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HomeMy WebLinkAbout13113 Gypsum Creek Rd - 219531200001INDIVIDUAL 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. 980. Please call for final inspection before covering any portion of installed system. OWNER: E.K. Van den Berg PHONE: 407-423-7656 MAILINGADDRESS:921 Georgia Ave. Winter Park, FL 32789 AGENT: PHONE: SYSTEM LOCATION: LICENSED INSTALLER: Ron Heinen P.O. Box 58 Eagle, CO 81631 LICENSE NO. DESIGN ENGINEER OF SYSTEM' INSTALLATION IS HEREBY GRANTED FOR THE FOLLOWING: 750 GALLON SEPTIC TANK OR GALLON AERATED TREATMENT UNIT. DISPERSAL AREA REQUIREMENTS: SQUARE FEET OF SEEPAGE BED 250 SQUARE FEET OF TRENCH BOTTOM. or 100 f t of S132 10j1 SPECIAL REQUIREMENTS: ENVIRONMENTAL HEALTH OFFICER: DATE: CONDITIONS: 1. ALL INSTALLATIONS MUST COMPLY WITH ALL REQUIREMENTS OF THE EAGLE COUNTY INDIVIDUAL SEWAGE DISPOSAL SYSTEM REGULATIONS, ADOPTED PURSUANT TO AUTHORITY GRANTED /N 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: 260 SQUARE FEET. INSTALLED SEPTIC TANK: ' GALLONS 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: i7 y DATE: ENVIRONMENTAL HEALTH OFFICER: DATE: (RECIMSPECTION NECESSARY) RETAIN WITH RECEIPT RECORDS PERMIT APPLICANT/AGENT: OWNER: AMOUNT PAID: RECEIPT #: CHECK #: CASHIER: _APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT r�} ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY Number: .5� /D P. 0. BOX 179 EAGLE, COLORADO 81631 949-5257 Vail 328-7311 Eagle 927-3823 Basalt ______PERMIT APPLICATION FEE $150.00 � nr}?Cn� nTrnni TEST FEE �P�r.nr_�r� � NAME OF OWNER: ,�� p/4.,y D,�m MAILING ADDRESS: Glig72Ee ?aeK. PHONE: ru7) r,L l -745� NAME OF APPLICANT (If different from owner): ADDRESS: PHONE: DESIGN ENGINEER OF SYSTEM (If applicable): ADDRESS: PHONE: _ PERSON RESPONSIBLE FOR INSTALLATION OF SYSTEM: oeoy LICENSED INSTALLER: YES ( ) NO ADDRESS: P®_ pax 0 . 9/6, 3/ PHONE: PERMIT APPLICATION IS FOR: (X NE14 INSTALLATION ( ) ALTERATION ( ) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Physical Address: Parcel Number: Lot Size: 5.3.5.,2ES Legal Description: BUILDING OR SERVICE TYPE (Check applicable category): Residential - Single Family ( ) Residential - Fourplex ( ) Residential - Duplex ( ) Commercial (Type) ( ) Residential - Triplex NUMBER OF PERSONS: ;2- NUMBER OF BEDROOMS: / WASTE TYPES Check applicable categories : Commercial or Institutional (X) Dwelling ( ) Non -Domestic Wastes ( ) Transient Use ( ) Garbage Disposal ( ) Dishwasher { ) 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 (�C) NO IS SYSTEM DESIGNED FOR LESS THAN 2,000 GALLONS PER DAY: ( YES ( ) NO WATER CONSERVATION PLAN: ( ) YES (>d 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: ()e) Well ( ) Spring ( } Creek/Stream Give depth of all wells within 200 feet of system: If supplied by community water, give name of supplier: SIGNATURE: G�izc� ��� DATE: aJ el. l/ /9wU INFORMATION BELOW TO BE FILLED OUT BY ENVIRONMENTAL HEALTH OFFICER: GROUND CONDITIONS SOIL PERCOLATION Percent ground slope U —s /0 Depth to Bedrock (Per 8' profile hole Depth to Groundwater table TEST RESULTS: /0 Minutes per inch in Hole #1 10 Minutes per inch in Hole #2 (o Minutes per inch in Hole #3 FIN "ISPOSAL BY: Absorption Trench, Bed ( ) Above Ground Dispersal ( ) Under Ground Dispersal { ) Other �a or Pit ( ) Evapotranspiration ( ) Sand Filter ( ) Wastewater Pond AMOUNT PAID: A �� RECEIPT NUMBER % —DATE: NOTE: SITE PLAN MUST BE ATTACHED TO APPLICATION. MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER". (Environmental Health Dept. - Rev. 4/88) 00 G�AC�EF=ram �o��� 4 wo { IA-1 i�au1,v.: S�ir , eo t o ,Y4 ® F' 7`. 