HomeMy WebLinkAbout438 Sierra Vista - 239127301002 - 0968ISINDIVIDUAL 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. 968.
Please call for final inspection before covering any portion of installed system,
OWNER: Ken Braunschmidt PHONE: 963-0284
MAILING ADDRESS:
AGENT: PHONE:
SYSTEM LOCATION: 43
LICENSED INSTALLER: Joe Zamora: Carbondale, CO LICENSE NO.
DESIGN ENGINEER OF SYSTEM:
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
1250 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS: 11
SQUARE FEET OF SEEPAGE BED 1200 SQUARE FEET OF TRENCH BOTTOM. 400' of 10" s b 2 !�
SPECIAL REQUIREMENTS: Surfarta-dr_alnage_must_hp controlLd to avoid ahsorption are okel)
piping shallow as possible -minimum 6" cover over piping. Provide inspection portal
at the end of each tren r h th t exceed 100' per trench.
ENVIRONMENTAL HEALTH OFFICER: DATE:
CONDITIONS:
1. ALL INSTALLATIONS UST CQMPLY WITH ALL REQUIREMENTS OFT AGLE 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 SHAH AUTOMATICALLY SEA VIOLATION OF A REQUIREMENT OF THE PERMIT AND CAUSE FOR BOTH
LEGAL ACTION AND REVOCATION OF THE PERMIT.
3. SECTION 111, 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 INSPECTOOk
NO SYSTEM SHALL BE DEEMED TO BE IN COML)ANCE 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: /,20 0 SQUARE FEET.
INSTALLED SEPTIC TANK: / GALLONS DEGREES FEET SQ2 /b
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: `
PROPER MATERIALS AND ASSEMBLY 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: /0
:
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF CESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANTIAGENT:
OWNER:
AMOUNT PAID: RECEIPT N: CHECK N: CASHIER:
019
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Eagle County OWTS Systems Cleaners Reporting Form
NOTE Required to be submitted to Environmental Health within 30 days of cleaning an OWTS
system
EAGLECOUNTY Systems Cleaner Company /,Lw��License Number
Email Address �aHrJt �w�)q's0lC-or'"<a,kvLf Phone g70-1,00'3302
Service Technician Qc!±s -o` Phone
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Tax Parcel# / Address of Service
Person Requesting Service y•'""-`r itfl Phone
Property Owner / r1O1O / 7 7
Septic System Permit Number Tank Size �e�w
Date of service 1914.Lr • Tank Material A X;L i
Sewage Disposal Site JS � 6VJh Cx
General Condition and Functionality of the System Gma
Recommended Repairs 1'U — tfc Zd 2U RRnIRLGc± Of--I.Eh
Site sketch showing location of the septic tank access lids measured from at least 2 fixed points
(Photos Encouraged)
Signed Date
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438 Sierra Vista, Carbondale CO 81623
Eagle County OWTS
Reference shot for location in relationship to property, primary side in the
foreground
General location of leach field and observation ports
Sewer Clean Out located between house and hot tub
Primary side with inlet T and tank to grade
Secondary side with outlet T, tank to grade