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HomeMy WebLinkAbout304 Strohm Cir - 211106405024J EAGLE 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 N° 622 328-7311 or 949-5257 or 927-3823 PERMIT NO. P.O. Box 528 - Gypsum, CO 81637 OWNER: James/Jamie Lawrence ADDRESS: 200 W. 20th St - Rifle, CO SYSTEM LOCATION: 304 Strohm Circle (Bertro h St,hrl;�,;a;pXj) LICENSED INSTALLER Gary Bertroch LICENSE NUMBER: 005-83 **CONDITIONAL INSTALLATION APPROVAL is hereby granted for the following: MINIMUM REQUIREMENTS: 1,200 gallon septic tank or aerated treatment unit. Absorption area or dispersal area computed as follows: PERCOLATION RATE: one inch in 5 minutes. Absorption Area per Bedroom 200 .sq. ft. No. of Bedrooms 4 _ x 200 sq. ft. minimum requirement per bedroom 800 total sq. ft. minimum requirement. SPECIAL REQUIREMENTS: DATE: 6/13/83 **CONDITIONS: INSPECTOR: Erik Edeen 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: sq. ft. Installed Septic Tank: gallons. Degrees: Design Engineer of System: Installer of System: Septic tank cleanout to within 12" of final grade or aerated access ports above grade? Yes No _ Proper materials and assembly? Yes No Compliance with permit requirements? Yes No Compliance with County/State regulations requirements? COMMENTS: Feet: Phone: Yes No (Any item checked "No" requires correction before final approval of system is made. Arrange a re -inspection when work is completed.) DATE: INSPECTOR: RE -INSPECTION DATE: INSPECTOR: APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY P.O. Box 850 Eagle, Colorado 81631 No. PERMIT APPLICATION FEE: $150.00 328-7311 PERCOLATION TEST FEE: $50.00 NAME OF OWNER : , e-s `,bl . tJ 0. L 0- ADDRESS: '90C7 �. Qom%• `. . NAME OF APPLICANT (if different from owner): ADDRESS: 05c�Zp yps c%/� DESIGN ENGINEER OF SYSTEM (if applicable): PHONE: PHONE: ADDRESS: PHONE: PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: Licensed Installer (see attached list): ADDRESS: ,eDX -�04/ YES _ NO ,D .� PHONE: PERMIT APPLICATION IS FOR: (>Q New Installation ( ) Alteration ( ) Repair LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Street/Rural Address: Lot Size: Legal Description: lodv BUILDING OR SERVICE TYPE (check applicable category): (� Residential - Single Family ( ) Residential - Duplex ( ) Residential - Triplex NUMBER OF PERSONS: WASTE TYPES (check applicable categories): ( ) Commercial or Institutional ( ) Non -Domestic Wastes (�) Garbage Disposal GX) Automatic Washer ( ) Other TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: QG,I Septic Tank ( ) Composting Toilet ( ) Vault Privy ( ) Greywater ( ) Pit Privy ( ) Aeration Plant ( ) Other ( ) Residential - Quadplex ( ) Commercial (state usage) (X) IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES ( ) NO WASTEWATER FLOW REDUCTION PLAN: YES ( ) NO () (I j Yeas, .6ee attached waztewatetc stow Leduc ti.on methods) NOTE: The Envikonmentat Nemeth OjjiceA may &educe the &equited abz0Apti,on cAea upon app&oval o.j an adequate wastewateA stow &eduction plan. SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( ) Spring ( ) Creek/Stream Give depth of all wells within 200 feet of system: If supplied by community wa er, give name of supplier: 2 SIGNATURE: DATE: - �3 INFORMATION BELOW -TO r.EFILLED OUT BV ENVIRONMENTAL HEALTH OFFICER: GROUND CONDITIONS: PeAcent G&ound Slope z Depth to Bed&ock (pe& 8' P&ojite Hate) Depth to GnoundwateA Tabte / > SOIL PERCOLATION TEST RESULTS:. Minute/s pen tinch in Hate #1 cS Minutes peA inch to Hote # 2 Minuta pe& inch to Hote #3 FINAL DISP By: ( Abso&ption Tench, Bed o& Pit ( ) Evapottcawspvcati.on ( ) Above G&ound Di6peA6at ( ) Sand Fif-teA ( ) UndeAg&ound Dispeu at ( ) Wa3tewate& Pond ( ) OtheA Amount Paid: A 00 •OZ Receipt NumbeA 'a :i Date: - 0 it, 1 NUMBER OF BEDROOMS: t ��t ( ) Dwelling Transient Use (><) Dishwasher Spa Tub ( ) Incineration Toilet ( ) Chemical Toilet ( ) Recycling, Potable Use ( ) Recycling, Other Use WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO NOTE: Site Plan must be attached to application. (Env. Health Department - Rev. 4-07-83) EAGLE COUNTY memorandum To: Subject: Mr. & Mrs. James Lawrence Enclosed ISDS Permit #622 From: File No.: Environmental Health Office T��7 June 28, 1983 This is to inform you that your ISDS Permit #622 has been finalized and signed off by Erik Edeen on June 20, 1983. I am enclosing a copy of this permit for your records. -- Lorraine Funke, Secretary Environmental Health Office Eagle County /if Enc. OWNER. PERCOLATION TEST FEE: S5n 44 -e � r I.S.D.S. APP. LEGAL DESCRIPTION: RURAL/ADDRESS: TYPE OF DUELLING: # OF BEDROOMS: DATE OF PERCOLATION TEST: `'��V� TYPE OF SOIL: TEST HOLES PRESOAKED? Yes No 41� WATER DEPTH PERCOLATION RATE: RECOMMENDED MINIMUM SEPTIC TANK SIZE: lZ RECOMMENDED MINIMUM LEACH FIELD SIZE: RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:©d Site has been reviewed and tested for percolation rate. a—/K;—F�s Date EnvironmentaT7ealtn UTTIcer COMMENTS: w 0622 S.olawet2 -31-9' StrohmLot- F JOB NAME Circle JOB NO. JOB LOCATION BILL TO DATE STARTED 0 DATE COMPLETED cess - f�03D� S1` r e it ?,I'[- X+b�-62H DATE BILLED JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL II TOTAL LABOR PERMIT #622 INSURANCE OWNER: James/ 3amrie Lawrence SALES TAX LOCATION:000304 Strohm Circle (Bertroch Subdivision) Gypsum [ I10 CtCv-S M ISC. COSTS INSTALLER: Gary Bertroch SIZE OF TANK: 1,200 gallons Degrees: 2800/Feet: 12' DWELLING: Single Family - 4 bedrooms x 200 sq.ft. PERC RATE: one inch/5minutes (800 sq.ft.) TOTAL JOB COST Finalized: 6/20/83 By: Erik Edeen GROSS PROFIT LESS OVERHEAD COSTS % OF SELLING PRICE NET PROFIT o IL-DER Printed in USA e