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HomeMy WebLinkAbout79 Fulford Ct - 210904102008INDIVIDUAL 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. 9 7S Please call for final inspection before covering any portion of installed system. OWNER: Deane Simonton PHONE: 328-1015 MAILING ADDRESS: P.O. BOX 983 Eagle, CO 81631 AGENT: PHONE: SYSTEM LOCATION: 79 Fulford Court, Kaibab Subdivision Lot 58 LICENSED INSTALLER: WY Construction, Inc. LICENSE NO. DESIGN ENGINEER OF SYSTEM - INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING: 1000 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT. DISPERSAL AREA REQUIREMENTS: SQUARE FEET OF SEEPAGE BED 600 SQUARE FEET OF TRENCH BOTTOM. or 2001 of 10" S132 SPECIAL REQUIREMENTS: Place inspection portals in end of each trench ENVIRONMENTAL HEALTH OFFICER: � DATE: CONDITIONS: 1. ALL INSTALLATIONS M ST COMPLY WITH ALL REQUIREMENTS OZ GLE LINTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS, ADOPTED PURSUANT TO AUTHORITY GRANTED I, .S. 1973, AS AMENDED. 2. THIS PERMIT IS VALID ONLY FOR CONNECTION TO STRUCTURESAVE 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: mo* SQUARE �F^EET. INSTALLED SEPTIC TANK: _1 " GALLONS 2 7L DEGREES l7 FEET SEPTIC TANK CLEANOUT TO WITHIN 8" OF FINAL GRADE, OR: ��/ PROPER MATERIALS ANDASSEMBLY 1" YES NO COMPLIANCE WITH COUNTY/STATE REGULATION REQUIREMENTS: IV 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: G ENVIRONMENTAL HEALTH OFFICER: DATE: (RE-INSPEC ION IF NECESSARY) RETAIN WITH RECEIPT RECORDS PERMIT APPLICANT/AGENT: OWNER: AMOUNT PAID: RECEIPT #: CHECK #: CASHIER: APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number: P. 0. BOX 179 EAGLE, COLORADO 81631 949-5257 Vail 328-7311 Eagle 927-3823 Basalt PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $125.00 � jf r. NAME OF OWNER: Peace y PON(, sivhao,jo" MAILING ADDRESS: PO Box 98 3 z 1 le, 916� 1 PHONE: NAME OF APPLICANT (If different from owner): ADDRESS: PHONE: DESIGN ENGINEER OF SYSTEM (If applicable): ADDRESS: PHONE: PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: WY CZSi(UGI !`00 , Inc, LICENSED INSTALLER: (A) YES ( ) NO ADDRESS: Box ar"®a ; �3`-e_j CQ4 V631 PHONE: �'4 5--iffy PERMIT APPLICATION IS FOR: NEW INSTALLATION ( ) ALTERATION ( ) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Physical Address: '7q Rji6rd Court Kaib4, Su6devisli3y Parcel Number: Lot Size: , i qcrec, Legal Description: lot 5-1" feaibnb 5,wivia0h BUILDING OR SERVICE TYPE (Check applicable category): Residential - Single Family ( ) Residential - Fourplex ( ) Residential - Duplex ( ) Commercial (Type) ( ) Residential - Triplex NUMBER OF PERSONS: +t- o NUMBER OF BEDROOMS: WASTE TYPES Check applicable categories): 3 b r_ —� Commercial or Institutional (X) Dwelling ( ) Non -Domestic Wastes ( ) Transient Use ( ) Garbage Disposal (X) Dishwasher O Automatic Washer ( ) Spa Tub ( ) Other (Specify): TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: �C 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 (J<) 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: If su lied by co unity water, give name of supplier: -T®v:� *9aciie SIGNATURE: ,� ~� �UJ'l DATE: INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER: GROUND CONDITIONS: Percent ground slope Sr - Depth to Bedrock (Per 8' profile hole)7 f Depth to Groundwater table 74 SOIL PERCOLATION TEST RESULTS: IS' Minutes per inch in Hole #1 ,-) a Minutes per inch in Hole #2 15, 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: r) S . RECEIPT NUMBER S 6 Z-(O DATE: 3 -1 rurry hillunrn rncurro. M. NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION. MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER". (Environmental Health Dept. - Rev. 4/88) 90 PERCOLATION TEST ENVIRONMENTAL HEALTH DEPARTMENT Eagle County FEE: $125.00 ISDS APPLICATION NO. OWNER: .gip..,. LEGAL DESCRIPTION: LA ,", RURAL ADDRESS: 7 �?rGf C a ,r TYPE OF DWELLING: �rd' NUMBER OF BEDROOMS: DATE OF PERCOLATION TEST: ,S_ `7 A 0 TYPE OF SOIL: o-o? TEST HOLES PRE-SOAKED: YES NO a s TIME WATER DEPTH II INCHES OF FALL RATE 1 2 3 II 1 2 3 ►I 1 t 2 3 11 1 2 3 4�/ /4:/ / o `,) 11 'ail ,� y i0r`tP! ionp/ 6.,6hf ®' S /49'o26 /-0 7 !- `L� -'' ar �� JOM?/ 10r1/'/ lempi g MI°I la9 as !,� , r3 ,l p /3 Pl 11.33r /d qV °®e w6 T. J) e P 3 —Sit d I ( �1 r '3 i Al M.10I O'U r1f t 3MPI /�- /3elO) IQo/-P/ /o/`ti} ✓%s lo:'/ i�'s aD , a y �� "13 812 L /3ry 13�� -s7 ao y any `` �7r" y '• y ' —L f ao�►�r �•��j ,�►P, li it 1 1,5 -d-u 0- JV f cv — 1) f, PERCOLATION RATE: a6 RECOMMENDEDMINIMUMSEPTIC TANK SIZE: 1000 ��, r4 4 J (,�2qo' RECOMMENDED MINIMUM _ _r%UjI FT_'_D S 4: �o (j t' / RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: aQ ,.� SITE HAS BEEN REVIEWED AND TESTED FOR PERCOLATION RATE. Envi ronm al Hea th Offi 1 Date COMMENTS: Rev. 5/31/84 EAGLE COUNTY 551 Broadway Eagle, Colorado 81631 (303) 328 7311 Date: June 18, 1990 Deane Simonton P.O. Box 983 Eagle, CO 81631 Re: Final of ISDS Permit No. 976 This letter is to inform you that the above referenced ISDS Permit has been inspected and finalized. Enclosed is a copy to retain for your records. Also enclosed are informational sheets regarding the care of your septic system. If you have any questions regarding this permit, please contact the Eagle County Environmental Health Officer, P.O. Box 179, Eagle Colorado 81631. Or we can be reached from Vail/Avon 949-5257; Basalt/El Jebel 927-3823; Eagle area 328-7311, indicate extension 530 after reaching the County Operator. Sincerely, Raymoxg P. Merry, RS Environmental Health Of i�er encl: Information Sheets ISDS Permit xc: ISDS File No. Board of County Commissioners Assessor Clerk and Recorder Sheriff Treasurer P.O. Box 850 P.O. Box 449 P.O. Box 537 P.O. Box 359 P.O. Box 479 Eagle, Colorado 81631 Eagle, Colorado 81631 Eagle, Colorado 81631 Eagle, Colorado 81631 Eagle, Colorado 81631 r „ ROUTE FORM •`�� EAGLE COUNTY ENVIRONMENTAL HEALTH OFFICE Name Date Route ed �9� ' 4� 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. PLANNING: Complies with - YES NO REVIEWED BY DATE Subdivision Regulations: Zoning Regulations: Recommend Approval: COMMENTS: BUILDING: Complies with - Building Permit Applied For: Building Permit Issued:. Recommend Approval: COMMENTS: ENGINEER: Complies with - _ Roads: Grading: Drainage: Recommend Approval: COMMENTS: YES NO REVIEWED BY DATE YES NO REVIEWED BY DATE ENVIRONMENTAL HEALTH,: Complies with - YES NO REVI Floodplain Permit Necessary: I.S.D.S. Regs. Compliance: Recommend Approval: COMMENTS �l��i.