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HomeMy WebLinkAbout3336 Gypsum Creek Rd - 211120300023ENVIRONMENTAL HEALTH P.O. BOX 811 PERMIT NO. EAGLE, COLORADO 81631 APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT Name of Owner: Phone: Address of Owner: Is facility within boundaries of a city/town or sanitation district? Distance to nearest sewer system: Location of Proposed System: Legal Discription: r PERMIT FEE $25.00 Type of Structure: Single Family Dwelling ( ) Other: No. Bedrooms Water Supply: Private Well ( ) Location: Distance From leach field: — Size of Lot: / G A C/?4ES Public Water Supply: An appropriate plat plan must accompany site inspection for this application showing required information. (See attached sheet.) The individual sewage disposal system will be constructed and installed in accordance with the regulations governing individual sewage systems within Eagle County, and shall comply with House Bill 1553 CRS 66-14, 1973. Payment shall be made to the Eagle County Treasurer. Permit, upon approval of this application, may be obtained at the Eagle County sanitarian's office. Appointment for final inspection must be made prior to construction by contacting the inspecting sanitarian. [Phone 328-7718 between 8:30 and 9:00 AM.] Refer to permit number. No approval will be given on any system without final inspection. Name, address, and telephone of person responsible for design of system: The undersigned acknowledges that the above information is true and that false information will invalidate the application or subsequent permit. f SIGNATURE OF APPLICANT: Date: (This application becomes invalid 6 months from above date.) HEALTH DEPARTMENT USE ONLY Percolation Information: f Tank Capacity: gal. (minimum) Absorption Area: '' Sq. ft. (minimum) REMARKS: APPLICATION IS: APPROVED ( .'') DENIED ( ) Permit No. Fee Receipt. File: The above individual sewage disposal system was installed by. AND HAS BEEN INSPECTED AND APPROVED BY A REPRESENTATIVE OF THE EAGLE COUNTY HEALTH DEPT. Date: Sanitarian: OLE PE COL%TIO;'' TEST AND SITIE IP;SP:ECTIO ; PE-LIIT NO. .0 / Street Address or Legal. Description: Ty ,e o; rJ.TeIi?��:_ If ;c of --� 'i 07 DO iT '.0-I?2ITE 3E' G,; TiCIS i,IPdD Date of Test: 5—/62�E Depth of hole- D_, eter. I2� Type of soil: Location of Test Hole: C G— Test hole jras presoaked from: (Time) (� To: Date: / ate) ( Time) - { ii .. .. I TnTl.�rc OF l ai T _1 ��� rr Tr1 2 3 !, 1' 2 _ 3 2 3 1, 2 s 3 .k, i Percolation Pate: C/ i- e I Site has been revie,Ted and tested for percolation rate. We recorr~end: APP OVAL CG�}DT^AP'';O�T1 ) � i � L ( Date 1`it7,T,: Plot plar, boundary line:, location of proposed buildin- or buildings and design of septic system must be Submitted wir-31, Apip-icaLion for Permt to Construct. The back of this form may be used to S-120TJ plot plan and design of system. C By: Sanitarian 1 . O. Boy- 811 Telephone (303) 32-8-7715 Ea, -le, Colorado 81631 EAGLE UNTY DEPARTMENT OF ENVIRONN 1TAL HEALTH Box 81 1 6th & Broadway Eagle, Colorado 81631 ,r.; (this does not constitute PERMIT t' a building or use permit) Owner System Location Licensed Contractor * Conditional Construction approval is hereby granted for a Septic Tank or Aerated treatment unit. Absorption area (or dispersal area) computed as follows: Perc rate inches in minutes sq. ft. absorption area per bedroom # of bedrooms x sq. ft. minimum requirement May we suggest Date Inspector FINAL APPROVAL OF SYSTEM: gallon No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system is approved %prior to covering any part. y Septic Tank cleanout to within 12" of final grade or aerated access ports above grade. /Proper materials and assembly. Adequate absorption (or dispersal) area. dequate compliance with permit requirements. Adequate compliance with County and State regulations/requirements. Date 67, ` v,--" Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations, adopted pursuant to authority granted in 25-10-104, CRS 1973 amended 25-1-614, CRS 1973 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 structures not approved by the building and Zoning office 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, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material variation from the terms or specifications con- tained in the application of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or )'nth x 1. •: .: -,. 0 -i• -4, O z -0 -+, U" -• g " :o D a) •D c- (D 0 • 0 O (D (n N O lv v O = (D 0 tD (D N -1 n `1 c �. D -+., _ +cc m -+ m -t m a a O ! a a 0) -1 w tT s sir — ((DD m n O u+-O* AO —O Gtp NCD (D�•.. C) D -1 CM (D (D ! n c J to c to -�. cD.- (D ° } t7 lo f (a. Lo + ON LD O O � O n -.+ W (D -* - (D -t �'• fi -' - - r G . O c -1 ;,re. - to 1 U7 C;ZE C1 CJ Cil to O Z c C, z C, ON to to n O. c 01 (D (D C (� "1 G -< \z O n - - ,. , -1. ca. - -+ _ ii -1 ca + v (D -+• aJ C) (D -{ tD fi (� . (D , -F a -° •D c a o' + -•cam, + 1 -+ Co ! + 1 O c tD O O -1 CD G o O O* -F Q) n N 4, O n p Z O O . c — — � J CD N (D _ — — :. e� m c — 4. —o Aim -1 a��o _. m -r X Z: O W (D 0.) 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