HomeMy WebLinkAbout1515 Cottonwood Pass Rd - 2111183000090 � --
APPLTC .TTO`T FOR I`:D`IDUAL SE:.'AGE DISPOSAL SYSTEM PERMIT
P
VTRO �_XE`+TAL HEALTH OFFICE - EAGLE COUNTY
P.O. Box 850 ,
Eagle, Colorado 81631 No. I(�
PERMIT APPLICATION FEE: S150.00 328-7311 PERCOLATION TEST FEE: $50.00
NAME OF OWNER: Cleaburn J. Gordon
ADDRESS: BOX 234 Gypsum. Colo. 81637 PHONE: .524-9(;P4
NAME OF APPLICANT (if different from owner):
ADDRESS: PHONE:
DESIGN ENGINEER OF SYSTEM (if applicable) : /V,e I�
ADDRESS: PHOIE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM:
Licensed Installer (see attffhed list): YES
ADDRESS:
PERMIT APPLICATION IS FOR: (X)o New Installation
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM
Street/Rural Address: 1515 Cottonwood Pass Rc
Lot Size: l _n &c-A rS
Legal Description: Sec. 19, T5-S, R-85 W 61
BUILDING OR SERVICE TYPE (check applicable category):
( Residential - Single Family
( ) Residential - Duplex
( ) Residential - Triplex
NUMBER OF PERSONS: 3
WASTE TYPES (check applicable categories):
( ) Commercial or Institutional
( ) Non -Domestic Wastes
( ) Garbage Disposal
(X) Automatic Washer
( ) Other - - -.
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
NO
PHONE: �� 0 7-2- ,
( ) Alteration ( ) Repair
1 /4
( ) Residential Quadplex
( ) Commercial (state usage)
NUMBER OF BEDROOMS: 2
(X) Dwelling
( ) Transient Use
( ) Dishwasher
( ) 'Spa Tub
(x)
Septic Tank
(
) Composting Toilet
(
)
Incineration Toilet
(
)
Vault Privy
(
) Greywater
(
)
Chemical Toilet
(
)
Pit Privy
(
) Aeration Plant
(
)
Recycling, Potable Use
(
)
Other
(
)
Recycling, Other Use'
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: YES ( ) NO (X)
,IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: YES (X) NO ( )
WASTEWATER FLOW REDUCTION PLAN: YES ( s) NO ( )
(I j yeas ,-see attached was ewateA 6tow nedue f i.on methodLs )
NOTE: The Env.cttonmenta2 Health Oj4icett may reduce the tequitr.ed absonpti.on area upon
appnovat o6 an adequate wastewatett jZow neducti.on ptan.-
SOURCE AND TYPE OF WATER SUPPLY: (X ) Well ( ) Spring ( ) Creek/Stream
Give depth of all wells within 200-feet of system: "J d N F
If supplied by community water, give name of shpplier:
SIGNATURE: 1 � . �%� T, �� ,/G. ` DATE: /C,, r�- 2 _ Fy 3
- - - - - - - - - - - - - f% - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INFORMAT1ON BELOW TO BE FILLED OUT By ENVIRON&IENTAL HEALTH OFFICER:
GROUND CONDITIONS: Pettcent GAound ST.ope C� - Z. 12
Depth to Bedttock (pet 8 ` Pno 4.�te Hote)
Depth to GAoundwateA Tabte
SOIL PERCOLATION TEST RESULTS: 20 Mtnutu pen inch in Hote #I
Afinutes pen inch to Hote # 2
M i.nuta pen -inch to Hote # 3
FINAL DISPOSAL By:
( ) AbsoApti.on Tnen h, Bed oA Pit
( ) Above GAound D.ispeuat
( ) Undetgtound Dizpe,usa.E
( ) O.thCA
If
Amount Paid: L d 0 0 Receipt Numbe,`c G 0 a b
( ) Evapottawsp.ittati.on
( ) Sand F.i Melt
( ) Wastewatet Pond
Date: (b-(-k-�,
(Env. Health Department - Rev. 4-07-83)
PERCnLA11ON TEST FEE: SSO
I.C, rPP.
01-INER:
LEGAL 0E-SC PTi
RURAL ADDRESS:
clea-zc,t-,
TYPE OF DUELLING: 4 OF BEDRnnMS: J
DATE OF PERCOLATION TEST: `������' �S� TYPE OF SOIL:
TEST HOLES PRESOAKED? Yes No L®--- a /-'j
TIME
WATER DEPTH
INCHES OF FALL
RATE
1
2
3
l
2
3
1
2
3
1
2
3
30
6�3
/
4(O
3 Z
t:
zi : qs
PERCOLATION RATE: ZU �--�
RECOMMENDED MINIMUM SEPTIC TANK SIZE: C20 j�
RECOMMENDED MINIMUM LEACH FIELD SIZE: �' OCR 5� /
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: z00 5A
Site has been reviewed and tested for —percolation rate.
Date Environmental Health Officer
COMMENTS:
bow,:
- 3
�yQ
fl_..- ,Ii
cn
i
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W.
645-83 TxPrcl# �'"-F-Tle,
J )/JOB NAME Sec E TSS, R85W, 6th P.M.,IIO I3'�.t r"Q JOB NO.
NE 1/4 of NW 1/4 _
1 5] S Cnttnnwnnd__-P__a_cc -- -- -- - -- ._-------___
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
AA�av'
60G�;
2ood
R 10 Aqts
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
2014 j�
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PERMIT NO. 645 �qj R, �qGr Gl &1e,
OWNER: a urn . o
P.O. Box 234 - .Gypsum, CO 81637
/
LOCATION:001515 Cottonwood Pass Road - 20 acres V
Sec. 19 -T5S - R85W of 6th pm (NE4 of NW4
INSTALLER: Randy Hill
SIZE OF TANK: 1,000 gallons Degrees: 10 Feet: 180
DWELLING: Single family - 3 bedroom x 200 sq.ft.
