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HomeMy WebLinkAbout120 Red Hill Rd - 211105314003INDIVIDUAL 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. 1080 Please call for final inspection before covering any portion of installed system. OWNER: Brian and Pam Bergstreser PHONE: (w) 328-6361 MAILING ADDRESS: P.O. BOX 581, Gypsum, CO 81637 AGENT: PHONE: SYSTEM LOCATION: 120 Red Hill Rd, Gypsum Lot 13, Filing 2, Tract 71, Bertroch Subdiv. LICENSED INSTALLER: W. Ye. Coonstruction LICENSE NO. 17-91 DESIGN ENGINEER OF SYSTEM: INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING: GALLON SEPTIC TANK OR 1000 GALLON AERATED TREATMENT UNIT. DISPERSAL AREA REQUIREMENTS: SQUARE FEET OF SEEPAGE BED 375 SQUARE FEET OF TRENCH BOTTOM. SPECIAL REQUIREMENTS: 140' of 10" SB2 requested by owner. Inspection portals at end of each trench. ENVIRONMENTAL HEALTH OFFICER:. c " DATE: CONDITIONS: 1. ALL INSTALLA ONS MUST COMPLY MENTS OF THE EAGLE COUNTY IN, SEWAGE DISPOSAL SYSTEM REGULATIONS, ADOPTED PURSUANT TO AUTH ITY GRANTED IN 25-10.104, C.R.S. 1973, AS AMENDED. 2. THIS PERMIT IS VALID ONLY FOR CONNECTI N 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. c INSTALLED ABSORPTION OR DISPERSAL AREA: 4$SQUARE FEET. Yloi ��W4F ® ' 512- ly(�� INSTALLED SEPTIC TANK: IP00 GALLONS 310 DEGREES 30 FEET Tf7 c fi Z1/ SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: I 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: ENVIRONMENTAL HEALTH OFFICER: DATE: (RE -INSPECTION IF NECESSARY) RETAIN WITH RECEIPT RECORDS PERMIT APPLICANTIAGENT: OWNER: AMOUNT PAID: RECEIPT #: CHECK #: CASHIER: ISDS Permit # /6 26 Building Permit -c w 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. r�cit��t*itYrYrYr�rk�r�k�kk�t�lrk�YYr�r�r�r�r�r�k�rir�c�k'�k,r�r�c�r�k�r�tr��k�r�k�kYr�rk�c��e�r�r�r�tsrk�r�r�rx�rr�r,�rr�r��cyrsryr�rr"' PROPERTY OWNER: MAILING ADDRESS APPLICANT/CONTACT PERSON: / Ria'I � ►y�� - PHONE: &y- %y,7y LICENSED SYSTEMS CONTRACTOR:' ADDRESS: PERMIT APPLICATION IS FOR: LOCATION OF PROPOSED INDIVID Legal Description:J-4. Parcel Number: a,jj - Physical Address: /_1 PHONE: NEW INSTALLATION ( ) ALTERATION ( ) REPAIR _SEWAGE SPOS SY TEM: -ov T Lot size: BUILDING TYPE: (Check applicable category) (✓✓) Residential / Single Family Number of Bedrooms ( ) Residential / Multi -Family* Number of Bedrooms ( ) Commercial / Industrial* Type HOT TUB Yes ( ). No (�) WATER CONSERVATION PLAN: Yes No TYPE OF WATER SUPPLY: Well( ) -Spring ( ) Surface ./ Public (i�Name of Supplier:' o� T Give depth of all wells within 200 feet of system: *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; - DATE: let - AMOUNT PAID: Gov RECEIPT# DATE: 17 CHECK # S 'J CASHIER: TIME LOG Travel Perc Final - ISDS PERMIT # 80 PERCOLATION TEST %U r1 EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT. OWNER: - ` s e° i� i �t5 i � % -t � � Ile, ,f: LEGAL DESCRIPTION: MAILING ADDRESS: ©pow a �x �` '/ G r .. y7 TYPE OF DWELLING: 5i� / NUMBER OF BEDROOMS TEST HOLES PRE-SOAKED: YES NO AI-e 0(".< TTMF. wnTRR nRpTN TMf'LiRC nr rAT_T_ Damr AP, cnTT DDnL+TT V 1 2 3 1 2 3 1 2 3 1 2 0' 10; s& I ts: s7 fi _ a 3 S Dl s--- .- ._ ,•--� - ---- �.___ 1 D ,:0..6 r 3 '0�` ff'o rd'c, R(oY �3 $ �8 3 ) s 3 1 8 3.1 3.� 3. 3 l t, I 5 lrr /a sr 7 7 5 S.7 5.7 ZI Z 12It 19 %+ 1 s ►� i a.7 7 D /r•'3► t/. 23q 9 232, ZJ 3.3 S 5 Time to drop last inch PERC RATE: a_sf r �'MINXMUM SEPTIC TANK SIZE: %0 0 (� MINIMUM LEACH FIELD SIZE: 3 %5— 4&7_ COMMENTS: eq /, Am /1 4 S� ' ,. ". J PER � S ATE: (: Environment ealkfi Officer Q 0, Flo ry rev. U. ��OlL1= a�f`"��, X %S�/'`�fa�s✓ , X /. �'l�-pe^' r -1-lAr I JOB NAME, ©S.:�l 41003 20 Rj iI , (l JOB Na OB LOCATION 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, MA 01, a Printed in U.S.A. r k