HomeMy WebLinkAbout445 Spring Creek Rd - 000000000000INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
P.O. Box 179 - 550 Broadway a Eagle, Colorado 81631
Telephone: 328-7311 or 949-5257 or 927-3823
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. -9 5 1
Please call for final inspection before covering any portion of installed system.
OWNER: Mark Becker PHONE: 524-7942
MAILING ADDRESS: P.O. Box 1045, Eagle, CO 81631
AGENT:
PHONE:
SYSTEM LOCATION: 0445 Spring Creek Rd. , Gypsum, CO 81637
LICENSED INSTALLER: owner LICENSE NO.
DESIGN ENGINEER OF SYSTEM:
INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING:
1250 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT.
DISPERSAL AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED 480 SQUARE FEET OF TRENCH BOTTOM. or 1601.f, of 10" SB 2
SPECIAL REQUIREMENTS:
ENVIRONMENTAL HEALTH OFFICER: _�
„ DATE: � ?�
CONDITIONS:
1. ALL INSTALMUST COMPLY WITH ALL REQUIREMEN OF HE E COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM
REGULATIONS, ADOPTED PURSUANT TO AUTHORITY GRANTED°I - 04, 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 111, 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 SYSTEMSHA'LL 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:-89tlP7fI!'FEFr.
INSTALLED SEPTIC TANK: v"xo GALLONS DEGREES FEET
SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR:
PROPER MATERIALS ANDASSEMBLY X YES NO
COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: X 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-r DATE:
ENVIRONMENTAL HEALTH OFFICER: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS PERMIT
APPLICANT/AGENT:
OWNER:
AMOUNT PAID: RECEIPT #: CHECK #: CASHIER:
APPLICATION FOR LNDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number: 3331
P. 0. BOX 179
EAGLE—COLORADO 81631
949-5257 '328-7311 Eagle 927-3823 Basalt e
PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00
NAME OF OWNER: %�i'( c �t /� G /
MAILING ADDRESS: �. d3 6X ��� ,` �°�Lt, PHONE: 02 `/-7cJL/
NAME OF APPLICANT (If different from owner):
ADDRESS:
DESIGN ENGINEER OF SYSTEM (If applicable):
ADDRESS:
PHONE:
PHONE:
PERSON RESPONSIBLE FOR INSTALLATION OF SYSTE .
LICENSED INSTALLER: ( ) YES ( ) NO
ADDRESS: PHONE:
PERMIT APPLICATION IS FOR: ( NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Physical Address: 2iw -Ttk(03• G` Sur` ���•
Parcel Number: Lot Size:
Legal Description:
BUILDING O ERVICE TYPE (Check applicable category):
Residential - Single Family ( ) Residential - Fourplex
( ) Residential - Duplex ( ) Commercial (Type)
( ) Residential - Triplex
NUMBER OF PERSONS: `-f _ NUMBER OF BEDROOMS:
WASTE TYPES Check applicable categories):
Commercial or Institutional (�ransient
welling
( ) on -Domestic Wastes ( Use
(✓arbage Disposal ( vDishwasher
( utomatic Washer ( ) Spa Tub
( ) Other (Specify):
TYPE OF IN VIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Septic Tank Composting Toilet ( ) Incineration Toilet
( ) Vault Privy ( ) Greywater ( ) Chemical Toilet
( ) Pit Privy ( ) Aeration Plant ( ) Recycling, Portable Us
( ) Other ( ) Recycling, Other U
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 ay reduce the required absorption area upon
approval of an adequate water onservation plan.
SOURCE AND TYPE OF WATER SUPPLY: ( ) Well ( ) Spring ( ) Creek/Stream
Give depth of all wells within 200 feet of system:
If supplied y commu ity wa er, give name of supplier:
SIGNATURE:
�� ,�,� DATE :
INFORMATION BELOW Td BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER:
GROUND CONDITIONS: Percent ground slope
Depth to Bedrock (Per 8' profile hole) ? Q6 O `
Depth to Groundwater table �r A0
SOIL PERCOLATION TEST RESULTS: A ® Minutes per inch in Hole #1
to Minutes per inch in Hole #2
CL® Minutes per inch in Hole #3
FIN DISPOSAL BY:
Absorption Trench, Bed or Pit
( ) Above Ground Dispersal
( ) Under Ground Dispersal
( ) Other
AMOUNT PAID: jR RECEIPT NUMBER
( ) .Evapotranspiration
( ) Sand Filter
( ) Wastewater Pond
�-1 q 0 DATE:
NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION.
MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY..TREASURER".
(Environmental Health Dept. - Rev. 4/88)
EAGLE COUNTY
BUILDING DIVISION
P. O. Box 179
Phone: 328-7311
z
INSPECTION REQUEST
4W DJUG PERMIT N
DATE: JOB
NAME:
TIME ❑ AMi CALLER: p�
RECEIVED: y°2 0 D ❑ PM r t� �C�s
❑ OTHER: LOCATION:yJ /)
r ❑ PARTIAL ® / �lP�1.*
Ready for Ins ection: ❑ MONDAY ❑ TUESDAY ❑ WEDNESDAY ❑ THURSDAY ❑ FRIDAY ❑ AM ❑ PM
COMMENTS:
i.
ROUTE FORM
EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE
2 N me '
Date Rout i2r/-Application o.
Locatio
Please review the attached Individual Sewage Dis osa��System Permit Application and
P,p
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: .� /1a►�„/ 1G1 '3i
COMMENTS: �� ,�1�((u�, +tr►�'�—�c l tc42
BUILDING: Complies with -
Building Permit Applied For:
Building Permit Issued:
Recommend Approval:
COMMENTS:
ENGINEER: Complies with -
Roads:
Grading:
Drainage:
Recommend Approval:
COMMENTS:
YES NO RFVTFLJFn RY nATF
ss
YES P40 REVIEWED BY DATE
ENVIRONMENTAL HEALTH: Complies with - YES NO REVIEWED BY DATE
Floodplain Permit Necessary:
✓
I.S.D.S. Regs. Compliance:
Recommend Approval:
Range 85 West of the 6th Principal
To�•mshil) 5 South, .
The SEi.NE4 of Section 9, ,under which patent issued, said land being
meridian, according to the Survey as follows: '
described according to t1�e Resurvey
A tract of
land situate in Tract 60 of Sectiondianbeing-Township
1
moreparticularly
South, Range 85 West of the 6th Principal Pel
described as fo11o1ys:
Beginning at Angle Point 6 of said Tract 60,
id Tract
thence S.
00°Ol'38" E. 1322.33 feet to Angle Point q of said Tract'CO3
thence S. 89'A-V90,� E. 132II.�3 feet alonggti Potn
�, the castel-ly line of said Tract
thence N. 00 13
60, o O„ W.
1;24,34 feet to Anylc Point 6 of. Tract GO the ,point
thence N. 89 50 2
of bcg':nning.
ly
Tog ethe r with a road and utility easement '10 fcfts�ic�"Tdi1ct1601, ex'tendingesoutherll
adjacent to and ��este�l�' of the easteill li"c l�'S ��, feet in length.
from the appal
ent centerline of a county road as built and in place to the norther'
line of the above described tract, being �aPPI-ONil"a .c. )
COUNTY OF EAGLE
STATE OF COLOI'ADO
I�
CT 3 1989
EAV31-L...COU'611 Y
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PERCOLATION TEST
ENVIRONMENTAL HEALTH DEPARTMENT
Eagle County
FEE: $125.00 ISDS APPLICATION NO. -3331
OWNER: M A% & a r
LEGAL DESCRIPTION:
RURAL ADDRESS: 0 VqS_ � /►.� � a �
TYPE OF DWELLING: ��+ F, ,�y NUMBER OF BEDROOMS:
DATE OF PERCOLATION TEST: /t) .20TYPE OF SOIL: S//� cA,
TEST HOLES PRE-SOAKED: YES _X NO
TIME
I WATER DEPTH II
INCHES OF FALL
RATE
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PERCOLATION RATE: _ C2 0
RECOMMENDED MINIMUM SEPTIC TANK SIZE:
RECOMMENDED MINIMUM ,LEACH FIELD SIZE:
RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM:(
SITE HAS BEEN R 4-E41ED AND TESTED FOR PERCOLATION RATE.
Envir ental He lth Offic Date
COYMYNTS : //
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Rev. 5/31/84 wiu���w��¢
EAGLE COUNTY
BUILDING
P. O. Box 17
Phone: 328-7311
°'V'S'°" INSPECTION REQUEST 17
451 Becher 0445 Spring C:reex C.
JOB NAME. JOB NO._
JOB LOCATION
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JOB
COST SUMMARY
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PRICE
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