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HomeMy WebLinkAbout1760 Gypsum Creek Rd - 211117101002REPAIR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT REPAIR Eagle County Department of Environmental Health PERMIT Np 0810 P.O. Box 850 - 550 Broadway Eagle, Colorado 81631 Telephone: 328-7311 or 949-5257 or 927-3823 YELLOW COPY OF PERMIT MUST PLEASE CALL FOR FINAL INSPECTION BEFORE BE POSTED AT INSTALLATION SITE COVERING ANY PORTION OF INSTALLED SYSTEM Owner: R; i i Knnnra Telephone: Address: 3734 Ligon Rd Ellicott, Maryland 21043 System Location: 1760 Valley Road Gypsum Licensed Installer: Bill Yeiks License Number: Conditional installation approval is hereby granted for the following: Minimum requirements:1000 Gallon Septic Tank or Aerated Treatment unit Absorption area of dispersal area computed as follows: Percolation rater_ Inch in Minutes Absorption area per bedroom NIA Sq. Ft. Number of Bedrooms_ X Sq. Ft. minimum requirement per bedroom - equals Total Sq. Ft. minimum requirement . .. j Special Requirements: �j,_ 5 5 Date: q ; & Environmental Health Officer: Sid Fox > ' ` 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 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 system is approved prior to covering any portion of the system. INSTALLED ABSORPTION OR DISPERSAL AREA: SQ. FT. INSTALLED SEPTIC TAN__ GALLONS; �'sU DEGREES; S FEET DESIGN ENGINEER OF SYSTEM:/. INSTALLER OF SYSTEM: `1' c_' �` �� l PHONE: 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: YESNO COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES NO COMMENTS: C� �+C?, ; (t�,�iI�__ " r 4-e,//IO (Any item checked NO requires correction before final approval of system is made. Arrange a re -inspection when work is completed.) 7 DATE (Final Approval),yENVIRONMENTAL HEALTH OFFICER: DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER: RETAIN WITH RECEIPT RECORDS PERMIT Name of Applicant: Richard Mayne Name of Owner: Bill Koonce Amount Paid: $190.00 ) Receipt Number: 3931 Date: 9-23-87 Cashier: Earlene Check Number— 1748 White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner p� (2 7DT Tl.:i i ten• '=lea u iL�..AL SF.�A�� D I S,�SaL C- Fr. c•,'T_ ENVIRO,: IENTAL EEALTii OFF TCE - EAGLE COU::TY i P.O. rd ;�50 Eagle, Colorado, 81631 o. \ PER_•1IT APPLICATTON FEE: S150.00 328-7311 PF.RC01_\TI0N TEST F- $125.00 MME OF OWNER: ADDRESS: •+ j� /� '.E: NAME OF APPLICANT (if different from caner): ADDRESS: DESIGN ENGINEER OF SYSTDI (cif applicable): ADDRESS: :: �".. INS ILLATION OF SYSTEM: Licensed Installer (see attached list). ADDRESS: PHONE: ` <.-��4�-;7/y/ PM!E : YES NO I r PER`fIT APPLICATION IS FOR: ( ) New Installation LOCATION OF PROPOSFn T-,TT)TITTT)TT T cstTAr^ n-rcDnc tT c-,- 0L1.eeL/z-ura1. tiaaress: Lot Size: Legal Description: BUILDI`:G SERVICE TYPE (check applicable cater:orv_) • ( Residential - Single Family ( ) Residential - Duplex ( ) Residential - Tr_olex NU;iBER OF PERSONS: WASTE TYPES (check aoplicable catezories)• ( ) Comiercial or Institutional ( ) Non -Domestic Wastes ( ) Garbage Disposal ( Automatic Washer ( ) Other _TYPE OF�D_1V1D XL SEC -.'AG- DISPOSAL SYST"t.'