HomeMy WebLinkAbout954 McLaughlin - 247106307018INDIVIDUAL 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. 1025
Please call for final inspection before covering any portion of installed system.
OWNER: William W. & Mary Boyd PHONE: 923-2719
MAILING ADDRESS: P.O. BOX 5748, Snowmass Village, CO 81615
AGENT: PHONE:
SYSTEM LOCATION: McLaughlin Dr., Lot 43, Fi 1 i ngl , Ruedi Shores
LICENSED INSTALLER: RRCExcayatim. Carbondale LICENSE NO.
DESIGN ENGINEER OF SYSTEM:
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
750 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF S(1EEPAGE BED 350 SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: 120—Lft of 101' s112, 75 I ft: (1 2 units) infiltrator per owners request
Keep system uphill as much as possible. Required 2 lines and place inspection por
at end of each line.
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 B� BE�COMPLrETED
NO SYSTEM S *k E DEEMED TO BE IN COMLIANCE WITH THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS UNTIL THE-SYSTEM.1 PPROVED
PRIOR 7 OVERING ANY PORTION OF THE SYSTEM.
IN ALLIED ABSORPTION OR DISPERSAL AREA: IZ SQUA =_ SET.
I STALLED SEPTIC TANK: GALLONS 0_ DEGREES FEET Ca�Y? C rC� I (/\ �e644
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALSAND ASSEMBLY YES NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS:_ YES NO
KED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK j$.C6MP ETED.
COMMENTS:
ENVIRONMENTAL HEALTH OFFICER: A�e� 4/J_A DATE:
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
tals
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: W l l—i i Gym IA/ -
MAILING ADDRESS: 59ile
NAME OF APPLICANT (If different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (If applicable):
CO, PHONE:
0/(a ly
PHONE:
ADDRESS: PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: /4t//+i-1
LICENSED J,N� LLER: (X.) YES ( ) NO
ADDRESS: 0101 AtL— 0_0 a PHONE: dP
PERMIT APPLICATION IS FOR: (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPO AL S ST,M-
Physical Address:���
Parcel Number: .CDT F-/Z_11V&/ Lot Size:
Legal Description:
BUILDING OR SERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential Triplex
NUMBER OF PERSONS: a° NUMBER OF BEDROOMS:
WASTE TYPES Check applicable categories):
Commercial or Institutional (iq Dwelling
( ) Non -Domestic Wastes ( ) Transient Use
( ) Garbage Disposal ( Dishwasher
O 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: (X� 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. YPE OF WATERSUPPLY: ( Well ( ) Spring ( ) Creek/Stream
Giv �pth of al wells within 200 feet of system:
Iffs J W by gmunity,water, give name of supplier: ,• e.V
SIGNATUAE-U lC1"-/ c�"(1 Vr% V V DATE:
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
( ) Othe
AMOUNT PAID: RECEIPT NUMBER DATE:
DATE:
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
(Environmental Health Dept. - Rev. 4/88)
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PERCOLATION TEST ^�
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER: ty ,'�ll`cwH o- o�l�cylf l��ti/C�
LEGAL DESCRIPTION: 10 �_
MAILING ADDRESS: F. 0 Y7 yk
TYPE OF DWELLING: I��S. G
NUMBER OF BEDROOMS
TEST HOLES PRE-SOAKED: YES NO
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PERC RATE: MINIMUM SEPTIC TANK SIZE: 7,S"_�
MINIMUM LEACH FIELD SIZE: ?J-V iA� Z
COMMENTS., % 7 / r lc� `� S i3, 7
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PERC TEST DONE BY:
f, , DATE: W --y°
Envi onmental Health Officer
rev. 6/90ks
Oxford
121 ESSEvrE
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1025-90 TxPrcl# GY
JOB NAME Lot 43, McLaughlin Drive
Filing I, Reudi Shores
--William/Mary __Bovd
J.OB, NQ0
JOB FOLDER Product. 278 5W?® NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 Printed in U.S.A.
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