HomeMy WebLinkAbout25187 Hwy 6 - 194108400055EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
PLEASE CALL FOR FINAL P. 0. Box 850 - 550 Broadway PERMIT MUST BE POSTED
INSPECTION BEFORE COVERING Eagle, Colorado 81631 AT INSTALLATION SITE
ANY PORTION OF INSTALLED SYSTEM
328-7311 or 949-5257 or 927-3823 PERMIT NO. N o 52 4
OWNER•Colorado State Highway Dept. ADDRESS: 4201 E. Arkansas, Denver, CO
SYSTEM LOCATION: Wolcott Trailer Park - east end of park
LICENSED INSTALLER: owner -installed k
LICENSE NUMBER:
**CONDITIONAL INSTALLATION APPROVAL is hereby granted for the following:
MINIMUM REQUIREMENTS: gallon septic tank or aerated treatment unit.
Absorption area or dispersal area computed as follows:
PERCOLATION RATE: 1 inch in 10 minutes.
Absorption Area per Bedroom sq. ft.
No. of Bedrooms 6 X 215 sq. ft. minimum requirement per bedroom
= 1300 total sq. ft. minimum requirement. / } b Isdn
SPECIAL REQUIREMENTS: This is a repair permit. Will use the ;existing septic
tank. Is installing a new leach field. Permit is for A3x�0&,M,M
six bedrooMa for two Mobile homes,
DATE: July 9, 1981 INSPECTOR: Sidney N. Fox��•
**CONDITIONS: '"9"`, -0-
1. All installation must comply with all requirements of the 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 building and zoning 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: No system shall be deemed to be in compliance with the Eagle
County Individual Sewage Disposal System Regulations until the installed system is
approved prior to covering any part.
Installed Absorption or Dispersal Area: / 41�O b sq. ft. /
Installed Septic Tank: �?V gallons. PK� TPe p-)
Design Engineer of System: IS�Y ,ti ar
Installer of System: /"7 ,:, Phone:
Septic tank cleanout to within 12" of final gr or
aerated access ports above grade? Yes 10
Proper materials and assembly? Yes No
Compliance with permit requirements? Yes No
Compliance with County/State regulations requirements? Yes No
COMMENTS: 7// , ,o,. rk2� / '.1 r,
(Any item checked "No" requires correction before final approval of sy tem is made.
Arrange a re -inspection when work is completed.)
DATE: `%� ,/5- INSPECTOR:
RE -INSPECTION DATE: INSPECTOR:
RETAIN WITH RECEIPT RECORDS PERMIT NO. NO 524
CHARGES State is exempt from charges Name of Applicant: State Highway Dept.
Percolation Test = $50.00 Name of Owner: same
Permit Fee (includes final inspection) = Amount Paid: State Govt. is exempt - n/a
ALL CHECKS OR MONEY ORDERS ARE TO BE Receipt Number: ---
MADE PAYABLE TO: EAGLE COUNTY Cashier: ---
White and Pink Copies - Environmental Health Department Green Copy Applicant/Owner
BUILDING OR SERVICE
( ) Residential - Single Family
( ) Residential - Duplex
( ) Residential - Triplex
NUMBER OF PERSONS: 3 1 ap'. Il.S(LS
WASTE TYPES (check applicable categories):
( ) Commercial or Institutional
( ) Non -Domestic Wastes
( ) Garbage Disposal
( ) Automatic Washer
( ) Other
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
i EN'VIRON'IENTAL HEALTH OFFICE - EAGLE COUNTY
P.O. Box 850
Eagle, Colorado 81631 No. a Z 5!
