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HomeMy WebLinkAbout320 Strohm Cir - 211107101002INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT Eagle County Department of Environmental Health PERMIT NO 0843 P.O. Box 850 - 550 Broadway Eagle, Colorado 81631 Telephone: 328-7311 or 949-5257 or 927-3823 YELLOW COPY OF PERMIT MUST PLEASE CALL FOR FINAL INSPECTION BEFORE BE POSTED AT INSTALLATION SITE COVERING ANY PORTION OF INSTALLED SYSTEM Owner: Austin Gi hhons Telephone:— 524-9680 Address: 1834 Daggett Lane Gypsum, Colorado 81637 System Location: 320 Strohm Circle Gypsum, Colorado 81637 Licensed Installer: Gary Bertroch License Number: 002-88-I Conditional installation approval is hereby granted for the following: Minimum requirements: 1250 Gallon Septic Tank or Aerated Treatment unit Absorption area of dispersal area computed as follows: Percolation rate: 3 Inch in 60 Minutes Absorption area per bedroom 200 Sq. Ft. Number of Bedrooms X 200 Sq. Ft. minimum requirement per bedroom - equals Total Sq. Ft. minimum requirement Special Requirements: Date: June 2. 1988 Environmental Health Officer: 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, 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 shall automatically be a violation of a requirement of the permit andcause 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 system is approved prior to covering any portion of the system. INSTALLED ABSORPTION OR DISPERSAL AREA: 7�D SQ. FT. 1-7 ' INSTALLED SEPTIC TANK:�S_> GALLONS; -� DEGREES;_7 DESIGN ENGINEER OF SYSTEM: INSTALLER OF SYSTEM: SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR / AERATED ACCESS PORTS ABOVE GRADE: YES L_ PROPER MATERIALS AND ASSEMBLY: YES ` NO COMPLIANCE WITH PERMIT REQUIREMENTS: YES COMPLIANCE WITH COUNTY / STATE REGULATION REQUIREMENTS: YES ✓ NO COMMENTS: (Any item checked NO requires correction before final approval of system is m 4, rr, e-i spection when work is completed.) ��f DATE (Final Approval _ ENVIRONMENTAL HEALTH OFFICER: DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER: RETAIN WITH RECEIPT RECORDS PERMIT Bertroch & Sons Name of Applicant: Austin M. Gibbons Name of Owner: Austin M. Gibbons Amount Paid: $275.00 Receipt Number: 4865 Date: 5-16-88 Cashier: Jo Check # 002 White and Pink Copies - knvironmental Health Department Yellow Copy - Applicant / Owner APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY P. 0. BOX 179 -`� EAGLE, COLORADO 81631 N0.� 949-5257 Vail 328-7311 Eagle 927-3823 Basalt PERMIT APPLICATION FEE $150.00 5-j&,46a PERCOLATION TEST FEE $125.00 NAME OF OWNER: K) MAILING ADDRESS: i834 D c C, l-ril Cgrsoi4t PHONE: 5 Z 4 0776 W NAME OF APPLICANT (If different from owner): ftk-rRoc(-f ;k 5©t'�S ADDRESS: ecy-, 204 ?sor-A coy 8(cOSI PHONE: -SZ4 -1`5 8(_. DESIGN ENGINEER OF SYSTEM (If applicable): ADDRESS: PHONE: PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: C-A(zti 13F_g_oc,4 LICENSED INSTALLER: () YES ( ) NO ADDRESS: bb2c Z6<f, PHONE: '5Z<f 9Se§' s-zy- ' 776 PERMIT APPLICATION IS FOR: (X) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Physical Address: Z a STPLO VA t1l\ e i (Z . C.,'I � Parcel Number: G_cot *k 7 Lot Size: t a 1 Legal Description: t5f_Pr"(Rc)cH SA&610. rz cur\)'�fo' BUILDING OR SERVICE TYPE (Check applicable category): Residential - Single Family ( ) Residential - Fourplex ( ) Residential - Duplex ( ) Commercial (Type) ( ) Residential"- Triplex NUMBER OF PERSONS: & I NUMBER OF BEDROOMS: WASTE TYPES Check applicable categories): Commercial or Institutional (;) Dwelling ( ) Non -Domestic Wastes ( ) Transient Use ( ) Garbage Disposal ( ) Dishwasher ( ) Automatic Washer ( ) Spa Tub ( ) Other (Specify): TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: Septic Tank Composting Toilet ( ) Incineration Toilet ( ) Vault Privy ( ) Greywater ( ) Chemical Toilet ( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Portable Use ( ) Other ( ) Recycling, Other Use WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE: ( ) YES (><) NO IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: ( ) YES { ) NO WATER CONSERVATION PLAN: ( ) YES ( ) NO NOTE: The Environmental Health Office may reduce the required absorption area upon approval of an adequate water conservation plan. SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( ) Spring ( ) Creek/Stream Give depth of all wells within 200 feet of system: PC>0 e_ If sup i qied by community water, give name of supplier: nUjtJ of C a ps urx SIGANTURE:Ctiu� ����� DATE: INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER: GROUND CONDITIONS: Percent ground slope SOIL PERCOLATION Depth to Bedrock (Per 8' profile hole Depth to Groundwater table TEST RESULTS: Minutes per inch in Hole #1 Minutes pet" inch in Hole #2 Minutes per inch in Hole #3 FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Above Ground Dispersal ( ) Sand Filter ( ) Under Ground Dispersal ( ) Wastewater Pond ( ) Other AMOUNT PAID: RECEIPT NUMBER NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION. DATE: (Environmental Health Dept. - Rev. 4/88) ✓ ll���-c� `1 m o oa 4 0,7lnl 0860� tia 3?aCC) WT PEAtJ PAArj. /.©2- --t4 7 'LO% In-L } /�l SCALP 1 k---40c no 4Us r,tj Gf�e 8om-s -SEPTIC, 4 PpZ-%CAV 0�J A)O, 32.06 fLAIJ PAPT ®f --?� 7 0 P, PERCOLATION TEST ENVIRONMENTAL HEALTH DEPARTMENT Eagle County FEE: $125.00 ISDS APPLICATION NO. OWNER:�� 112Z LEGAL DESCRIPTION: Zy S /-p 1-7 RURAL ADDRESS: TYPE OF DWELLING: NUMBER OF BEDROOMS: <L DATE OF PERCOLATION TEST: -TYPE OF SOIL: TEST HOLES PRE-SOAKED: YES NO TIME WATER DEPTH INCHES OFFALL RATE PERCOLATION RATE: 3 RECOMMENDED MINIMUM SEPTIC TANK SIZE: 1 2-So RECOMMENDED MINIMUM LEACH FIELD SIZE: a Q ®& �— --- S RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: 2-O SITE HAS BEEN REVIEWED AND TESTED FOR PERCOLATION RATE. z2Z Environmental Health Officer COMMENTS: Rev. 5/31/84 Date ROUTE FORM-77� EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE ✓(� Ar in-tin!0. G�bb�n S 'ame 8 32-0& Date Routed 320 Strohfn Ci rck ¢ m Application No. Location Please review the attached Individual Sewage Disposal System Permit Application and return it with this completed form the the Environmental Health Office. 4,y� ING: Complies with - YES NO REVIEWED BY TE ion Regulations: �/ A Zoning Regu j Recommen oval:. COMMENTS: BUILDING: Complies with - Building Permit Applied For: Buildina Permit Issued: Recommend Approval: COMMENTS: ENGINEER: Complies with - Roads: Grading: Drainage: Recommend Approval: COMMENTS: YES NO RFVTFIiFn RY noTP YES NO REVIEWED BY DATE ENVIRONMENTAL HEALTH: Complies with -: YES Floodplain Permit Necessary: 4Z I.S.D.S. Regs..Compliance: Recommend Approval: COMMENTS: IEWED BY DATE 843 Gibbons Lot 7 Bertroch JOB NAME. Sub 320 Strohm circle JOB NO. - JOB LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL PERMIT # 843 OWNER: Austin Gibbons LOCATION: 320 Strohm Circle, Gypsum INSTALLER: Gary Bertroch SIZE OF TANK: 1550 Gallon DWELLING: 5 BR Residence PERC RATE: 3 inches per hour ABSORPTION AREA: 1,000 square feet FINALIZED: 7-14-88 BY: Erik Edeen JOB COST :)SS PROFIT OVERHEAD COSTS SELLING PRICE NET PROFIT JOB FOLDER Product 278 t�(& NEW ENGLAND BUSINESS Printed in U.S.A.