�A ©a�f JG���✓ , ����'%;! / � �/A r.� /'ova=^--� _ ;?e/lq �?o 4 976 Simonton Lot 58 Kaibab Sub 79 Fulford Court JOB NAME JOB NO. BILL TO DATE STARTED DATE COMPLETED DATE BILLED JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL PERMIT # 976 OWNER: Deane Simonton LOCATION: 79 Fulford Court, Kaibab Subdivision INSTALLER: WY) (Construction DWELLING: 3 bedrooms SIZE OF TANK: 1000 gal. PERC RATE: 15 mpi FINALIZED: 6/15/90 TOTAL LABOR INSURANCE SALES TAX nnlsc.cosTs TOTAL JOB COST GROSS PROFIT LESS OVERHEAD COSTS OF SELLING PRICE NET PROFIT 4' s 1 )L,DER 1 4� �J 7-1 b V � Printed in U.S.A. PLEASE Ri: i ;SPORT"ION Ws t h YUi; Ji ! C. PLAN F1iVL1 : �.C: 73' i 049 ti251 9?7-382:3 f ENVIRONMENTAL HtALTH, "°•1 BOX 850 EAGLE, COLORADO 81631 PERM)J 0. 00 PERCOLATION TE-ST FEE = $50 APPLICATION FOR INDIVIDUAL. SEWAGE DISPOSAL SYSTEM PERMIT NO. NAME OF OWNER:ell AUDRES.�: � HO aE: NAME 0�" APPLICANT (IF DIFFERENT FROM OWNER) : ADDRESS: PHONE: DE:S.[(:N ENGINEER? OF SYSTEM (IF APPLICABLE): ADDRESS: _ _ PHONE: PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: 4-4-b-(2- L%b,e/eGA —� ADDRESS: _ 3 5 � � (�� , C� , PHONE: Q 7- d, PF'RK!T APPLICATION IS FOR: (k) New Installation ( ) Alteration ( ) Repair LOCATION OF PROPOSED FACILITY: County =_AaL.E7--- Lot Size City or Town, if within City or Town Limits LEGAL DESCRIPTION:--.�_L-aT:. S�— STREET (RURAL) ADDRESS: ..PoL i` SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY? Yes ( ) No BU)1 D`NG Og 5FRV.rF.`TYPE: (,heck s,,pplicable category) dwell ing ( ) Rfisidential - i� :soex Residential - Duplex ( ) Residential Qu�idpl ex Commercial State usage Persons # Bedrooms WASTE TYPES: (Check all applicable) r/ ( ) Commercial or Institutional Dwelling ( Z_�arbage Grinder ( ) Non -domestic wastes ( ) Transient Use (itti, ( ) Other (r—i�Automa-ti c; 14astir r SOURCE AND '[YNE OF 14ATER SUPPLY: ( ) Well ( ) Spring ( ) Creek or Streayi Give depth of all wcl l s within 200 feet of t' c system: If supplied by community water, give name of supplier: TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (!L Septic Tank ( ) Aeration Plant ( ) Chemical Toilet ( ) Vault Privy ( ) Composting Toilet ( ) Recycling, Potable U :e ( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, Other Use ( ) Greywater ( ) ,.Other WILL EFFLUENT BE DISCHPIRGED JiKEi iL'F' 11-0 WATC1 Yes No Siyrature Date * * * * * * * * * * * * * t * * * * * *. * * * * * * * * *. * * INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL. HEALTH OFFICER '?OUND CONDITIONS: Percent Ground Slope: Depth to Bedrock (per 8` Profile Hole): Depth to Groundwac- T;�ble: SOIL PERCOLATION TEST RESULTS: Minutes per inch in Hole No. 1 — Minutes per inch in Hole Fao> 2 P'iinutes per inch i-o dole No. 3 FINAL DISPOSAL BY: ( ) Absorption Trench, Bed or Pit ( ) Evapotransoirat.ion ( ) Above Ground Dispersal ( ) Sand Filter ]� Underground Dispersal ( ) 'Wastewater Pond P C Other -r",k cud z- i®a ' x. 1- d r -lq-qU -Z�776 136 Goa~ �y -iy -,w - i - - - r f V i - t 1 1 i I