HomeMy WebLinkAbout2101 Emma Rd - 246511400006INDIVIDUAL 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. 1155 —92
Please call for final inspection before covering any portion of installed system.
OWNER: Christine Lee PHONE: 927-4399
MAILING ADDRESS: 2101 Emma Road, Basalt, CO 81621
AGENT: PHONE:
SYSTEM LOCATION: 2101 Emma Road, Basalt, CO 81621
LICENSED INSTALLER: Ed Dreager 11-92
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:
150 SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Owner requesting Infiltrators - Install 4 Infiltrators in trenches
with inspection portals.
i1
ENVIRONMENTAL HEALTH OFFICER: DATE: � 7 �\^
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: 150 SQUARE FEET. r /
INSTALLED SEPTIC TANK: /000 GALLONS �?d DEGREES '2� 2 FEET rd?o 41W erne+ dT GLtt}�,
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: \,
PROPER MATERIALS ANDASSEMBLY \`�, 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: J ��
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT R: CHECK M: CASHIER:
Incomplete Applications Will NOT Be Accepted
( Site Plan MUST /be at tA-Mched))
SCL� OQGI O � PYC �e�S/
ISDS Permit #
Building Permit #
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY
P. b. BOX 179
EAGLE, CO 81631
328-8755/927-3823 (Basalt)
:+::�Yc:k*�k'Yc��k:r:eJek:��Yc*YtycyeYlYtkYtle*xYe�:l•:t*:�:�yc'Yt1e:�r:k�rA•:�Yc�ycyck;kyc:k:�yckYeye�Ye*xYrYe�',��r:4 �e�
* PERMIT APPLICATION FEE 50 PERCOLATION TEST FEE 125.0
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
:�7r*YrJt�Y*ycYt�tyc�Yt*�k*kYtyc:YY<ycyc�cycYt�ycycx'y[:4ycycYCYtyc���cJc*�ckyc*�*4cYf*��+cyc�yt:l^Yt:+c�*Yc�cyc�Y[��*�c�:ck
PROPERTY OWNER:
MAILING ADDRESS: ��a/ �1�jr�,�/��E.� 'PHONE: 2�7-�/1�/
S 42tjn7>TR1rTOR:
PHONE - PHONE:
COMPANY/DBA :`, Vim`, ADDRESS:
*Ykh'YcycYCYcK'�c�c*Yc:�Ycyc:k**YcYCYCYc�cYc*ycYc* k*Yr*Ycycyc�kY:YtYCYrYc* h�: :�:k*:k:k �cYrycYc****Yr*****
PERMIT APPLICATION IS FOR: (NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description:
Tax Parcel Number: Lot Size�'G'/`�S
Phvsical Address:
BUILDING TYPE: (Check applicable category)
(yResidentialjSingle Family Number of Bedrooms /
( ) Residential/Multi-Family* Number of Bedrooms
( ) Commercial/Industrial* Type
TYPE OF WATER SUPPLY: (Check applicable category)
( ✓j^Well ( ) Spring ( ) Surface
( ) Public Name of Supplier:
*These systems require design by a Registered Professional Engineer
SIGNATURE:
Date. 'S` 9-63--
***vcxvc*vc*vc**vc*vcvcvc*vc**;�c*vc
AMOUNT PAID: �� )— (��`� RECEIPT + : DATE: -)IQ 9
CHECK #: f CASHIER:
TIME LJG: TRAVEL:
9", 4f 5/?`q'L
PERC:
FINAL:
15U5 PERMIT
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER:
LEGAL DESCRIPTION:
MAILING ADDRESS:
TYPE OF DWELLING: �,c�r �.,s NUMBER OF BEDROOMS
TEST HOLES PRE—SOAKED: YES— NO
TIME wnmvn r%VDmv
1
2
3
1
--- ---
2
-
3
••.,.a,�r
1
yr
2
rrii,L
3
KH"1'r;
12
6UIL PROFIT
3
0, /00
�D
62�
7
%t. L.�
6� 5
/, D
/�>
S
3 3
2
� 75
2
)S
F3
61
71
12.
13.0
Ig 2S
5
5
i)
/D
/U
8
/a 7J
/3.5
i9.7�
5
/D
�� �✓ f� o
/0
Time to drop last inch /0
PERC RATE: 0s& 10 MINIMUM SEPTIC TANK SIZE: 756
MINIMUM LEACH FIELD SIZE: ISO 2 or
COMMENTS: OU)r,
L L
tnsQ2G 6h aw'
PERC TEST DONE BY:
DATE: 5
Envi Pnmenta;l Health Officer
rev. 6/90ks $Ve5 r F/o S% �Or eXtl� ' 93%
5
I 1 I '-. , Y I LI YI 1.
ATT—A
Y
I IILJI9L IYV. JI.-�GC'"tt�IJ II•Z'_7. JI_I `vi�u_i 1.-'.1In1I I 1
TeRM,t � liss- qa
10
VA 0 nA-j
oildDs d a
'A
r*
4
7
�
n
5
OZOS 96 GZ:91 90OZ/Z0/PO
1155-92 - Parcel #2645-114-00-006,
2101 Emma Road, Basalt, CO
Christine Lee Gelb ie ( n ,JOB NO,
LAG 1 AlATIAIJ
as
DA'TEE\\)STAJ\RA`TED
DATE COMPLETED
DATE BILLED
l �
420 L
y
1.
n
rn J
�\
S .ram V-
JOB COST SUMMARY
/
v-sL4 � w O u G WIC/ u �
TOTAL SELLING PRICE
TOTAL MATERIAL
p l G� %r. " r(Q !�O✓ �- ` �D rZ
TOTAL LABOR
;. Pi1�J y���-e.. v✓,°�( , / _ ��, r� L� ,. (� G[�Gc k,
INSURANCE
SALES TAX
7 6 _
MISC. COSTS
'LQ,�X lC 0v11L )= l r "U Y .6�'e &'4A
0- 1,;7SD Cl
C-1 (
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
JOB FOLDER Product 278 �e NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MASS. 01471 JOB FOLDER Printed in USA
Cot