HomeMy WebLinkAbout11151 Hwy 6 - 211104100017EAGLL—, —NTY DEPARTMENT OF ENVIROK,_-_)AL HEALTH
PERMIT MUST BE POSTED ON LOCATION Box 811 6th & Broadway CALL FOR FINAL INSPECTION BEFORE
Eagle, Colorado 81631 COVERING ANY PART OF SYSTEM
Owner
System Location
PERMIT NY,
JACK E. SCHMIDT
Licensed EiLtgVja Ihstalg•
43� (this does not constitute
a building or use permit)
11151 Highway 6_". Gypsum, CO
* Conditional Construction approval is hereby granted for a 1.000 gallon (2-compartment)
XXX Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate 1 inches in 10 minutes 600 sq. ft. (12' x 50' )
absorption area per bedroom 300 sq. ft. /bedroom
# of bedrooms 2 x 300 sq. ft. minimum requirement
May we suggest that you install a 1,000gallon minimum septic tank with a minimum
600 sq. ft. leach field.
Date May 6, 1980 Inspector Erik W. Edeen
FINAL APPROVAL OF SYSTEM:
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.
S Tank cleanout to within 12" of final grade or aerated access ports above grade.
er materials and assembly.
equate absorption (or dispersal) area.
dequate compliance with permit requirements.
Ad
Date
equate compliance with County and State regulations/requirements.
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, 3.20equires 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
hnth
328� .
/-(r 4c/`r J G iu_ L / Gc. /c. y i ri iV i —''O� 'e /v�v Lamr/' C i 'C - .OW v r-- — C
949-5257 927-3823
ENVIRONMENTAL HEALTH
BOX 850
EAGLE, COLORADO 81631
PERMIT FEE $75 PERCOLATION TEST FEE =,I DO
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
NAME OF OWNER:
ADDRESS:
NAME OF APPLICANT (IF
ADDRESS: 6- k
NO. f1*7/
Re ZZ C_ t z T
�r ... PHONE:
IFFERENT FROM OWNER) :t�1
PHONE: Se :7,,?J .
uESI I N ENGINEER 01 S i STEM", ( I F APPLICABLE )
ADDRESS:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
ADDRESS: �_' I fl C u Oka. ( $ Q, �
PERMIT APPLICATION IS FOR: ( New Installation ( ) Altera"
LOCATION OF PROPOSED FACILITY: County a ,;.
City or Town, if within City or Town Limits
l_4 P)f re., tl f �e S,L ; dT GY�osu,:, a „� rryowe
LEGAL DESCRIPTION: -p,ace( of ILd
S o .i iA ..e ?-5- cd es r of lA e
PHONE: \
t
;ion ( ) Repair Lot Size orite j j— /'i�}
cy
C/P3P� de rc_., k7e 2,.J
7_
r" O re -ice.. I
STREET (RU AL) ADDRESS : ',_ �' Pz� S as ;„ T C.e_
>`f%i�3"� ///S/ �. C� k n trcam'
SYSTEM ESIGNED FOR LESS TH N 2,000 GALLONS PER' DAY? ( Yes ( ) No
BUILDING OR SERVICE TYPE: (Check applicable category)
Residential - Single-family dwelling ( ) Residential - Triplex
( ) Residential - Duplex ( ) Residential - Quadplex
Commercial - State usage
# Persons # Bedrooms _
C�2 S:Cr P y�'ieC'Ij
�� fQ
WASTE TYPES: (Check all applicable)
( ) Commercial or Institutional .Dwelling ( ) Garbage Grinder
( ) Non -domestic wastes ( ) Transient Use ( ) Dishwasher
( ) Other ( ) Automatic Washer
SOURCE AND TYPE OF WATER SUPPLY: ( ) Well >cy Spring ( ) Creek or Stream
Give depth of all wells within 200 feet of the system:
If supplied by community water, give name of supplier:
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
`'�Septic Tank ( ) Aeration Plant ( ) Chemical Toilet
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, Potable Use
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, Other Use
( ) Greywater ( ) Other
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO 14ATERS OF THE STATE? ( ) Yes No
Signature
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER
GROUND CONDITIONS: Percent Ground Slope:
Date � : � /%g
Depth to Bedrock (per 8' Profile Hole): Depth to Groundwater Table:
SOIL PERCOLATION TEST RESULTS: /D Minutes per inch in Hole No. 1
/D Minutes per inch in Hole No. 2
/D Minutes per inch in Hole No. 3
FINAL DISPOSAL BY: Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Above Ground Dispersal ( ) Sand Filter
( ) Underground Dispersal ( ) 'Wastewater Pond
( ) Other
REPAIR PERMIT APPLICATION - ~
FOR INDIVIDUAL SE14AGE DISPOSAL SYSTEMS
A permit fee of $75. shall be charged for alteration, enlargement, or any repair
involving alteration of an existing sewage disposal system. This fee is authorized
by Eagle County Individual Sewage Disposal System Regulations adopted and effective
March 27, 1980.