-i PROPOSED: PHONE: -- %�Ops- ( ) Alteration Repair Z ( ) Residential - Quadplex ( ) Cc::-::ercial (state usage) NrBER OF BEDROOMS: ( M-Telling ( ) Transient Use ( ) Dishwasher ( ) Spa Tub (!� Septic Tank ( ) Composting Toilet ( ) Incineration Toilet ( ) Vault Privy ( ) Greywater ( ) Chemical Toilet ( ) Pit Privy ( ) Aeration Plant ( ) .. in�, Potable Use Recycling-, ( ) Other ( ) Recycling, Other Use WILL EFFLUENT BE DISC:iARGED DIRECTLY INTO i'AT_RS OF THE STATE: YES ( ) NO IS SYSTEX DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES (VI NO ( ) WASTE::'ATER FLO:d REDUCTION PLAN: YES ( ) NO (✓� 16 Yes, See attached waS.texLte Stcto nedLLGtCC;Z methcd5) NOTE: The Env,c�L0;unentaZ Heae ui 03'�.i C_'L mail .seduce .the •teoui tl-d ab.se,Lpti on a,'cea upon apptUVaZ US an ad2Guai.' CL'aS iel'a:Le SCC'CU •%edLLCtCO;I p�a;?. SOURCE AND TYPE OF ?DATER SUPPLY: ( ) Well ( ) Spr;no ( ) Give depth of all wells within 200 feet of system: .1ve Creek/Stream If supplied by community water, give name f supplier:,�_��s SIGNATURE - - - - DATE: - - - - - - - - - - - - 9�a - - - - - - - - - - - - - - - - - - INFORMATION BELOW TO BE FILLED OUT BY ENV IRON,'IENTA HEALTH OFFICER: GROUND CONDITIONS: Percent G,,Lou►zd Slope r Depth .to Bedto ch ( pen 8' Pto 'ZZe Note) Depth .to GtoundClC,te,,L Tabte SOIL PERCOLATION TEST RESULTS: h(-i►uLtes pet inch to No.ee #2 ii i.iCUIi i,s ije,-L -(.tEch to fiil.(e 43 FINAL DISPOSAL BY• ( �() Abso.,cptio;l Trench, Bed o,•L Pit ( ) Evapot,%anspiAa,tion ( ) Above Gteund DZs pe/'Lsa.(,_1 ( ) Saizd F. Uct ( j Undetgnouizd Dispe,tsae ( ) Was.te<L'atc.'c Pond ( ) Oth ,'L "V 9-o 8 � Amau;Lt Pa, d: j0 Recccpt Nwnbc-'c �j9�/ Data, ------------------------ _----------------- NOTE: Site Plan must be attached to -application. (Env. Health Department - Rev. 4-07-33) PERCOLATION) TEST ENVIRONIMENlTAL HEALTH DEPARTMENT Eagle County FEE: $50.00 ISDS APPLICATION INO. 31/?- 014NER: / 6 LEGAL DESCRIPTION: .RURAL ADDRESS: -766 i TYPE OF DWELLING: NUMBER OF BEDROOMS: ^' DATE OF PERCOLATION TEST: TEST HOLES PRE-SOAKED: TIN,'F YES WATER DEPTH 3 I 1 2 3 NO TYPE OF SOIL: INCHES OF FALL 3 RATE 9 PERCOLATION RATE: RECOMMENDED MINIMUM SEPTIC TANK SIZE: oc) RECOMMENDED MINIMUM LEACH FIELD SIZE: cy)di - cyu� — RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: ('� (0�� c SITE HAS BEEN REVIE1,,1ED AND TESTED FOR PERCOLATION RATE. A-Y C-` Environmental Health Officer COMMENTS: cq Rev. 5/31/84 2 L/ Date s m UO Ilbo GYfbapo C� 2d Merle bb,s 3 JOB NAME 49al JOB NO. JOB LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED 5 - D (2! S -aa JOB COST SUMMARY TOTAL SELLING PRICE PERMIT #810 REPAIR OWNER: R ICHARD MAYNE LOCATION: 1-72-0 VALLEY ROAD INSTALLER: BILL YEIKS SIZE OF TANK? 1000 GALLONS DWELLING: RES. SINGLE FAM. PERC RATE: N/A ABSORPTION AREA: N/A FINALIZED: 9-30-87 Vo� No(. GYPSUM 2 BEDROOM BY: ERIK EDEEN; 4 f �+ '` " AL - • • . ,,, 5►x•w,,, �� ' .w "'�• "• A-' �4 JOB FC Printed in U.S.A. Incomplete Applications Will NOT Be Accepted (Site Plan MUST be attached) n ISDS Permit # _ Building Permit APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY P. 0. BOX 179 EAGLE, CO 81631 Eagle (970)328-8755, Fax (970)328-0349, E1 Jebel (970)927-3823 * FEE SCHEDULE * APPLICATION FEE $350.00 * THIS FEE INCLUDES THE ISDS PERMIT, SITE EVALUATION (PERCOLATION TEST, * SOIL PROFILE OBSERVATION) AND FINAL INSPECTION * ADDITIONAL FEES MAY BE CHARGED IF A REINSPECTION IS NECESSARY, OR A * PRE -CONSTRUCTION SITE VISIT OR CONSULTATION IS NEEDED * REINSPECTION FEE $47.00, PRE -CONSTRUCTION SITE VISIT FEE $85.00 * MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER" PROPERTY OWNER: ' f G r L MAILING ADDRESS: l 00 GYPSu ► l-) ONC P d GY(_IUMCep PHONE: APPLICANT/CONTACT PERSON: ��E (L3 1'`T4t) 8 eS PHONE: S 2_q- Ce.LL �?/o- 0 gSS LICENSED SYSTEMS CONTRACTOR: has EXC: `i- T tC(C �� 6 PHONE: Sz ((-7447 COMPANY/DBA: ADDRESS: "(CC) G` p!SU" OJL (a, *************************************************************************** PERMIT APPLICATION IS FOR: ( NEW INSTALLATION ( ) ALTERATION ( ) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DIS/ Legal Description: LoT5 I Tax Parcel Number: Physical Address: .2-1((- «1- 6 t- 60a SYSTEM: Lot Size: + ac,-,,� I ' (a 0 G yP_a� rn -- C-� yPsU "--� o-►c c( BUILDING TYPE: (Check applicable category) Residential/Single Family ( ) Residential/Multi-Family* ( ) Commercial/Industrial* Number of Bedrooms Number of Bedrooms Type *These systems require design by a Registered Professional Engineer TYPE OF WATER SUPPLY: (Check applicable category) ( ) Well ( ) Spring ( ) Surface (�) Public Name of upplier:1� AP PL I CANT SIGNATURE: Date: /0/�/0 *************************************************************************** AMOUNT PAID: RECEIPT #: DATE: A CHECK #: 4Lt I I CASHIER: ISDS PERMIT # 2 2L-0 �') PERCOLATION TEST EAGLE COUNTY ENVIRONMENTAL HEATLH . Uwrgbx: J I e. Ic IQ- (" aN a v I-� - � 1 r -PHSYSICAL ADDRESS LEGAL DESCRIPTION: MAILING ADDRESS: TYPE OF DWELLING: L n t I t5 Ky N T Z 14 A n5 C k < 1' c34 I NUMBER OF BEDROOMS: TEST HOLES PRE-SOAKED: YES NO SOIL TIME WATER DEPTH INCHES OF FALL RATE PROFILE f11 if L ! " �� �// 0. 5Jr 3 " ! „ i y ILL,`r-, S h �a.® , S t 5" i � ' �� /c © • �l l� { 'L / i �i t/ 9` 2;s [[ Q` ^ 1 iaF rapt �lt L/ Ll 5 Ta.0 10 r ,r 111Y1G 1V linkir LAN1 INUH: 1 - ERU R jE: fly)0 ccc-�xv— Y'iLZ— 2j ?ZS Cam_ MINIMUM LEACH FIELD SIZE:' kUNIMUM SEPTIC TANK SIZE: L 0 0 0 �7 � 11 yy��w. So, 1 1"ra � I IQ Q wc'�- 4c hP c\rO c:Ti i'yO rRs /tCGticl NM\4e C. Gil a k/ 5' Gti r rct/) S!�3. G ��\ IZUJU G\C �S� Gn il+�2ti J 2 @ u9 ?� , Sfl 1f') C I ii I tY C ('Z- O ENVIRONMENTAL HEALTH SPECIALIST DATE 4 I y t 4 � I S 0— bC,c(' Ol7Sui SI)fY SA/ut LNY 2240-02 Tax #2111-171-01-002 '`JOB NAME_ Lot 1B, Kuntz Ranch, HOBBS JOB NO. 1760 Gypsum Creek Rd., Gypsum If1Q 1 f1f�AT1AlU DATE STARTED DATE COMPLETED DATE Ell LED ka R I�AM� I , ll�r�i NNE . ......... . X .......... 9 1 11'', 0, 111r,"mall • COST SUMMARY TOTAL SELLING PRICE 13 WN / • ' ��� W/'r 7' TOTAL LABO�=E wt. LIL `/�. �% / / , -■ —le 0 Mm _--■ TOTALEN •_COSTINE� PRO LESS.: ..._ s■ JOB FOLDER Product 278 JOB FOLDER Printed in UZA