HomeMy WebLinkAbout22111 Colorado River Rd - 168522300005INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
Eagle County Department of Environmental Health, PERMIT N® 0899
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: Paul Bohl i n Telephone: (212) 679-2317
Address: 40 Park Avenue, New York, New York 10016
System Location: 2211 Colorado River Road, Gypsum, Colorado 81637
Licensed Installer: _ George Roberts 6"),40- 0-402
License Number: _ 019-89-I
Conditional installation approval is hereby granted for the following:
Minimum requirements: Gallon Septic Tank or Aerated Treatment unit
Absorption area of dispersal area computed as follows: �� �f��
Percolation rate: Inch in Minutes OL- F.V�c`
Absorption area per bedroom Sq. Ft.
q", /44C---
Number of Bedrooms X Sq. Ft. minimum requirement per bedroom -
equals Total Sq. Ft. minimum requirement
Special Requirements: Minimum 750 gallon septic tank. Site plan. 8 x 8 x 10 dry well.
Date: April 6, 1989 V `
Environmental Health Officer:
CONDITIONS:
Erik Edeen
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 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 system is approved prior to covering any portion of the system.
INSTALLED ABSORPTION OR DISPERSAL AREA: SQ. FT.
INSTALLED SEPTIC TANK: GALLONS; DEGREES; FEET
DESIGN ENGINEER OF SYSTEM:
INSTALLER OF SYSTEM: PHONE:.
SEPTIC TANK CLEANOUT TO WITHIN 12"OF FINAL GRADE OR
AERATED ACCESS PORTS ABOVE GRADE: YES NO
PROPER MATERIALS AND ASSEMBLY: YES NO
COMPLIANCE WITH PERMIT REQUIREMENTS: YES NO
COMPLIANCE WITH COUNTY / STATE REGUL TION REQUIREMENTS: YES NO
COMMENTS:,fyh&wh?Ao R e /- i �� i /''L'/
(Any item checked NO requires correction before final approva of system is ma A an e re -inspection when
work is completed.) f
DATE (Final Approval) EN VIROWMENTAL HEALTH OFFICER:
DATE (Re -Inspection) ENVIRONMENTAL HEALTH OFFICER:
RETAIN WITH RECEIPT RECORDS
PERMIT
Name of Applicant: (George Roberts Name of Owner: Paul Bohl i n
Amount Paid: $150.00 Receipt Number: 1510 Date: 3-15-89 Cashier: Jo Brophy
Check # 1614
White and Pink Copies - Environmental Health Department Yellow Copy - Applicant / Owner
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE EAGLE COUNTY Number: 32 71
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail 328-7311 Eagle 927-3823 Basalt
PERMIT APPLICATION FEE $150.00 I PERCOLATION TEST FEE $125.00`
NAME OF OWNER: Aq�_ 80 Y-i� ~
MAILING ADDRESS: q0 pA,etZ 4-,7€ IU,?4. 0, , 00f6 PHONE:
-NAME OF APPLICANT ( I f different from owner) :
ADDRESS: iax �--` / "(/A-7Z_> Ca rG6s;� PHONE: 9
DESIGN ENGINEER OF SYSTEM (If applicable
ADDRESS:
PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: Gea-c�2. Roberts
LICENSED INSTALLER: (x) YESOK)-891( ) NO^-
ADDRESS: "P.O. '80)( 2ZO) V0 i l CO S R057 PHONE : qLl q - 1144(o
PERMIT
APPLICATION IS FOR:
N OF PROPOSED INDIVIDUAL
Physical Address: I b
Parcel Number:
Legal Description:
BUILDING OR SERVICE TYPE
(?5) Residential -
( ) Residential -
( ) Residential -
NUMBER OF PERSONS:
NEW INSTALLATION
SEWAGE DISPOSAL SYST M:
- 22-3 - ®U - bo "r
ALTERATION ( ) REPAIR
ze:
(Check applicable category):
Single Family ( ) Residential - Fourplex
Duplex ( ) Commercial (Type)
Triplex
NUMBER OF BEDROOMS: c=—
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 ( )
Give depth of all wells within 200 feet of system:
If suppl_�14_ by commuDkty t carve name of supplier:
SIGNATURE:
DATE:
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope
SOIL PERCOLATION
Creek/Stream
Depth to Bedrock (Per 8' profile hole
Depth to Groundwater table
TEST RESULTS: Minutes per inch in Hole #1.
Minutes per 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 Imo%O DATE:
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
S
(Environmental Health Dept. - Rev. 4/88)
ROUTE FORM
EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE (��J
Paul Bohlin (George Roberts)
3-31-89
Name qq01-(L1q(o
Date Routed 22111 Colorado River Road -- Hpp-i-Tcation No.
Location
Please review the attached Individual Sewage Disposal System Permit Application and
return it with this completed form the the Environmental Health Office.
PLANNING: Complies with - YES NO REVIEWED BY DATE
Subdivision Regulations:
Zoning Regulations:
Recommend Approval: 3 /
COMMENTS:
BUILDING: Complies with -
Building Permit Applied For:
Building Permit Issued:
Recommend Approval:
COMMENTS:
ENGINEER: Complies with -
Roads:
Grading:
Drainage:
Recommend Approval:
COMMENTS:
ENVIRONMENTAL HEALTH: Complies with -
Floodplain Permit Necessary:
I.S.D.S. Regs. Compliance:
Recommend Approval:
COMMENTS:
YES NO REVIEWED BY DATE
G' 3
YES NO REVIEWED BY DATE
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JOB NAME_
JOB LOCATION
BILL TO
DATE STARTED
899 Bohlin 2211 Co. River
Road 1685-223-00-005
PERMIT #: 0899
OWNER: PAUL BOHLIN
DATE COMPLETED
LOCATION: 2211 Colorado River Rd., E (gle
INSTALLER: GEORGE ROBERTS
SIZE OF TANK: 750 gal.
DWELLING: 2 BEDROOMS (1n
PERC RATE:
ABSORPTION AREA: �
�D
FINALIZED: BY: EE
once
JOB FOLDER
DATE BILLED
JOB NO. 2
2
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