•PERMIT APPLICATION FEE: $150.00 328-7311 PERCOLATION TEST FEE: $50.00
NAME OF OWNER:
ADDRESS:
S
i q, i.la"v .S
NAME OF APPLICANT (if different from owner):
ADDRESS:
9
DESIGN ENGINEER OF SYSTEM (if applicable):
ADDRESS:
PERSON RESPONSIBLE FOR L1VJ1riLlui11v1V yr ;�iSI "I_:
Licensed Installer (see attached list):
Q, PHONE:
6
PHONE: 2V 7 le Cl
%if a-0
PHONE:
YES NO
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: ( ) New Installation ( ) Alteration ( k%j Repair
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Street/Rural Address:
Lot Size:
Legal Description: & UT�. TW fgs f 0t`.rraC_& -/'f �5A F-9 W.� GAF
( ) Residential _ Quadplex
( ) 2omm7ciai (state usage)'
NUMBER OF BEDROOMS:
( Dwelling
( ) Transient Use
( ) Dishwasher
( ) Spa Tub
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( Septic Tank ( ) Composting Toilet ( ) Incineration Toilet
( ) Vault Privy ( ) Greywater ( ) Chemical Toilet
( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Potable Use
( ) Other ( ) Recycling, Other Use
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO (c/)
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES (/S NO ( )
WASTEWATER FLOW REDUCTION PLAN: YES ( ) NO
(I� yes, see attached tua6tewateA 6tow neducti.on methods)
NOTE: The Envi tonmentat- Heaf th 064ice/t may teduee the AegLvked absotption area upon
apptova2 a4 an adequate wa�stewatetc 6Zow neduction plan.
SOURCE AND TYPE OF WATER SUPPLY: (,4 Well ( ) Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system:
If supplied by community water, give name of supplier:
SIGNATURE: DATE: ZFZ
- - - - - -
INFORMATION BELOW r10BE FILLED OUT By ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: PeAcent Gnound Stope
Depth to Bedno ck (pen 8' Pno 4 ite Hote )
Depth to GAoundwaten Tab.2e
SOIL PERCOLATION TEST RESULTS: inute/s pen inch in Hote 1
Minutes pen inch to Ho.Ee #2
Minutes pen .inch to Hote # 3
FINAL DISPOSAL BY:
( ) AbwLption Tnench, Bed on Pit ( ) Evapottampikation
( ) Above Gnound DLpeuat ( ) Sand Fitters
( ) Unde/tgtound DZspeuat ( ) Wastavaten Pond
( ) Othet
Amount Paid: 6 IN Receipt Numbet Date: J
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
NOTE: Site Plan must ber=2a,trtac3h�e� to a{ppl i� IM n� 4
(Env. Health Department - Rev. 4-07-83)
t
FEE: $50
APPLICATION "0.
OWN ER: 71 e
LEGAL DESCRIPTION:
RURAL ADDRESS:
TYPE OF DWELLING: yyj�/ IF s # OF BEDROOMS: 62
DATE OF TEST: %= �J- �� TYPE OF SOIL:
TEST HOLES PRESOAKED: YES Ll--' NO S"' � X¢0 G l
a
TIME
WATER DEPTH
INCHES OF FALL
RATE
1
2
3
1
2
3
1
2
3
1
2
y3
IL
PERCOLATION PATE: �D �J� / TANK SIZE• ��� - � .�' ! 1 /�
LIT —
SQUARE FOOTAGE PER BEDROOM: � LEACH FIELD SIZE: �OC� / �,�%o�✓
Site has been reviewed and tested for percolation rate.- - K. X O
L:e reco-,mend: APPROVAL (// DISAPPROVAL
r'
DATE: --7 r 91— I
EAGLE COUNTY f'
" ,� ENVIRONTMENTAL A TH OFFICER
PLEASE kn URN THIS POR-iIOiV WITH YOUR SIIL PLAN AND FEES
'328-7311 949-5257 927-3823
{ ENVIRONMENTAL HEALTH
BOX 850
EAGLE, COLORADO 81631
PERMIT _ S75 PERCOLATION TEST FEE = 50
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
NAME OF OWNER:
ADDRESS: 'y 2
NAME OF APPLICANT ( I F DIFFERENT FROM OWNER) :
ADDRESS: o6 o K 6 3 A Vow, Ca /e Ff 6-7 o
DESIGN ENGINEER OF SYSTEM (IF APPLICABLE):
ADDRESS:
NO. 8F0
PHONE: 757- 9331
PHONE:
9419- -V'/*o
PERSON.RESPONSIBLE FOR INSTALLATION OF,SYSTEM: ldiedtJ7Ge
ADDRESS:.,Ro Y j*(, 3. Ayy*). e /6 S I &Jo PHO IE: ?y Q+ WOO
PERMIT APPLICATION IS FOR: ( ) New Installation ( ✓) Alteration Repair
