HomeMy WebLinkAbout5397 Upper Cattle Creek Rd - 23915101004 - 1000ISINDIVIDUAL 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. 1 000'"'
Please call for final inspection before covering any portion of installed system.
OWNER: Stephen Peightal PRONE: 963-2635 '
MAILING ADDRESS: 0111 Navajo, Carbondale, CO 81623
AGENT: PHONE:
SYSTEM LOCATION: _Upper Cattle Creek Road, Lot 4, Block 1, Filing I of Homestead Acres
LICENSED INSTALLER: Rudd Construction, 16311 Hwy 82, Carbondale CO LICENSE NO.
DESIGN ENGINEER OF SYSTEM:
INSTALLATION
11IS HEREBY GRANTED FOR THE FOLLOWING:
GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED 805 SQUARE FEET OF TRENCH BOTTOM. or 260 If of 10" S132 , or 162.5
If of infiltrator system (26 units) in trench design.
SPECIAL REQUIREMENTS:
Place inspection portals at end of each line Profile hole to be done when
foundation is excavated.
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 COML/ANCE WITH THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS UNTIL THE SYSTEM IS APPROVED'
PRIOR TO COVERING ANY PORTION OF THE SYSTEM.
/ LiN'
INSTALLED ABSORPTION OR DISPERSAL AREA: �` O .SQyAeRE FEET.
INSTALLED SEPTIC TANK: GALLONS DEGREES FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: /
PROPER MATERIALS AND ASSEMBLY ✓✓✓ 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 S125.00
NAME OF OWNER: Stephen K. Peightal
MAILING ADDRESS: 0111 Navajo, Carbondale, Co 81623 PHONE: 963-2635
NA14E OF APPLICANT (If different from owner):
ADDRESS: PHONE:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS:
PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: Rudd Construction
LICENSED INSTALLER: ( ) YES ( ) NO _
ADDRESS: 16311 Hwy. 82, Carbondale, Co PHONE: 963-1210
PERMIT APPLICATION IS FOR: ( x) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address:Upper Cattle Cfeek Road
Parcel Number: Lot Size: 3.5 acres
Legal Description: Homestead AC:res i of 4 R1 nrk 1 Fi 1 i ncl 1
BUILDING OR SERVICE TYPE (Check applicable category):
x Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: Four NUMBER OF BEDROOMS: _Pour
WASTE TYPES Check applicable categories):
Commercial or Institutional (x) Dwelling
( ) Non -Domestic Wastes ( ) Transient Use
( ) Garbage Disposal (x) Dishwasher
(x ) 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 EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: ( ) YES (x) NO
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: (x ) YES ( ) NO
WATER CONSERVATION PLAN: ( ) YES (x ) 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 ( ) Creek/Stream
Give depth of all wells within 200 feet of system: None
If supplied bkomm,ni y water, give name of supplier:
SIGNATURE: DATE: 7 - Z4 -�l0
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope 3,— 10
Depth to Bedrock (Per 8' profile hole
Depth to Groundwater table
SOIL PERCOLATION TEST RESULTS: 50 Minutes per inch in Hole #1
ZG Minutes per inch in Hole #2
zo Minutes per inch in Hole #3
FINAL
DISPOSAL BY*
nch ed or Pit (
) Evapotranspiration
FAbsorption
Above Ground
Dispersal (
) Sand Filter
Under Ground
Dispersal (
) Wastewater Pond
( )
Other
r�J `
RECEIPT NUMBER-?,
�7
/ /40DATE: %
AMOUNT PAID:
/
!`SIC /^V hnl"nrn
_/0 rIIC LITLD.
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
(Environmental Health Dept. - Rev. 4/88)
I S D S aE#FffT # 3c-/a 7
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER: ,�q Xejj
LEGAL DESCRIPTION:
MAILING ADDRESS:
TYPE OF DWELLING: /2QSr�� NUMBER OF BEDROOMS Ll
TEST HOLES PRE-SOAKED:
YES NO_
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Time to drop last inch 3 as 2-C2
PERC RATE: MINIMUM SEPTIC TANK SIZE • 12.rD
MINIMUM LEACH FIELD SIZE: f t 2
COMMENTS: E,15- e
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PERC TEST DONE BY: S/Ae
Env
rev. 6/90ks
DATE: -7- rI -T 0
Health Officer
auuu reignLal
.JOB NAN Upper Cattle Cr.
Lot 4,.Block 1
ON
BILL TO
DATE STARTED DATE COMPLETED DATE BILLED
L eff —I-
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MA 01471
JOB FOLDER
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
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