HomeMy WebLinkAbout377 Pilgrim Dr - 210519303007 - 0932ISINDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
P.O. Box 179 - 550 Broadway • Eagle, Colorado 81631 g1s�%y
Telephone: 328-7311 or 949-5257 or 927-3823
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 932
Please call for final inspection before covering any portion of installed system.
OWNER: Gary Bossow PHONE: 476-4880
MAILING ADDRESS: Drawer IV I Vail, CO 81658
AGENT:
PHONE:
SYSTEM LOCATION: Lot 4 Pilgrim Downs; 2nd Unit; Only / C/um
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LICENSED INSTALLER: Owner LICENSE NO.
DESIGN ENGINEER OF SYSTEM:
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
1000 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED 15-6 a SQUARE FEET OF TREN H BOTTOM.
SPECIAL REQUIREMENTS: �g�!—
ENVIRONMENTAL HEALTH OFFICER: DATE: 0
CONDITIONS:
1. ALL INSTALLATIONS MUST COMPLY WITH ALL REQUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM
REGULATIONS, ADOPTED PURSUANT TO AUTHORITY GRANTED /N 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.
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INSTALLED ABSORPTION OR DISPERSAL AREA: SQUARE FEET.
INSTALLED SEPTIC TANK: ®"40 GALLONS DEGREES FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALSAND ASSEMBLY YES NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: A, YES NO
ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS COMPLETED.
// 1
COMMENTS: w�XIAx ayycl,
ENVIRONMENTAL HEALTH OFFICER:- DATE:
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AG ENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
n� APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT 3322
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number:
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail 328-7311 Eagle 927-3823 Basalt
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00
NAME OF OWNER: Gary Bossow
MAILING ADDRESS: Drawer nX" Un Sege ale 8 �� PHONE: 476-4880 CMA
NAME OF APPLICANT (If different from owner): Same
ADDRESS: Same PHONE:
DESIGN ENGINEER OF SYSTEM (If applicable): Owner
ADDRESS: Same
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: owner
LICENSED INSTALLER: ( ) YES ( x) NO
ADDRESS: same
PHONE:
PHONE:
PERMIT APPLICATION IS FOR: ( x) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address:
Parcel Number: Lot 4 Pilgrim Downs Lot Size: 6.1 Acres
Legal Description: Lot 4 Pilgrim Downs
BUILDING OR SERVICE TYPE (Check applicable category):
x Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: NUMBER OF BEDROOMS:
WASTE TYPES Check applicable categories):
Commercial or Institutional (') Dwelling
( ) Non -Domestic Wastes ( ) Transient Use
( ) Garbage Disposal ( ) Dishwasher
( ) Automatic Washer ( ) Spa Tub
( ) Other (Specify):
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank Composting Toilet ( ) Incineration Toilet
( ) Vault Privy ( ) Greywater ( ) Chemical Toilet
( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Portable Use
( ) Other ( ) Recycling, Other Use
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: ( ) YES (') NO
IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: (;) YES ( ) NO
WATER CONSERVATION PLAN: ( ) YES ( ) NO
NOTE: The Environmental Health Office may reduce the required absorption area upon
approval of an adequate water conservation plan.
SOURCE AND TYPE OF WATER SUPPLY: (y ) Well ( ) Spring ( ) Creek/Stream
Give depth-OT-la�j wel ithin 200 feet of system:
f d b t er ive name of su liar•
I F i y w g pp
SIGNATURE: DATE:
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 Huie #i
Minutes per inch in Hole #2
Minutes per inch in Hole #3
FINAL DISPOSAL BY:
Absorption Trench, Bed or Pit
( ) Above Ground Dispersal
( ) Under Ground Dispersal
( ) Other
AMOUNT PAID:
( ) Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION:
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER RECEIVED
(Environmental Health Dept. - Rev. 4/88)
J U L 3 1 1989
EAGLE COUNTY
COMMUNITY DEVELOPMENT
PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE: $125.00 ISDS APPLICATION NO.
OWNER:
LEGAL DESCRIPTION: 11./ G
RURAL ADDRESS: e/
v
TYPE OF DWELLING: NUMBER OF BEDROOMS:
DATE
OF PERCOLATION TEST:
V �� '� TYPE OF SOIL:
TEST
HOLES PRE-SOAKED:
YES NO
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PERCOLATION
RATE:
1�71_2 "Z
RECOMMENDED
MINIMUM
SEPTIC TANK SIZE:
RECOMMENDED
MINIMUM
LEACH FIELD SIZE.
RECOMMENDED
MINIMUM
SQUARE FOOTA PER BEDROOM:V
i
--10T f /
SITE HAS BEEN REVIEWED AND TESTED FOR PERCOLATION RATE.
55
Environmental Health Officer Date
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COMMENTS: 2 Sri J-P�i�
C-S-e
Rev. 5/31/84
932 Bossow Lot 4 Pilgrim Downs
JOB NAME_
JOB NO. O
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
PERMIT NO. 932
OWNER; Gary Bossow
LOCATION: LOT 4 Pilgrim
2nd Unit Only
INSTALLER. OWNER
SIZE OF TANK. 1000 gal.
DWELLING: 5 Bedrooms
PERC RATE: 40 MPI
ABSORPTION AREA: 180 if
Finalized: 11-14-89
Downs
of SB2
BY: RPM, RS
STS
)TAL JOB COST
GROSS PROFIT
=_SS OVERHEAD COSTS
Rio OF SELLING PRICE
NET PROFIT
JOB FOLDER Product 278 Q® NEW ENGLAND BUSINESS SERVICE, INC., c Parcel N o . 210 b -193 - 03 - 00 /
Pdnted 10 U.S.A.
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Gordon R. Pierce
A.I.A.
ARCHITECTURE
PLANNING
DEVELOPMENT
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Vail Office
1000 South Frontage Road West
Vail, Colorado 81657
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303/476-4433 .
Beaver Creek Office
P.O. Box 2313
Beaver Creek, Colorado 81620
303/949-6049
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Revisions:
09
Job No:
Drawn By:
Checked By:
Date: 06/27/1989
Sheet 1 Of
S-1