LOCATION OF PROPOSED FACILITY: County Lot Size
City or Town, if within City or Town Limits
LEGAL DESCRIPTION: Ja i- �Lj4> , JW Flu .Sec K
STREET (RURAL) ADDRESS: ��,vg 6twtt•� !,(fS. G %�e F�a� �'�yr✓
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY? Yes ( ) No
BUILDING OR SERVICE TYPE: (Check applicable category)
( a Residential - Single-family dwelling
( ✓) Residential - Duplex -_T�vo '%W§
( ) Commercial - State usage
# Persons f J # Bedrooms 3
WASTE TYPES: (Check all applicable)
( ) Commercial or Institutional
( ) Non -domestic wastes
( ) Other -- - -
Residential - Triplex
Residential - Quadplex
Dwelling
( ) Transient Use
( ) Garbage Grinder
( ) Dishwasher
(� Automatic Masher
SOURCE AND TYPE OF WATER SUPPLY: ( ✓) Well ( ) Spring ( ) Creek or Stream
Give depth of all wells within 200 feet of the system: 1
If supplied by community water, give name of supplier:
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( ✓� Septic Tank ( ) Aeration Plant ( ) Chemical Toilet
( ) Vault Privy.. ( ) :Composting Toilet ( ) Recycling, Potable Use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, Other Use
( ) Greywater ( ) Other
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO 14ATERS OF THE STATE?
Si gnatur 0, 2(2 ;Xk
( ) Yes ( ✓ ) No
Date ;7— /— Pl
* * * * * * * q * * * * * * * * * * * * * * * * * * * * * * *
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 No. 1
Minutes per inch in Hole No. 2
Minutes per inch in Hole No. 3
FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Above Ground Dispersal ( ) Sand Filter
( ) Underground Dispersal ( ). 'Wastewater Pond
( ) Other
. -1
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COPELAND CONCRETE, INC.
28803 us Hwy 6 Rifle, Co 81650 Phone: 625-1112
Some one must be on the job
at time of delivery to help
our driver, or we will send
an extra man at M 00 Rr.
Thank You.
101
Baffle and tee
built in.
8► ].3"
17" 13"
20"
7K7
i
5i4`► 41 lA" Knock'outs
� 40
Bottom thickness 4"
5'
Top Thickness 411
Concrete baffle
divides 1/3 on
outlet side &
2/3 on inlet side.
Model C.H. 1250 Gallon Septic Tank. Concrete bottom & side walls
reinforced with " 10-10 mesh plus 4-3/8 rebar in bottom. Top reinforced
with " ".1neah & 6-3/8 rebar.
Digging Specs: 6t wide x 111 long. 41 10" from bottom of excavation
to center of inlet. 41 7" from bottom to the outlet.
Drawing Page 33
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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 $100.00 for maintenance of the individual sewage
disposal system, no fee shall be required.
A percolation test fee of $50.00 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-CONFORt-LING, ANEW SYSTEM SHALL- BE INSTALLED,
COMPLYING WITH ALL CURRENT REGULATIONS._ IF A NEW SYSTEM IS REQUIRED, ALL FEES ARE
APPLICABLE.
-DESCRIPTION OF PROBLEM/MALFUNCTION:, JA,M ISY ® i Sd k CPi�t�
TYPE AND SIZE OF SYSTEM PRESENTLY IN USE:
DATE PRESENT SYSTEM WAS INSTALLED:
PERMIT NUMBER FOR ORIGINAL SYSTEM, IF A PERMIT WAS ISSUED BY THIS DEPARTMENT: #
SITE PLAN BELOW SHOWING PRESENT SYSTEM COMPONENTS:
Y,
OWNER
APPLI
ADD
DATE:
JOB NAME _
0524
Wolcott Trailer Park
East
en
Hsi
G
JOB 'NO.
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
IW6'��
YA �
�'.& �
QC -
141 �L� �
9
_
MOTE D,v V40LCUt\
1 5r7`S RieAV2- £2r+-T
Adel ss 661/0-J u� o
-----
-- --
T07 Sby,n- a(u1u wI� WCCiPd 1�a5e�
TOTAL N
PERMIT #524
TOTAL �!o
OWNER: Colorado
State Highway Department
INS -- _--�•- -� �-- I.
