HomeMy WebLinkAbout1008 Polar Star Rd - 210904101011INDIVIDUAL 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. 984'
Please call for final inspection before covering any portion of installed system.
OWNER: Greg Baldwin PHONE: 328-6954
MAILING ADDRESS: P _ 0 _ Rnx 1232, Eagle, CO 81631
AGENT: PHONE:
SYSTEM LOCATION: 1008 Polar Star Drive, Upper Kai bab, Lot 2, Filing 1
LICENSED INSTALLER: 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 600 SQUARE FEET OF TRENCH BOTTOM. or 200 f t of 10" S62
SPECIAL REQUIREMENTS: --Place inspection portals at end of each line of S132011
ENVIRONMENTAL HEALTH OFFICER: �� DATE: a ® G 0
CONDITIONS: 44
1. ALL INSTAL IATI S MUST COMPLY WITH ALL REQUIREN THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM
REGULATIONS, ADOPTED PURSUANT TO AUTHORITY GRAN /N 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 III, 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. Q
INSTALLED ABSORPTION OR DISPERSAL AREA: 6&& SQUARE FEET. Z 00 mQ a '���� Q �T let' J eZ
INSTALLED SEPTIC TANK: 1 "o GALLONS //))
�nnDEGREES' 60 FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALS AND ASSEMBLY /V YES NO
COMPLIANCE WITH COUNTYISTATE 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:
i
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT �Q
i
ENVIRONMENTAL HEALTH OFFICE EAGLE COUNTY Number:
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail 328-7311 Eagle 927-3823 Basalt
L_ PERMIT APPLICATION FEE $150.00 ERCO-LATL N TE r_-FEE. $125.00
NAME OF OWNER:
MAILING ADDRESS:
NAME OF APPLICANT (If different from owner)-
ADDRESS.:",,— 15- z
DESIGN ENGINEER OF SYSTEM (If applicable):
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
LICENSED INSTALLER: ( ) YES 9z
ADDRESS:
PHONE:
PERMIT APPLICATION IS FOR: (> NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Physical Address: 1003 oar iU-9— Ooper kCxi a6-
Parcel Number: Lot Size:
Legal Description: LeA __2
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
( x) Garbage Disposal (x) Dishwasher
(�C) 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 ( x) N0
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: () YES ( ) NO
WATER CONSERVATION PLAN: ( ) YES (�>e4 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: �v-.;-
If supplied by co ity water, give name of supplier: o (�
SIGNATURE: (9/ At 124 Z'"li DATE: �OS� �U
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope 7
Depth to Bedrock (Per 8' profile hole
Depth to Groundwater table >
SOIL PERCOLATION TEST RESULTS: ao Minutes per inch in Hole #1
b Minutes per inch in Hole #2
D Minutes per inch in Hole #3
FINAL DISPOSAL BY:
( bsor do Trench. Bed or Pit
( ) Above Ground Dispersal
( ) Under Ground Dispersal
( ) Other
AMOUNT PAID: f- OCR RECEIPT NUMBER
( ) Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
r a DATE: 1p S
rncurrD. 777777
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
(Environmental Health Dept. - Rev. 4/88)
P"'(il- /
EAGLE COUNTY
55.1 Broadway
Eagle, Colorado 81631
(303) 328 7311
Date: June 20, 1990
Greg Baldwin
P.O. Box 1232
Eagle, CO 81631
Re: Issuance of Individual Sewage Disposal System Permit No. 984
Enclosed is tour ISDS Permit No. 984 This copy of the
permit must be posted on the installation site. You must
call our office for final inspection before covering any
portion of the installed system. If you have any questions,
please feel free to contact us at the following numbers for
your calling area: Vail/Avon 949-5257; Basalt/El Jebel
927-3823; Eagle area 328-8730.
Sincerely,
Raym d P. Merry, R.S
Envi onmental Health if cer
xc: ISDS file
Board of County Commissioners Assessor Clerk and Recorder Sheriff Treasurer
P.O. Box 850 P.O. Box 449 P.O. Box 537 P.O. Box 359 P.O. Box 479
Eagle, Colorado 81631 Eagle, Colorado 81631 Eagle, Colorado 81631 Eagle, Colorado 81631 Eagle, Colorado 81631
LOT 2
2.4 5 ac.
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SEPTIC -TANK_ giz To Im
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PECK
OSE.
PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE: $125.00 ISDS APPLICATION NO. 3 3 8 9
OWNER: G- If
LEGAL DESCRIPTION:
RURAL ADDRESS: ! Pala,.- 5-ice;12,r,�jle
TYPE OF DWELLING: Pe Ver a,/ NUMBER OF BEDROOMS: ,3
DATE OF PERCOLATION TEST: Jinn -?a TYPE OF SOIL: 0' /6 ®' T-01!°
6 fr _ 3.4
DIY . Via'®ate
TEST HOLES PRE-SOAKED: YES , NO -fV4 prkbles
TIME
WATER DEPTH
1I INCHES OF FALL
RATE
i1
2
3 II
1
2
3
II 1
1 2
3
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2
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to
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10 "to
to : > a
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19 %
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PERCOLATION RATE: 20 r",./;�.
RECOMMENDED MINIMUM SEPTIC TANK SIZE:
RECOMMENDED MINIMUM LE" -F-L9 9B SSI-H-t -r-
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:
SITE HAS BEEN REYIE,11ED AND TESTED FOR PERCOLATION RATE.
Environmental Heal ;-Offi Date
COMMENTS : /o a,/ p ,jC Do o vC 0.(e ..,f4 �®
Rev. 5/31/84
ROUTE FORM
EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE
.9—59q
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:
Building Permit Issued:
Recommend Approval:
COMMENTS:
ENGINEER: Complies with -
Roads:
Grading:
Drainaae:
Recommend Approval:
COMMENTS:
YES NO REVIEWED BY DATE
YES NO REVIEWED BY
DATE
ENVIRONMENTAL HEALTH: Complies with - YES NO REVIEWED BY DATE
Floodplain Permit Necessary:
I.S.D.S. Regs. Compliance:
Recommend Approval:
7
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COMMENTS: /s 2
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984 Baldwin Lot 2 Filing 1
JOB NAME Upper Kaibab 1008 Polar Star
Drive JOB NO.
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
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
JOB FOLDER Product 278 �® NEW ENGLAND BUSINESS SERVICE, INC,, GROTON, MA 01471 JOB FOLDER
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