For minor repairs of less than $100 for maintenance of the individual sewage
disposal system, no fee shall be required.
A percolation test fee of $50 shall be charged for all new leach fields on repair
permits. Percolation testing may be waived at the discretion of the Environmental
Health Officer on certain repair cases where prompt action must be taken to prevent
a. ,h.ealth hazard.
IF PRESENT SYSTEM IS PRE-EXISTING, NON -CONFORMING, A NEW SYSTEM SHALL BE INSTALLED,
COMPLYING WITH ALL CURRENT REGULATIONS. IF A NEW SYSTEM IS REQUIRED, ALL FEES ARE
APPLICABLE.
DESCRIPTION OF PROBLEM/MALFUNCTION:
TYPE AND SIZE OF SYSTEM PRESENTLY IN USE:
DATE PRESENT SYSTEM WAS INSTALLED
PERMIT NUMBER FOR ORIGINAL SYSTEM, IF A PERMIT WAS ISSUED BY THIS DEPARTMENT:
SITE PLAN BELO1,4 SHOWING PRESENT SYSTEM COMPONENTS: -
OWNER OF SYSTEM:
ADDRESS:
APPLICANT:
ADDRESS:
DATE:
PERCOLATION TEST
FEE: $50
APPLICATION NO.
OWNER:
LEGAL DESCRIPTION:
RURAL ADDRESS:
TYPE OF DWELLING: # OF BEDROOMS: .
DATE OF TEST: TYPE OF SOIL:
TEST HOLES PRESOAKED: YES l� NO
TIME
WATER DEPTH
INCHES OF FALL
RATE
1
2
3
1
2
3
1
2
3
1
2
3
;as
�a3
z !v
Z 5
1610
10 �
t
Z
t--o
la
l 0
if
I
PERCOLATION RATE: f C� TANK SIZE: Q
SQUARE FOOTAGE PER BEDROOM: LEACH FIELD SIZE: C2 Q _
�-
Site has been reviewed and tested for/percolation rate. {�
We recommend: APPROVAL ✓ DISAPPROVAL
DATE: LZ
EAGLE COUNTY
ENVIRONMENTAL HEALTH OFFICER
BUILDING PERMIT APPLICATION
Jurisdiction m '
0
0
A
Applicant to complete numbered spaces only. N
JOB ADDR ESS
LEGAL
1 DESCR.
LOT NO,
ELK
TRACT
(SEE ATTACHED SHEET)
OWNER MAIL ADDRESS
2
ZIP
PHONE
CONTRACTOR MAIL ADDRESS
3
PHONE
LICENSE NO.
ARCHITECT OR DESIGNER MAIL ADDRESS
4
PHONE
LICENSE NO.
ENGINEER MAIL ADDRESS
5
PHONE
LICENSE NO.
LENDER MAIL ADDRESS
6
BRANCH
USE OF BUILDING
7
8 Class of work: ❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑
MOVE ❑ REMOVE
9 Describe work:
10 Change of use from
Change of use to
11 Valuation of work: $
PLAN CHECK FEE
PERMIT FEE
SPECIAL CONDITIONS:
Type of
Const.
Occupancy
Group
Division
Size of Bldg.
(Total) Sq. Ft.
No. of
Stories
Max.
Occ. Load
Fire
Zone
Use
Zone
Fire Sprinklers
Required ❑Yes ❑No
APPLICATION ACCEPTED BY
PLANS CHECKED BY
APPROVED FOR ISSUANCE BY
No. of
Dwelling Units
OFFSTREET PARKING SPACES:
Covered Uncovered
NOTICE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB-
ING, HEATING, VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC-
TION AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR
IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS
COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.
ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS
TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED
HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT
PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING
CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
Special Approvals
Required
Received
Not Required
ZONING
HEALTH DEPT.
FIRE DEPT.
SOIL REPORT
OTHER (Specify)
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
SIGNATURE OF OWNER IF OWNER BUILDER) (DATE)
WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
Form 100.1 1-77 TEMP. FILE
0430 -,,11151 Hwy 6 Gypsum,
JOB NAME Schmidt ',''\ ,-
Parcel
JOB NO.
2OR
JOB LgCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
ff r1 �y
r
i
210_02Ts
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
To- �
t'Z,
PERMIT # 430 '^
OWNER: &ck E. Schmidt
LOCATION: ' 11151 Highway 6 - Gypsum
INSTALLER:
SIZE OF TANK: 1,000 gallon two -compartment
DWELLING: Resendial - 2 bedrooms x 300 sq.ft.
PERC RATE: one inch/10 minutes (600 sq.ft.)
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
Finalized: 5-10-80 By: Erik Edeen
1LDER
Printed in U.S.A.
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Date--------------------------------------------------------------
Permit# ------------------------------------------------------
nsP• ------------------------------------------------------------
EAGLE COUNTY, COLORADO
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