LOCATION:
Wolcott Trailer Park
(east end of park)
SA
MISc. COSTS
INSTALLER: Owner
SIZE OF TANK: REPAIR PERMIT FOR NEW LEACH FIELD ONLY
215 sq.ft.
DWELLING:
Two trailers - total
of 6 bedrooms x
(1,300 sq.ft.)
PERC RATE:
One inch/10 minutes
TOTAL JOB COST
GROSS PROFIT
Finalized:
7-15-81
By: Erik Edeen
LESS OVERHEAD COSTS
% OF SELLING PRICE
JOB FOLDER Product 278 Qp NEW ENGLAND BUSINESS SERVICE, U
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INDIVIDUAL 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. 10 3
Please call for final inspection before covering any portion of installed system.
OWNER: Department of Highways c/o Leonard Oeltjenbruns PHONE: 945-7441
MAILING ADDRESS: BOX 1430, Glenwood Springs, CO
AGENT: PHONE:
SYSTEM LOCATION: Wolcott Trailer Park (West End)
LICENSED INSTALLER: Leonard Oeltj enbruns (Hiway Mtco Supervisor) LICENSE NO.
DESIGN ENGINEER OF SYSTEM,
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
(2) 1000 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: 854 square feet trench/280 square feet 10" SB2/29 infiltrator chambers
REPAIR PERMIT FOR NON CONFORMING SYSTEM.
Place portals at end of each trench.
Z.
lor 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 COMLIANCE WITH THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS UNTIL THE SYSTEM IS APPROVED'
PRIOR TO COVERING ANY PORTION OF THE SYSTTEE���M�. ,, /{,
INSTALLED ABSORPTION OR DISPERSAL AREA: f/� SQUARE FEET. P/Gt l '/� ^��r%5
INSTALLED SEPTICTANK� DOD GALLONS ar
DEGREES 35 FEET N.W. cc/ner pf/�
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: \
PROPER MATERIALS ANDASSEMBLY V 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: - 9/
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
ISDS Permit # 1�03
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: Ca .G b v F T, 4/,j s /Do L• �R� f i a �,,
MAILING ADDRESS: A 0, /3 D30 , lr� one W 0 0J Jpl2rn,y� PHONE • `=i' �� � - 94gl
APPLICANT/CONTACT PERSON: 5 PHONE: 9 - % 4141
LICENSED SYSTEMS CONTRACTOR: L ebti p,e U AIs (//L,, fc p v .1
ADDRESS: P 13 S j
. 0 , a /y 3 6 , o o %=2 /A' 5, (0 PHONE: -7 At' � 1-/ 41
77
PERMIT APPLICATION IS FOR: ( ) NEW INSTALLATION () ALTEP.ATION
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: { ) REPAIR
Legal Description:
Parcel Number: Lot size:
Physical Address:
BUILDING TYPE: - -- (Check applicable category)
{ Residential / Single Family Number of Bedrooms���„ es�� ( ) Residential / Multi -Family* Number o Bedr oms
( ) Commercial / Industrial* Type i1/1IT; , anQ S HOT TUB .._ Yes ( ). No
WATER CONSERVATION PLAN: Yes ( ) No
TYPE OF WATER SUPPLY: Well( Spring,( ) Surf ce
Give depth of all wells within 200 feet of system: wo Co Lc,
O
*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"
s _
SIGNATURE: DATE : _s
*��x��*xrrrrrxraxrrrycxyr*s****�rr�r 7rxr*r*�r*xxs**�"',r
AMOUNT' PAID : CDOH N/o Fee- RECEIPT#
DATE:
CHECK # CASHIER:
TIME LOG
Travel Perc Final
I
COMMUNITY DEVELOPMENT
DEPARTMENT
(303) 328.8730
EAGLE COUNTY, COLORADO
November 25, 1991
Department of Highways
c/o Leonard Oeltjenbruns
Box 1430
Clenwood Springs, CO 81601
RE: Final of ISDS Permit No. 1103
Dear Mr. Oeltjenbruns:
725 CHAMBERS AVE.
P.O. BOX 179
EAGLE, COLORADO 81631
FAX (303) 328.7207
This letter is to inform you that the above referenced ISDS
Permit has been inspected and finalized. Enclosed is a copy to
retain for your records. Also enclosed are informational sheets
regarding the care of your septic system.
