATION BELO"O BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER: GROUND CONDITIONS: Percent ground slope Depth to Bedrock (Per W 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 t FINAL BY: -;DISPOSAL Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Above Ground Dispersal ( ) Sand Filter ( ) Under Ground Dispersal ( ) Wastewater Pond ( ) Other ^ C AMOUNT PAID: /,•� RECEIPT NUMBER DATE: rurry hmmorn ar rncurro. IA.I C NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION. MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER". (Environmental Health Dept. - Rev. 4/88) Date Routed ROUTE FORM EAGLE,EQUNTY ENVIR�6r ENTAL HEALTH OFFICE ame Locatibn catron-wo. 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 REVIEWED BY DATE Subdivision Regulations: Zoning Regulations: Recommend Approval: COMMENTS: I%a iki Post-it61 "r /n NO REVIEWED BY DATE .moo � q st p 7664 (�� ROUTING - RE!rST✓�/ Please ❑ READ To —) Ir HANDLE ❑ APPROVE and ❑ FORWARD ❑ RETURN ❑ ❑ KEEP OR DISCARD REVIEW WITH ME Date COMMENTS: ENVIRONMENTAL HEALTH: Complies with - Floodplain Permit Necessary: I.S.D.S. Reds. Compliance: Recommend Approval: COMMENTS: vrc nin DMITCLirn Qv nATC ILJ ITV 1\LY1L""U UI U11L- CiL-11�1<- c1 Z�- •---» REPAIR PERMIT APPLICTAION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEMS f, A permit fee of $150.00''shall .be charged for alteration, enlargement or any repair involving alteration of an existing sewage disposal system. This fee is authorized by Eagle County Individual Sewage;Dispbsal System Regulations adopted and effective March 27, 1980. For minor repairs of less than $100,.00 for maintenance of the individual sewage disposal system, no fee shall be required. A percolation test fee of $125 shall be charged for all new leach fields on repair permits. Percolation testing may be waived at the discretion .of the Environmental Health Officer on certain repair cases where prompt action must be taken to prevent a health hazard. IF PRESENT SYSTEM IS PRE-EXISTING, NON -CONFORMING, A NEW SYSTEM SHALL BE INSTALLED COMPLYING WITH ALL CURRENT REGULATIONS. IF A NEW SYSTEM IS REQUIRED, ALL FEES ARE APPLICABLE.,__ 4N .DESCRIPTION OF PROBLEM/MALFUNCTION: TYPE AND SIZE OF SYSTEM PRESENTLY IN USE: '50 o DATE PRESENT SYSTEM WAS INSTALLED: PERMIT NUMBER FOR ORIGINAL SYSTEM, IF A PERMIT WAS ISSUED BY THIS DEPARTMENT # SITE PLAN BELOW S140WING PRESENT SYSTEM COMPONENTS: Q�a� !-ro' OWNER OF SYSTEM: ADDRESS: .6�� /®�.1 ts.�-v��°��vr PHONE: &3) APPLICANT: C2_ . ADDRESS: PHONE: DATE: 4541 Frying Pan 944 Pearce Road JOB NAME_ JOB LOCATION BILL TO DATE STARTED DATE ED ar JOB NCO.! qVZ-1 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 Printed in U.S.A.