HomeMy WebLinkAbout892 McLaughlin Ln - 247106307019INDIVIDUAL 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. 974
Please call for final inspection before covering any portion of installed system.
OWNER: Jack miller PHONE: 925-6930
MAILING ADDRESS: P.O. Box 4285 Aspen, CO
AGENT: PHONE:
SYSTEM LOCATION: Lot 44, Filing I, Ruedi Shores
LICENSED INSTALLER: owner LICENSE NO.
DESIGN ENGINEER OF SYSTEM:
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
1250 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
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SQUARE FEET OF SEEPAGE BED 1 ZOO SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Place inspection portals in leach field.
ENVIRONMENTAL HEALTH OFFICER: -� DATE:
CONDITIONS:
1. ALL INSTALLATIONS UST COMPLY WITH ALL REQUIREMEN S �TEAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM
REGULATIONS, ADOPTED PURSUANT TO AUTHORITY GRANTED 1C.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 1/1, 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.
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INSTALLED ABSORPTION OR DISPERSAL AREA: �Q ,%QJJAfM FEET.1 G rj
INSTALLED SEPTIC TANK: ''�� GALLONS 90 DEGREES 3 0 FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALS ANDASSEMBLY —t 2 YES 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
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 Basalt
PERMIT APPLICATION FEE $150.00
PERCOLATION TEST FEE $125.00
NAME OF OWNER: jAcr— /✓�/l.L�%Z.
MAILING ADDRESS: Sax A.sft�iU 6 PHONE: 125�_J::�gg0
- NAME OF APPLICANT (If different from owner): <
ADDRESS: 4-0 j If �a 6 , ruev ( si�j-P O,PH0NE:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS: PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:�fL
LICE^ISED INSTALLER: ( ) YES NO
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: (Y) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address: C. rjI,.iAJG
Parcel Number: Lot Size: /, I
Legal Description:
BUILDING OR SERVICE TYPE (Check applicable category):
Residential'- Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: NUMBER OF BEDROOMS:
WASTE TYPES Check applicable categories):
Commercial or Institutional ( ) Dwelling
( ) Non -Domestic Wastes ( ) Transient Use
(o�) Garbage Disposal ( ) Dishwasher
(,C) Automatic Washer ( ) Spa Tub
( ) Other (Specify) :���(
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
_t$.. 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 s community water, give name of supplier: Pv reVc �(g;-cf
%W�
SIGNATURE: DATE: 4. cc -<: o
INFORMATION B�JOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope
SOIL PERCOLATION
Depth to Bedrock (Per W profile hole
Depth to Groundwater table
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: RECEIPT NUMBERy��')D DATE: -
....W r r
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
(Environmental Health Dept. - Rev. 4/88)
- /-94
Date Routed
ROUTE FORM
EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE
Name
7Z DrPS
Loca ion )
J-31,4116
Application No.
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:
BUILDING: Complies with -
Building Permit Applied For:
Buildina Permit Issued:
Recommend.Approval:
COMMENTS:
ENGINEER: Complies with -
Roads:
Grading:
Drainage:
Recommend Approval:
COMMENTS:
TES RV RETIEWED B
I«��wlj. _ . J�
_N_- ���
YES NO REVIEWED BY DATE
ENVIRONMENTAL HEALTH: Complies with -.,YES NO REVIEWE _BY DATE
Floodplain Permit Necessary:
I.S.D.S. Regs. Compliance:
Recommend Approval:
COMMENTS:
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PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE: $125.00 ISDS APPLICATION NO. 33��
OWNER:
LEGAL DESCRIPTION: D 7" q
RURAL ADDRESS:
TYPE OF DWELLING: t,�`
NUMBER OF BEDROOMS:
DATE OF PERCOLATION TEST: TYPE OF SOIL: D' 3 Tutor
TEST HOLES PRE-SOAKED: YES NO
_ TIME
( WATER DEPTH
Il INCHES OF FALL
RATE
i
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3
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3
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PERCOLATION RATE: ;2 .S /'-I
RECOMMENDED MINIMUM SEPTIC TANK SIZE: 4-12 3— e)a
RECOMMENDED MINIMUM LEACH FIELD SIZE: /a0a70 x �,4/ or/GGt o ,j
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: 200 'fie ioow
SITE HAS BEEN REVIEWED AND TESTED FOR PERCOLATION RATE.
> 1,2,5_147e
Envir ntalHealth Officer DaTte
COMMENTS:
Rev. 5/31/84
974 Miller Lot 44 filing I
Ruedi Shores
JOB NAME JOB NO. q7�
1l1R 1 A!`ATl(1N '
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
1
JOB COST SUMMARY
TOTAL SELLING PRICE
PERMIT # 974
OWNER: Jack Miller
LOCATION: 0892 McLaughlin
INSTALLER: owner
SIZE OF TANK: 1250 Gallons
DWELLING: 4 Bedrooms
PERC RATE: 25 MPI
ABSORPTION AREA: 300 Lineal
FINALIZED: September 11,
BUILDING PERMIT # 4472
Ln. Lot
ft.
1990
44, Filing I,; Ruedi Shores)
BY; Roger Hosea
'TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MtSc.COSTs
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
Printed i[i U.S.A.
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