HomeMy WebLinkAbout311 Strohm Cir - 211106407017EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
PLEASE CALL FOR FINAL P. 0. Box 850 - 550 Broadway PERMIT MUST BE POSTED
INSPECTION BEFORE COVERING Eagle, Colorado 81631 AT INSTALLATION SITE
ANY PORTION OF INSTALLED SYSTEM
328-7.'�1.1"'o' r 949-5257 or 927-3823 PEZMIT NO. No 604
e `7 63
OWNER: Gregory Louis Moch ADDRESS: P.O. Box 264 - Gypsum, CO 81637
SYSTEM LOCATION: Lot 12R - Filing #5 - Bertro-h Subdivision - Gypsum
LICENSED INSTALLER: Owner LICENSE NUMBER:
**CONDITIONAL INSTALLATION APPROVAL is hereby granted for the following:
MINIMUM REQUIREMENTS: 1250 gallon septic tank or aerated treatment unit.
Absorption area or dispersal area computed as follows:'
��PLACEMENT �O.F.,TANK
PERCOLATION RATE: one inch in 15 minutes.
Absorption Area per Bedroom 260 sq. ft. Degree:
Lineal Feet:
No. of Bedrooms 4 x 260 sq. ft. minimum requirement per be room
1040 total sq. ft. minimum requirement.
SPECIAL REQUIREMENTS: iiojj4j;Z&Z
x A
DATE: April 6, 1983 INSPECTOR:
**CONDITIONS:°``„�
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1. All installation must comply with all requirements of the 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 building and zoning 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 installed system is
approved prior to covering any part.
Installed Absorption or Dispersal Area: sq. ft.
Installed Septic Tank: jr gallons.
Design Engineer of System:
Installer of System:
Septic tank cleanout to within 12" of fi l grae o
aerated access ports above grade? Yes No
Proper materials and assembly? Yes No _
Compliance with permit requirements? Yes No
Compliance with County/State regulations requirements?
COMMENTS:
C�_NPhone:
Yes No
(Any item checked "No" requires correction before f' 1 pp val of system is made.
Arrange a re-i pect'on when work is completed.)
DATE: 61 1 INSPECTOR:
RE -INSPECTION D TE: INSPECTOR:
E E•III L
Sri` ��ro �.,.L-
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~' E ;GLE, C0L01D 0 81631
Pf'`:' SEE: ", f150 FE�COLATIri;J TEST FEE = S70
w APPLICATION' FOR I-NDIVIDUAL SE.1T..Gr DISPOSAL SYSTE.; PEP''IT
N,4P'JE OF 0111NER: C)et:--
ADDRI-:SS: Ln , I f. --- PHONE:
NAME OF APPLICANT (IF DIFFERENT FROM 0','Jf'.ER):
)`,L'GRE"SS: !.`"0 . & I -0(64 C (4P50�M
DF.SIGN ENGINEER OF SYSTEM (IF APPLICABLE):
ADDRESS:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEPI:
ADDRESS: 000mi x a6q 4qoonofi
PFRNIT APPLICATION IS FOP.: ( ,,Jew Installation
LOCATION OF PROPOSED FACILITY: County _ AC L
City or Town, if within City or Town Limits
S7 PHONE: S _2
PHONE:
bou
�2RA-,/ t' PHOffE: % 7 _
( ) Alteration ( ) Repair
Lot Size Z. /15 )qc-ie `
LEGAL DESCRIPTION:
STREET (RURAL) ADDRESS:
IS SYSTEM DESIGNED FOR LESS THAN 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
FF Pc.'.i 5C1ri5 - --- ` Rr„1rn0MRS
WASTE TYPES: (Check all applicable)
( ) Commercial or Institutional Dwelling
(ems Garbage Grinder �✓�
( ) Non -domestic wastes ( ) Transient UsP
Dishwasher
( ) Other -
_ (,� Automatic Masher
SOURCE AND TYPE OF DATER SUPPLY: ( ) Well ( ) Spring
( ) Creek or Stream -
depth 200 feet the
�'G��'Slo•"" '
Give of all wells within of system:
If supplied.by community water, give name of supplier:
v
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(1/r Septic Tank ( ) Aeration Plant ( )
Chemical Toilet
Vau L P`rlVIV
Y'-iiilti
( ) Pit Privy ( ) Incineration Toilet ( )
Recycling, Other Use
( ) Greywater ( ) Other
"WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ( ) Yes (L-fNo
-',',Si gnat ure
Dater
INFORfJATION BELO!-f TO BE FILLED OUT BY ENVIRntif IEINTAL HEALTH
OFFICER
nnnwin rn.i )T rTnf!c _ Percent around Slone:
Depth to Bedrock (per 8' Profile Hole): —
Depth to Groun.f'iater Table: _
SOIL PERCOLATION TEST RESULTS: Ninutes per
inch in Hole No. 1
tD Minutes per
inch in Hole No. 2
P?inutes per
inch in Hole No. 3
FINAL DISFCS;^,L BY:(� Absorption Trench, Bed or Pit
( ) Evapotranspiration
( ) Above Ground Dispersal
( ) Sand Filter
( ) Underground Dispersal
( ) 1.4aste:•iater Pond
( ) Other
PERCOLATION TEST FEE:.$50*
OWNER:
I.S.D.S. APP. #
Environmental Health Officer
LEGAL 'CESCRIPTIONY r3l 844--br0tl,
RURAL ADDRESS:
TYPE OF DWELLING: OF BEDROOMS:
DATE OF PERCOLATION TEST: TYPE OF SOIL:
TEST HOLES PRESOAKED? Yes No
WATER DEPTH
INCHES OF FALL
PERCOLATION RATE:
RECOMMENDED MINIMUM SEPTIC TANK- SIZE
RECOMMENDED MINIMUM LEAN FIELD SIZE: Io qo
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:
Site has been reviewed and tested for percolation rate.
I-/- 6�1
Date
COMMENTS: 2G=.
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0604 Moch Lot 12 Filing 5 �.
JOB NAME Bertroch Sub 2111-064-07-006mow
JOB N4.
ina i ncert.nni
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
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JOB COST SUMMARY
TOTAL SELLING PRICE
-
TO _MATERIAL
LABOR
PERMIT # , �f 1RANCE
ES TAX
OWNER: Gregory Louis Moch
P.O. Box 26,4_ - Gypsum y COSTS
ow31i� �IAV1 C� Bertroch Subdivision -Gypsum
LOCATION: Lot 12B - Filing #5
INSTALLER: Gary Bertroch
SIZE OF TANK: 1,,250 gallons
DWELLING: Single family - 4 bedrooms x 260 sq.ft.
PERC RATE: one inch/15 minutes (1,040 sq. ft .) TOTAL JOB COST
GROSS PROFIT
Richard Pylman LESS OVERHEAD COSTS
jjy; % OF SELLING PRICE
Finalized: 6/30/83
NET PROFIT
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JOB FOLDER Product.278 Q® NEW ENGLAND
O • :�T , M1' Printed in U.S.F1.
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