4 A ew14 4,- ,mod 7-• 7-o.�-- sa,,J % a,,a' Lvi ' Ti .4' Alc�,+�.i q o se-1 46 It a J 00 AI EAGLE COUNTY 551 Broadway Eagle, Colorado 81631 (303) 328 7311 Date: June 14, 1990 E. K. Van den Berg 921 Georgia Ave. Winter Park, FL 32789 Re: Issuance of Individual Sewage Disposal System Permit No. 980 Enclosed is your ISDS Permit No. 980 . This copy of the permit must be posted on the installation site. You must call our office for final inspection before covering any portion of the installed system. If you have any questions, please feel free to contact us at the following numbers for your calling area: Vail/Avon 949-5257; Basalt/El Jebel 927-3823; Eagle area 328-8730. Sincerely, Raym d P. Merry, R. Envi onmental Health xc: ISDS file Board of County Commissioners Assessor P.O. Box 850 P.O. Box 449 Eagle, Colorado 81631 Eagle, Colorado 81631 cer Clerk and Recorder Sheriff Treasurer P.O. Box 537 P.O. Box 359 P.O. Box 479 Eagle, Colorado 81631 Eagle, Colorado 81631 Eagle, Colorado 81631 { EAGLE COUNTY 551 Broadway Eagle, Colorado 81631 (303) 328 7311 Date: June 25, 1990 E.K. Vanden Berg 921 Georgia Ave. Winter Park, FL 32789 Re: Final of ISDS Permit No. 980 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, Raymo 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 PERCOLATION TEST ENVIRONMENTAL HEALTH DEPARTMENT Eagle County FEE: $125.00 ISDS APPLICATION NO. 3,3 qO OWNER: f al. -I [�le" �111 LEGAL DESCRIPTION: SPA a� 9G 5� DlQ RURAL ADDRESS: TYPE OF DWELLING: S,'t% NUMBER OF BEDROOMS: DATE OF PERCOLATION TEST: -TYPE OF SOIL: — g fU � r TEST HOLES PRE-SOAKED: YES NO TIME I WATER DEPTH 1! INCHES OF FALL RATE 1 2 3 ► 1 2 1 3 II 1 1 2 3 1 2 3 17 /✓`� // / ,' / % ` as / /r I /(D : r/ a „ V MI®! 3..3!` /1e/ 1. l '" 8i / S' / a 3 r'' ref p I l :-L- � Ga /� •r. � // �I I/I T,j i ill / M �. G !"&MP !/ � = 30 tl ; 3 q ad f l' o PERCOLATION RATE: /Q RECOMMENDED MINIMUM SEPTIC TANK SIZE: /d 0'0 Q;A,/ — RECOMMENDED MINIMUM tfAt4 IZE RECOMMENDED MINIMUM SQUARE FOOTAGE PER BEDROOM: NL -/ow - 3. S�, v,•r s/e%/<� �, 3� SITE HAS BEEN REVIEWED AND TESTED FOR PERCOLATION RATE. vi ronme COMMENTS: Rev. 5/31/84 -6w, ,- /, s -/m al t ffj,i'` Date. i r �� V/A .,"le— youu van wwwr Derg JOB NAME JOB NO. —`/ JOB LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED �S a O t V e ? Lt/ 6t�•� G l/l,f 2 .I G� /t-P-Gt� ud-e �J�'h '✓GL C7N-� a 1 r`e-- e �. � l U1G�/' � / .��/Z � E�� �- �]�2'2C� G�o��Cl ��d �. D I ( e7s 3 3dd z/O6 S 1-6e-(/ 4 !�G✓ r� GjGc J/c e JOB COST SUMMARY TOTAL SELLING PRICE TOTAL MATERIAL PERMIT # 980 OWNER: E.K. Vanden Berg LOCATION: Gypsum Creek Rd. INSTALLER: Ron Heinen SIZE OF TANK: 1000 gallons. BEDROOMS: 1 PERC RATE: 10 moiG ABSORTION AREA: 300 sq. ft. 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