HomeMy WebLinkAbout111 Blue Creek Trl - 239127105004 - 1213-93ISINDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION
P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631
Telephone: 328-8755
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 1 2 1 3
Please call for final inspection before covering any portion of installed system.
OWNER: SukWon Back PHONE: 927-4600
MAILING ADDRESS: P.O. BOX 1224 C;ry: Carbondale State: CO Zip: 81623
APPLICANT: Dick Carney PHONE: 945-4482
SYSTEMLOCATION: 0111 Blue Creek Trail TAX PARCEL NUMBER: 2391-271-05
/-0044
LICENSED INSTALLER: Zamora Excavating, Inc. j LICENSE NO: C / - 9. S
DESIGN ENGINEER OF SYSTEM:
INSTALLATION HEREBY GRANTED FOR THE FOLLOWING:
12 5 (1_ GALLON SEPTIC TANK
ABSORPTION AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED 1273 SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Minimum 34 infiltrator units in trenches. (As per installers request)
Install inspection portal at end of each trench.
ENVIRONMENTAL HEALTH APPROVAL: 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. 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. CHAPTER IV, SECTION 4.03.29 REQUIRES ANY PERSON WHO CONSTRUCTS, ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED.
FINAL APPROVAL OF SYSTEM: (TO BE COMPLETED BY INSPECTOR):
NO SYSTEM SHALL BE DEEMED TO BE IN COMPLIANCE WITH THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS UNTIL THE SYSTEM IS APPROVED
PRIOR TO COVERING ANY PORTION OF THE SYSTEM-.-1
INSTALLED ABSORPTION OR DISPERSAL AREA: Z 1 � SQUARE FEET.
INSTALLED SEPTIC TANK: 1 - 0 GALLON DEGREES_ FEET FROM iiRClyw 00ya-11 ract 54 C C-z q 'Jt
SEPTIC TANK ACCESS TO WITHIN 8" OF FINAL GRADE AND
PROPER MATERIAL AND ASSEMBLY 1,/ YES _ NO
COMPLIANCE WITH COUNTY / STATE REQUIREMENTS: L/YES NO
ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS CORRECTED.
COMMENTS:
ENVIRONMENTAL HEALTH APPROVAL: /C Lmk (�(� P i'C �l DATE: &
ENVIRONMENTAL HEALTH APPROVAL: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS
APPLICANT / AGENT:
OWNER:
PERMIT FEE PERCOLATION TEST FEE RECEIPT# CHECK#
ISDS Permit # /Z
Building Permit #. C!140
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE- EAGLE COUNTY
P.O. BOX 179
EAGLE, CO 81631
328-8755/927-3823(Basalt)
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $200.00
**************************************************************************
PROPERTY OWNER:
MAILING ADDRESS: I&f)r 12Zy i 4AAWYPHONE: yX7 41do0
�. r_�,3^��+,7rT+0�nA?m nT 1CFp.Cf�?S. �%G•j(� Cg��! DidQ7eTE: ZITS yySZ
--
LICENSED SYSTEMS CONTRACTOR: Zi}naaaz,4 �xG'Ari,¢T7�VL !/VG•
ADDRESS: C �,tlQ,q-G,E 11024) PHONE •
***************************************************************************
PERMIT APPLICATION IS FOR: (>d) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description: S0; AJZ,�4 "c% - R 7 7k4d- %s A#Af- ' 8'7do G Pfi
Parcel Number:13:�t:�s�,ei w j Lot size:
Physical Address:
BUILDING TYPE: (Check
(X) Residential /
( ) Residential /
( ) Commercial /
TYPE OF WATER SUPPLY:
O/// atwg heel MCI 64 ✓64fle,
applicable category)
Single Family Number of Bedrooms
Multi -Family* Number of Bedrooms
Industrial* Type
Well UX) Spring ( ) Surface
Public ( ) Name of Supplier:
*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 • l/ `� ��� J vim" yk DATE • '91.1 aly3
*************************************'**************************************
AMOUNT PAID : ,6( oQ RECEIPT# q z� DATE:
) a 3 j q1
CHECK # CASHIER• C_e jaA -
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER.
LEGAL DEgrRIPTION: b0A ::* I s ti1�
i,
MAILING ADDRESS : L, G1C � Z�Z�I l "rll� ��Cj i� �1 �� C L� 2)) (o zz
TYPE OF DWELLING: �'S , NUMBER OF BEDROOMS-1
�k�kYr�yr��1c���Yt�k��k�lr�lc�Y�c �Cyr��k�k�5r���Ir���k�YcYe�r��k��lr�
TEST HOLES PRE-SOAKED:
TIME WATER DEPTH
r!
YES NO
INCHES OF FALL
RATE
SOIL PROF
Time to drop last inch 35
PERC RATE: 5C) MINIMUM SEPTIC TANK SIZE:171 C`aJ�
MINIMUM LEACH FIELD SIZE: 2 Cf_{ek6`��1
,'15
COMMENTS: (1{
PERC TEST DONE BY:
Environmental Health Of icer
rev. 6/90ks
Ljo x
DATE : 3/Zz/ q3
39
Tax Parcel #2391-271-05-004,
?'ue Creek Trail, Sukwon Back
JOB NO.
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 Product 278 ®@ NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MASS. 01471 JOB FOLDER Printed in USA
v
00615
710 - 0�5fx
,P,V " m
*4Sf 4.
17,
lift
—jo*