If you have any questions regarding this permit, please contact
the Eagle County Environmental Health Division, P.O. Box 179,
Eagle, Colorado 81631. We can also be reached, depending on your
calling area, at the following numbers: Eagle Valley 328-8730;
Basalt/El Jebel 927-3823.
Sincerely,
Y
C. Kelley Carhart
Office Assistant
ckc
Encl: Information Sheets
Final ISDS Permit
cc: Chrono File
ISDS File
Building Permit Filey
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ISDS PERMIT 7 1163
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER: De
p q `ul �lTlP.hbruns �l
LEGAL DESCRIPTION: V
MAILING ADDRESS : PQ 'Boy 1436 Glenujaa .5 rin NO,
TYPE OF DWELLING: 5F R //
��b,�Je /aWx°-s NUMBER OF BEDROOM, 3+3 i
TEST HOLES PRE-SOAKED: YES NO
TTMP. 'rT. .TT"^ ter. r.wt.
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PERC RATE: l/SE /D - MINIMUM SEPTIC TANK SIZE:
MINIMUM LEACH FIELD SIZE: ?54 %2 �r&"A 980 R oT 10"5$l/�q fh-Fi14,Jor vb"Le,,
COMMENTS : �512C_lr pelrt3111 Fz*- nd)i ctm Ermihq 5y5&VIII,
PERC TEST DONE BY:
EnvirogmentalV Hea
rev. 6/90ks
cer
DATE: 9, '2 - 9/
10 x 135o / CPJv
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FEE: $50
APPLICATION '30.
MINER:
LEGAL DESCRIPTION:
RURAL: ADDRESS.
TYPE OF MJTELLING : /�%ZQ� # OF BEDROOMS:
DATE OF TEST: TYPE OF SOIL:
TEST HOLES PRESOAKED: YES NO
TIM'�IE 11 WATER DEPTH II INCHES OF FALL 11 RATE
PERCOLATION PATE: 1
SQUUE FOOTAGE PER BEDROOML: OD
TANK SIZE:
LEACH FIELD SIZE: Q
Site has baen reviewed and tested Cor percolation race.-
Ve reco=—,end: APPROVU �� DISAPPROVAL
DATE:<
EAGLE C UN;TY
)ATE REFERRED
h
ROUTE FORM
CeAo - SAcNe 9c wot
N i _E
Coit t4w', . �P-_fhA?.
LOCATION
APPLICATION NO.
.'lease review the attached application and return it and this completed form
=o the Environmental Health Office..
I A TTTT T ITt�
,omments
Complies with: Yes No Reviewed By
Subdivision Regulations
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PLEASE RE I UkIV '[HIS POR"i UN 11iI i H YOUR -SITE PLAN AND FEES
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PERMIT FEE = $75
949-5257 927-3323
ENVIRONMENTAL HEALTH BOX 850 lw�
EAGLE, COLORADO 81631
PERCOLATION TEST FEE = $50
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
NAME OF OWNER: Co Ia �'ia le- A.44 A so ati tDepl.
ADDRESS: 'y?o / E',Is/ 141?ll, A,,-VIts PHONE: 7S 7
NAME OF APPLICANT (IF DIFFERENT FROM OWNER)- 104ce,, jDR,'c -7-
ADDRESS: 0y %4 .14 3 /q 00 _ (10 /0 S(l6 2 a PHONE: � y q� y,/1►o
DESIGN ENGINEER OF SYSTEM (IF APPLICABLE):
ADDRESS:
PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: ,Cp��ea �.Q.•eTN
ADDRESS: 63 Vo.yt�pfd S fb.2e PHONE: 7#9- 4//6d
PERMIT APPLICATION IS FOR: ( ) New Installation Alteration ( Repair
LOCATION OF PROPOSED FACILITY: County ;",a s /!c.
City or Town, if within City or Town Limits
LEGAL DESCRIPTION:
STREET ( RURAL) ADDRESS: he Lc S (a 4-
Lot Size ' #e c,
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IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY? (--� Yes ( ) No
BUILDING OR SERVICE TYPE: (Check applicable category)
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1103-91
JOB NAME,
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JOB, NO. 7
.40'JOEI LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
- - -
t'
- --
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 JOB FOLDER Printed in U.S.A