PERC RATE: one inch/20 minutes 600 sq.ft.
(900 sq.ft. leach field installed)
PinAIi7erl• 11inmi Rv: Erik Edeen
JOB FOLDER Product 278 �® NEW ENGLAND BUSINESS SERVICE, INC., GROTON. MA 01471
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i U.S.A.
INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION
P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631
Telephone: 328-8755
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE.
Please call for final inspection before covering any portion of installed system.
OWNER: Cleaburn Gordon
MAILING ADDRESS: P.O. Box 234
PERMIT NO. 1340
524-9624
CIry: GYP sum State: CO Zip: 81637
APPLICANT:_ Marl a Hnbbs PHONE: 524-7 01
SYSTEMLOCATION: 1515 Cottonwood Pass RD TAX PARCEL NUMBER: 2111-183-00-009
LICENSED INSTALLER: Hobbs' 'Excavation, Merle Hobbs LICENSENO: 20-94
DESIGN ENGINEER OF SYSTEM:
INSTALLATION HEREBY GRANTED FOR THE FOLLOWING:
GALLON SEPTIC TANK "Existing tank(1000 gal.)
ABSORPTION AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED 575 SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Install 16 infiltrator units in trenches. Install inspection portals
at the end of each trench.
I ENVIRONMENTAL HEALTH APPROVAL:
DATE: c5
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. 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. CHAPTER IV, SECTION 4.03.29 REQUIRES ANY PERSON WHO CONSTRUCTS, ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED.
FINAL APPROVAL OF SYSTEM: (TO BE COMPLETED BY INSPECTOR):
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: 975 SQUARE FEET.
INSTALLED SEPTIC TANK: 1000 gal GALLON O.—DEGREES— 70 FEET FROM house's north facing corner
SEPTIC TANK ACCESS TO WITHIN 8" OF FINAL GRADE AND
PROPER MATERIAL AND ASSEMBLY _ X YES —NO
COMPLIANCE WITH COUNTY/STATE REQUIREMENTS: X YES NO
ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS CORRECTED.
COMMENTS: If owner begins using the i rri g_ari nn ditch to the east of the beach field, the
ENVIRONMENTAL HEALTH APPROVAL:
ENVIRONMENTAL HEALTH APPROVAL:
APPLICANT/ AGENT:
'ERMIT
PERCOLATION TEST FEE
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS
OWNER:
RECEIPT #
CHECK #
DATE: � z
,nL;omplete Applications Will NOT Be Accepted
(Site Plan MUST be attached)
ISDS Permit ,#
Building Permit #
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE.- EAGLE COUNTY
P. O. BOX 179
EAGLE, CO 81631
328-8755/927-3823 (Basalt)
* PERMIT APPLICATION FEE 440ft=PERCOLATION TEST FEE200.00
* MAKE ALL REMITTANCE PAYABLE:;JTO: "EAGLE COUNTY TREASURER"
PROPERTY OWNER: /3 6�_ O t� 0o �J
MAILING ADDRESS: 2.j % Q w C G PHONE:
APPLICANT/CONTACT PERSON: 140 PHONE:
LICENSED SYSTEMS CONTRACTOR: PHONE: �)V- 7�-o�
COMPANY/DBA: BRESS: C4
PERMIT APPLICATION IS FOR: ( ) NEW INSTALLATION ( ) ALTERATION (- REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description: S f /�l -S��� - ��``� �% aye /vim i
Tax Parcel Number: �-- ":.Lot .Size:
Physical Address: -1�_Z Z (-,3e 7zyjuson1,\ � .cs A D
V`eIBUILDING TYPE:. (Check applicable category)
"L (y' Residential/Single Family
( ) Residential/Multi-Family*
( ) Commercial/Industrial*
TYPE OF WATER SUPPLY: (Check applicable category)
( Well ( ) Spring ( ) Surface
( ) Public Name of Supplier:
Number
Number
Type _
of Bedrooms_
of Bedrooms
*These systems' require design by,a Registered Professional Engineer
SIGNATURE: Date: e/ 2 /- 9 $C
AMOUNT PAID:J6001 o - RECEIPT #: 1"260e) DATE: o?/
CHECK #: l CASHIER:
/SU^0'�itsa�r A.
ISDS PERMIT
9
A
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER:
LEGAL DESCRIPTION:
MAILING ADDRESS:
TYPE OF DWELL TR ;;: NUMBER OF BEDROOMS d
TEST HOLES PRE-SOAKED: YES NO
TTMF. L7T mein TTTI TT:
NMI�
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ii�
ANIMI
MIMMM
ml�
ml�NMI
MIE11�MIMMr
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WMI
imm
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Time to drop last inch 't"
PERC RATE: MINIMUM SEPTIC TANK SIZE: ",t5�-Y`
MINIMUM LEACH FIELD SIZE: Q
COMMENTS - b C
1 �
PERC TEST DONE BY:
rev. 6/90ks
�f
CE : cJ I (X L` 1 LY / i),e i s
1340-94 - Parcel #2111-183-00-009i1 t y-�'� �
JOB NAME `:. 1515 Cottonwood pass Rd. ee�ti- � o &� ! k-z JOB NO.
,0'05JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
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JOB COST SUMMARY
r
TOTAL SELLING PRICE
j O
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
JOB FOLDER Product 278 ®p NEW ENGLAND BUSINESS SERVICE. INC., G,ROTON, MA 01471 JOB FOLDER
7 1
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Printed in U.S.A.