HomeMy WebLinkAbout4535 Frying Pan Rd - 246702300023INDIVIDUAL 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. 1096
Please call for final inspection before covering any portion of installed system.
OWNER: Ralph and Carolyn Pearce PHONE: 234-9380
MAILING ADDRESS: 3321 Vivian Ct, Wheatridge, CO 80033
AGENT: PHONE:
SYSTEM LOCATION: 4535 Frying Pan Road, Basalt Tract 41 Sec/Twn/Rnc
LICENSED INSTALLER: Dreager Excavating LICENSE NO. 10-91
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 SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Repair of existing system: 1000 gal tank being requested by
owner being installed
CALL FOR FINAL INSPE TION BEFORE COVERING ENVIRONMENTAL HEALTH OFFICER: DATE: / G�
CONDITIONS:
1. ALL INSTALLATIONS MUST COMPLY WITH ALL REQUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM
REGULATIONS, ADOPTED PURSUANT TO AUTHORITY GRANTED /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 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: SQUARE FEET.
INSTALLED SEPTIC TANK: GALLONS DEGREES FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALS ANDASSEMBLY YES NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: YES NO
ANY ITEMCHECKEDNO REQUIRES CORRECTION BEFORE FINIAL AP OVAL OF SYSTEM IS MADE.. ARRANGE A RE -INSPECTION WHEN WORK IS COMPLETED.
COMMENTS: �/ $�Pinl %e /ram/ q6 '0i' e' 7� e,/`
ENVIRONMENTAL HEALTH OFFICER: DATE: IZ.3�� 9�
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANTIAGENNT: �)
AMOUNT PAID: l X lCil�l��I ECEIPT #:
OWNER:
CHECK #: CASHIER:
idly L
LICENSED SYSTEMS CONTRACTOR:
ADDRESS: � p ,rr t `{ �''� -r r- PHONE: I"a % - JYJ
*****yc,rxxx xxx*'t'oxxxttrrttx�rtrtrxxtx�rttxrrrxxtc*xxyrrx�rxxxxxrrxx�r
PERMIT APPLICATION IS FOR: ( ) NEW INSTALLATION { ) ALTERATION
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description: lre&r- jel ���
Parcel Number: �/ �,J Lot size:
Physical Address : y3 r Y„lG
w ma,c,
rug. s E
x*xxx,r
REPAIR
BUILDING TYPE: - -- (Check applicable category)
(!� Residential / Single Family Number of Bedrooms .Z
( ) Residential./ Multi -Family* Number of Bedrooms
( ) Commercial / Industrial* Type
HOT TUB, - Yes { ). No
WATER CONSERVATION PLAN: Yes ( ) No (✓)_ _
TYPE OF WATER SUPPLY: well(✓) .Spring-( ) Surface { -)
Give depth of all wells within 200 feet of system: 6se.FEar
'rThEse ,systems require design by a Registered Professional Engineer
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION
MAKE ALL REMITTANCE PAYABLE TA�? -EAGLE COUNTY TREASURER -
s
11
ISDS Permit # �� 0/'
Building Permit #
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE- EAGLE COUNTY
P.O. BOX 179
EAGLE, CO 81631
328-8730/927-3823(Basalt)
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00
PROPERTY OWNER:
MAILING ADDRESS: 22.L r
APPLICANT/CONTACT PERSON:
SIGNATURE: xD
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AMOUNT- PAlt:Xl RECEIPT# ry
DATE:
CHECK # CASHIER:
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REPAIR PERMIT APPLICATION
FOR INDIVIDUAL, SEWAGE DISPOSAL SYSTEMS
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 Disposal System
Regulations adopted and effective March 27, 1980.
For minor repairs of less than 51o0.00 for maintenance of the individual
sewage disposal system, no fee shall be required.
A percolation test fee of $125.00 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. I£ A NEW SYSTEM IS
REQUIRED, ALL FEES ARE APPLICABLE.
DESCRIPTION OF PROBLEM/MALFUNCTION:
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TYPE AND SIZE OF SYSTEM PRESENTLY IN USE: /fit,
DATE PRESENT SYSTEM WAS INSTALLED: 1596 %
PERMIT NUMBER FOR ORIGINAL SYSTEM, IF A PERMIT WAS ISSUED -BY THIS
DEPARTMENT: #
SITE PLAN BELOW SHOWING PRESENT SYSTEM COMPONENTS:
p7�,E•
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OWNER OF SYSTEM: .4zror/ .4�ocY,✓ /j'j
ADDRESS: ,?I i
APPLICANT: 'a6�
,4vo-✓ADDRESS :
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DATE:-3-9/
2c/aPp 2/91
PHONE:
PHONE:
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JOB NAME 1096-91 !� j V p
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(05B 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 Produpt.278 Q® NEW ENGLAND BUSINESS SERVICE, INC„ GROTON, MA 01471 printed in U.S.A.
JOB FOLDER
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