HomeMy WebLinkAbout5001 Salt Creek Rd - 210728400043INDIVIDUAL 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 1 02
Please call for final inspection before covering any portion of installed system.
OWNER: Dexil & Thea Rold PHONE: 584-6856
MAILING ADDRESS: 142 W. Terrace Drive, Hanford, CA 93230
AGENT: Merle Hobbs, Box 703, Eagle, CO 81631
PHONE:
SYSTEM LOCATION: 4.9 miles from Salt Creek turn off, up Salt Creek
LICENSED INSTALLER: Merle Hobbs LICENSE N0.42-91
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 150 SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Septic tank and Absorption trenches must be 50 feet AWAY FROM STREAM
AND POND. Install inspection portals at end of each trench.
Installer requesting 10" SB2 = 60' of 10" SB2 pipe in a trench configuration
ENVIRONMENTAL HEALTH OFFICER: DATE: 10/8/91
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 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: 4976e SQUARE FEET. #114
JJ�1�'
INSTALLED SEPTIC TANK: /� 50 GALLONS DEGREES 5FEET >Ce►r► 5N/. 6r,4600' dl /6S e
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.. e•r- 1 L
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
ISDS Permit
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:J� ---J)4,PHONE:
APPLICANT/CONTACT PERSON: r�!%� �p%S= PHONE:
LICENSED SYSTEMS CONTRACTOR:��i'Z413 J
ADDRESS: &A 703�---� ( /
*******xcxtarxrxx*rx*xr **rrrxxxxrrxsrxrxrar PHONE:tyrytxxx tx 7`�*
PERMIT APPLICATION IS FOR: ( ) NEW INSTALLATION { ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDU SEWAGE DISPOSAL SYSTEM:
Legal Description : S 7 -- ..A S P3 G�
Parcel Number: -:21n7Lot site:
Physical Address.
BUILDING E: : •- (Check applicable category)
(TYKResidential / Single Family Number of Bedrooms
(-) Residential / Multi -Family* Number of Bedrooms
( ) Commercial / Industrial* Type
HOT TUB - Yes ( ), No
WATER CONSERVATION PLAN: Yes ( ) No
TYPE OF WATER SUPPLY: Well(.) -Spring 'f Surface ( •)
Public ( ) Name of Supplier:
Give depth of all wells within 200 feet of system:
*These systems require design by a Registered Professional Engineer
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
SIGNATURE:
1/1'� o /�� / Z_
**********r *xx xrrxxxxx�r�e�rx yr�r x�ror xrr*x�rr��r*Err�� yr*�
AHOUNT-PAID.
�J RECEIPT# �D-� DATE:
CHECK CASHIER:
ZME LOG
Travel Perc Final
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RECEIVED
OCT 0 7 In
EAGLE COUNTY
COMMUNITY DEVELOPMENT
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ISDS PERMIT # IpZ
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER: 1)eXi I �o�� -
LEGAL DESCRIPTION: q9 miles try �/1 Creek lvrr OR, up S-N C "k �cy
MAILING ADDRESS: ✓�if'�r% �� 3,Y 703
TYPE OF DWELLING: SF R"s NUMBER OF BEDROOMS_
TEST HOLES PRE-SOAKED: YES_ NO
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PERC RATE: Mp1 MIN} j SEPTIC TANK SIZE: %SQ
MINIMUM LEACH FIELD SIZE : _Tsi-��e� r �esl� ld SaZ = �d oT /d �582 r e
COMMENTS :IF
onGE / N!!3' Li75/w// L �%sE'c�7{p,rr Tor fa / cam" C ef L^arc /�G-Gfn
PERC TEST DONE BY:
EnviroraTnentaV Health O
rev. 6/90ks
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DATE: i-?7-91
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JOB FOLDER Product 278 ®® NEW ENGIAND BUSINESS SERVICE, INC., GROTON, MA 01471 Printed in U.S.A.
JOB FOLDER
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