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HomeMy WebLinkAbout3631 Gypsum Creek Rd - 211129200004INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631 Telephone: 328-8755 YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 1 3 3 1 Please call for final inspection before covering any portion of installed system. OWNER: Richard & Jeanne Kesler PHONE: 524-7280 MAILING ADDRESS: 3631 Gypsum Creek Rd. city: Gypsum State: CO Zip: 81637 APPLICANT: SAA PHONE: SYSTEM LOCATION: 3631 Gypsum Crk. Rd., Gypsum TAX PARCEL NUMBER: 2111-292-00-004 LICENSED INSTALLER: Merle Hobbs / Hobbs Excavation LICENSENO: 20-94 DESIGN ENGINEER OF SYSTEM: INSTALLATION HEREBY GRANTED FOR THE FOLLOWING: 1250 GALLON SEPTIC TANK ABSORPTION AREA REQUIREMENTS: SQUARE FEET OF SEEPAGE BED 9.86 SQUARE FEET OF TRENCH BOTTOM. SPECIAL REQUIREMENTS: Install 27 infiltrator units in trenches or 340 lineal SB2 it trenches Install inspection portals at the end of each trench ENVIRONMENTAL HEALTH APPROVAL: DATE: 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. 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. CHAPTER IV, SECTION 4.03.29 REQUIRES ANY PERSON WHO CONSTRUCTS, ALTERS OR INSTALLS AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM TO BE LICENSED. FINAL APPROVAL OF SYSTEM: (TO BE COMPLETED BY INSPECTOR): 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: 1050 SQUAREFEET.Via 28 infiltrator unitsin trenches INSTALLED SEPTIC TANK: 1250 GALLON 260 DEGREES 55 FEET FROM clean out between tank & house SEPTIC TANK ACCESS TO WITHIN W OF FINAL GRADE AND PROPER MATERIAL AND ASSEMBLY _ ',X YES _ NO COMPLIANCE WITH COUNTY/STATE REQUIREMENTS: X YES _ NO ANY ITEM CHECKED NO REQUIRES CORRECTION BEFORE FINAL APPROVAL OF SYSTEM IS MADE. ARRANGE A RE -INSPECTION WHEN WORK IS CORRECTED. COMMENTS: ENVIRONMENTAL HEALTH APPROVAL. DATE: S/Iv L q4 ENVIRONMENTAL HEALTH APPROVAL: DATE: (RE -INSPECTION IF NECESSARY) RETAIN WITH RECEIPT RECORDS APPLICANT / AGENT: OWNER: PERMIT FEE PERCOLATION TEST FEE RECEIPT # CHECK # K Incomplete Applications Will NOT Be Accepted (Site Plan MUST be attached) I ISDS Permit # 1 J!� I Building Permit # APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY P. O. BOX 179 EAGLE, CO 81631 328-8755/927-3823 (Basalt) ************************************************************************** * PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $2.00.00 * * * MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER" ************************************************************************** PROPERTY OWNER: 1 1C-q+KD I+jVb T;5-4,y (le� lC(=5 LE R. MAILING ADDRESS: 3631 Cy os eym OW-Fe"iC 4,4-A PHONE: 52-72-80 GyPSum , Coc0&-"9'b'v F/&S7 APPLICANT/CONTACT PERSON: Toy►h ICE A H 2 PHONE: SLR-7Z8 0 LICENSED SYSTEMS CONTRACTOR: ob f S q PHONE: 5ZV- 7.50/ o✓ 5z.V' 7'L5/7 COMPANY/DBA: AD6,55 6-XCA047-10At ADDRESS: 176o �V4sym e4e-&-ic 4w ********************************************************************* **** PERMIT APPLICATION IS FOR: (✓� NEW INSTALLATION ( ) ALTERATION ( ) REPAIR LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM: Legal Description: SEE Ar-rA-6E E/ Z Tax Parcel Number: SCNEDuC� Size: /a Ac,ee-s Physical Address: 3631 Gt/,Dsu n? e4eE 'K BUILDING TYPE: (Check applicable category) W Residential/Single Family ( ) Residential/Multi-Family* ( ) Commercial/Industrial* Number Number Type _ TYPE OF WATER SUPPLY: (Check applicable category) ( ) Well ( ) Spring ( .) Surface (� Public Name of Supplier: %wy or- G)osuoA of Bedrooms 4 of Bedrooms *These systems require design by a Registered Professional Engineer SIGNATURE: Date: ************************************************************************ j r� � f n AMOUNT PAID: 35p . RECEIPT #: l �53` �15So DATE: 41 / 7 f CHECK #: CASHIER: ISDS PERMITr 19 0 PERCOLATION TEST EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT. OWNER: Y pp 'e, LEGAL DESCRIPTION: MAILING ADDRESS:- r�)Lost (_y��c"� Ck . TYPE OF DWELLING: CIS, NUMBER OF BEDROOMS TEST HOLES PRE-SOAKED: YES_ NO TTMF 1 2 3 1 ----- --- 2E --- 1 „�... ..� 2 any,.. 3 c�a-►ir, 1 2 �UlL YKUr"1L 0' :15 (9 A -d C7 1 r7 ✓J ID� 1� eS 5., �L l„ 1 s �y 075 2, .a5 1.5 3.C) DJ 3.3 %e i8 3' 10.5 5 a .- '�.5 4' 9 � (0 . a5 Q � , �5 �P �- 5 5' q r�i s 113: ;�i «5 � )5 0 5 b '75 l �,j 7' ►.5D 5i 5'2 1� 5 i�i, �5 �,I Z 1 50 a la j g' 5( 1) iCis0 ►. " �� 5 .� 5 Iu � ��so;c_ Time to "top last inch PERC RATE: (�S�i '�jr j MI/N;IMUM SEPTIC TANK SIZE: 1 a50 MINIMUM LEACH FIELD SIZE: COMMENTS: �` GLt�� G� �Z.LS (�t�? `�Z� ✓l�C� UZ j o'i PERC TEST DONE BY: DATE: Environmental Health Offi Joy rev. 6/90ks �� �'`' _G�Ob_ _ '�5 2-;� - q � A. 2 r r /�, j 4, e4 � � � 0 A) N H rt N rt rt rt GD a N- 0 H ON 0 0 �rW O'�'O•(D (D N MZO' �r (D P- (D (D (D Q N A) ooz a v0 �0 () 0 O• K O �r f-' 0 (D (D H (D (D (D O M- S (D �'LS w0 P. 0 zzm:j m 7rON� crocnK v �0 0 0 0 0Q 910 rt* - cr t7 0zftKK0 0�'� rt, to Ow• 00300 MA) z0 rt (KD o Mao��o°ati F0-'N ` • M((DD (D tOaON a(D O NHto rt (D(DLi MLQ(D 0(Dz KQ"" :1�WUln0 �► w K (D K (D N 0 rt K A+ z (D UOi N In0 rt K 0• � z•N N N CTt' O O�'� ((DD O -% 0 % � W �' � rt (D ` L=! A� N rt W rt A! •• f�D'C O• K w W O, (D 0 0 (D H (Z A) W kD • kD m vatrnA► Z (D O'M W N t� O M rt rt A. I - 'II rt `< M &Mrt, 0 (OA ((DD fD P- to z OO O crt,c t ~`O Oo (D rt rt* 0 :' :< 0- (KID �F-''dN x K �aD)`t z f D a (D 0 0 ON a a N- 03 K FAcn m kD£ EK w � (D En'O rt ct N G m ----- �4 a,g W,:p w t15a, j i } _ -fit-- -- — _.._ ._. � ,___ ___.._•_ ...� ._._ , 1 1331-94 - Parcel #2111-292-00-004 JOB NAME 3631 Gypsum Creek Rd. KESLER JOB NO. JOB LOCATION BILL TO DATE STARTED DATE COMPLETED DATE BILLED L` y I 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 JOB FOLDER Prqduct 278 �© NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 JOB FOLDER 1- qq h�.d.k- �'dL1--tqK C�ecta Printed in U.S.A. IVAN