HomeMy WebLinkAbout14936 Hwy 6 - 211101100002INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
P.O. Box 179 - 550 Broadway • Eagle, Colorado 81631
Telephone: 328-7311 or 949-5257 or 927-3823
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 90'
Please call for final inspection before covering any portion of installed system.
OWNER: Oames A. Fitzsimmons PHONE: 524-9722
MAILING ADDRESS: 3316Gypsum Creek Road, Gypsum, CO 81637
AGENT: Self
PHONE:
SYSTEM LOCATION: 12 miles West of Eagle
LICENSED INSTALLER: Owner Installed LICENSE NO.
DESIGN ENGINEER OF SYSTEM, N/A
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED SQUARE FEET OF TRENCH BOTTOM.
SPECIAL REQUIREMENTS: Two 1000 gallon septic tanks and :140' of SB2 for each system
V
ENVIRONMENTAL HEALTH OFFICER: Erik Edeen DATE: May 10, 1989
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 AND CAUSE FOR BOTH
LEGAL ACTION AND REVOCATION OF THE PERMIT.
3. SECTION Ill, 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: (TO BE COMPLETED BY INSPECTOR):
NO SYSTEM SHALL BE DEEMED TO BE IN COMLIANCE 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: Z 60 SQUARE FEET.
INSTALLED SEPTIC TANK: ` 7 GALLONS O �Q DEGREES FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALS AND ASSEMBLY YES NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: YES NO
ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS COMPLETED.
COMMENTS:
ENVIRONMENTAL HEALTH OFFICER: DATE: S" 17
-V
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS
APPLICANT/AGENT: James A. Fitzsimmons (Corky)
PERMIT
OWNER: Same
AMOUNT PAID: $275.00 RECEIPT 1558 CHECK#: 6952 CASHIER: April Rusch
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number: 32 92
P. 0. BOX 179
EAGLE, COLORADO 81631
949-5257 Vail 328-7311 Eagle 927-3823 Basalt
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE125.00
NAME OF OWNER: Lj Nm.f�5 �1 5 �«g ) pn
MAILING ADDRESS: `3'3 / e-' 6- c
NAME OF APPLICANT (If different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: _
LICENSED INSTALLER: ( ) YES ( NO
ADDRESS:
��r_-1
PHONE:
PHONE:
PHONE:
PERMIT APPLICATION IS FOR: ( ) NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM -
Physical Address: J- e J G
Parcel Number: Lot Size:
Description: Sa �GSS 89-1ZA/ L- A -A e �wp 55&N
Legal C j _
p
BUILDING OR SERVICE TYPE (Check applicable category):
2—( Residential - Single Family ( ) Residential - Fourplex
) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: 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 INDI UAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank Composting Toilet ( ) Incineration Toilet
( ) Vault Privy ( ) Greywater ( ) Chemical Toilet
( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Portable
Use
Recycling, Other Use
WILL EFFLUENT �BEeDISCHARGED 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 c ervation plan.
SOURCE AND TYPE OF WATER SUPPLY: (ll ( ) Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system: hJ-o k%, e
If supplied by community water, give name of supplier:
SIGNATURE: Gl ' DATE:
INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope
Depth to Bedrock (Per 8' profile hole
Depth to Groundwater table
SOIL PERCOLATION TEST RESULTS: Minutes per inch in Hole #1
Minutes per inch in Hole #2
Minutes p'er inch in Hole #3
FINAL DISPOSAL BY:
Absorption Trench, Bed or Pit
( ) Above Ground Dispersal
( ) Under Ground Dispersal
{ ) Other
AMOUNT PAID: $Zi��.OQ_ RECEIPT NUMBER
( ) Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
J 8 DATE:
Coq Z. UW
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER".
(Environmental Health Dept. - Rev. 4/88)
PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE: $125.00 ISDS APPLICATION NO.
OWNER: :i 7 �S /�. ��nd5a��s
LEGAL DESCRIPTION: 1__2_% /6 1_z(_�s
RURAL ADDRESS:
TYPE OF DWELLING: NUMBER OF BEDROOMS:
DATE OF PERCOLATION TEST: �' �� TYPE OF SOIL:��
TEST HOLES PRE-SOAKED: YES NO
TIME
I WATER DEPTH fI
INCHES OF FALL
RATE
1
2
3
1
2
3
1
2
3
1
2
3
/
I
?
03�-�
i
I
1
PERCOLATION RATE: 2 () ��
RECOMMENDED MINIMUM SEPTIC TANK SIZE: 2 — z000 aet l�
RECOMMENDED MINIMUM LEACH FIELD SIZE:f''�
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:CJ<�
SITE HAS-BEEN REVIEWED AND TESTED FOR PERCOLATION RATE.
Environmental Health Officer
COMMENTS:
Rev. 5/31/84
Date
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EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE
ltzmo A. 6 tz�i'mM ns - Card
_ Name
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Date Routed 1 Z Mi Its i1�ea p�_^ _ 'o6k plon
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: g
COMMENTS: 7 '61 - dft Ate :.. AHve". -Lin .,,_
BUILDING: Complies with - YES, NO REVIEWED BY
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
DATE
YES NP REVIEWED BY DATE
I
0
907 Fitzimmons
JOB NAME JOB NO.
JOB LOCATION
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
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