HomeMy WebLinkAbout17021 Hwy 131 - 168916400014INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION h�
P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631
Telephone: 328-8755
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE.
Please call for final inspection before covering any portion of installed system.
PERMIT NO. 1403
OWNER: Gwen Braatz PHONE: 653-9918
MAILINGADDRESS: 17021 Hwy 131 city: Bond State: CO Zlp: 80423
APPLICANT: Kerry Braatz PHONE: 653-4498
SYSTEM LOCATION: 17021 Hwy 131 TAX PARCEL NUMBE 1p6/8.,9-164-00-001
LICENSED INSTALLER: � r-( �1'OY-C1 �rX-e&V-&tAft* Randy Braatz I�a cLCENSENO: -47"9'- 5 6 - 9 6
DESIGN ENGINEER OF SYSTEM:
INSTALLATION HEREBY GRANTED FOR THE FOLLOWING: (� �h J `4/f pL /)
1 0 GALLON SEPTIC TANK
ABSORPTION AREA REQUIREMENTS: /y �y ^ ,` R J ,
SQUARE FEET OF SEEPAGE BED 5 6 2. 5 SQUARE FEET OF TRENCH BOTTOM. V i�I '$ nil h, 1 �V, Yd KJiG+a 1 �-
SPECIAL REQUIREMENTS: Install 562.5 SF of absorption area in A minimum of.-9 tranybes Tnet211
inspection ports at the end of each trench,
is completed.
ENVIRONMENTAL HEALTH APPROVAL: DATE:
ll 9
CONDITIONS:
1. ALL INSTALLA IONS MUST COMP TH 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: 806 SQUAREFEET. In a bed configuration
INSTALLED SEPTIC TANK: 1250 GALLON 115 DEGREES 29 FEETFROM the 1 no next t0 the house
SEPTIC TANK ACCESS TO WITHIN 8" 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.
jl 3 �J j
COMMENTS: �« [�L[�'�" i'J7S " twi , a v L'�Y/ 2 1 s- � 1�K72vti-r r-e-d�M1+2_ i c
wtfj %'C fSSue-� * a fi& - �7
ENVIRONMENTAL HEALTH APPROVAL: DATE:August , 199
ENVIRONMENTAL HEALTH APPROVAL: DATE:
(R - SSARY)
RETAIN WITH RECEIPT RECORDS
APPLICANT / AGENT:
PERMIT
PERCOLATION TEST FEE
OWNER:
RECEIPT #
CHECK#
w
Incomplete Applications Will NOT Be Accepted
(Site Plan MUST be attached)
ISDS Permit # ! l,o
3
Building Permit # 7 -b/ `? 5
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 $200.00
* *
* MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
**************************************************************************
PROPERTY OWNER: 6�6^j, i5g4vtrz
MAILING ADDRESS: _ ��®L/ �`�'� 131 �"VI� L,�B• �e2 PHONE: /9/y
APPLICANT/CONTACT PERSON: � 9i9 PHONE: 3-77?
LICENSED SYSTEMS CONTRACTOR: } PHONE: ��o
COMPANY/DBA: Dfv ikh G(e • ADDRESS: a //9 swc 5
*************************************************** ****************** ****
PERMIT APPLICATION IS FOR: N ) NEW INSTALLATION ( ) ALTERATION () REPAIR
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Legal Description:
5r'-C-� 7,roc/,J-
St-DS0,4-�Q,4
tc-A,- ss!> 1
Tax Parcel Number:
Lot Size: 0-4cecm—
Physical Address:
BUILDING TYPE: (Check applicable category)
()() Residential/Single Family
( ) Residential/Multi-Family*
( ) Commercial/Industrial*
TYPE OF WATER SUPPLY: (Check applicable category)
( ) Well ()() Spring ( ) Surface
( ) Public Name of Supplier:
Number
Number
Type _
Z3
of Bedrooms
of Bedrooms
*These systems require design by a Registered Professional Engineer
SIGNATURE: Date: 2 /
**************************************************************************
AMOUNT PAI JJ RECEIPT #: �DATE: o I I
CHECK #: AL
CASHIER: � C
Community Development Department
(970) 328-8730
Fax: (970) 328-7185
TDD: (970) 328-8797
EAGLE COUNTY, COLORADO
August 29, 1996
Kerry Braatz
17021 Hwy 131
Bond, CO 80423
RE: Final of ISDS Permit No. 1403-95 Parcel #1689-164-00-001.
Property location: 17021 Hwy 131, Bond, CO.
Dear Mr. Braatz:
Eagle County Building
P.O. Box 179
500 Broadway
Eagle, Colorado 81631-0179
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. This permit does not indicate compliance
with any other Eagle County requirements. Also enclosed is a brochure regarding the care of
your septic system.
Be aware that later changes to your building may require appropriate alterations of your septic
system.
If you have any questions regarding this permit, please contact the Eagle County Environmental
Health Division at 328-8755.
Sincerely,
jal-a
Janet Kohl
Environmental Health Department
Eagle County Community Development
ENCL:Information Brochure
Final ISDS Permit
cc: files
Community Development Department
(970)328-8730
Fax: (970) 328-7185
TDD: (970) 328-8797
EAGLE COUNTY, COLORADO
DATE: July 24, 1996
TO: Randy Braatz
FROM: Environmental Health Division
Eagle County Building
P.O. Box 179
500 Broadway
Eagle, Colorado 81631-0179
RE: Issuance of Individual Sewage Disposal System Permit No. 1403-94, Tax Parcel
#1689-164-00-001. Property Location: 17021 Hwy 131, Bond, CO,Braatz
residence.
Enclosed is your ISDS Permit No. 1403-94. It is valid for 120 days. The enclosed copy of the
permit must be posted at the installation site. Any changes in plans or specifications invalidates
the permit unless otherwise approved. Please call our office well in advance for the final
inspection.
Also enclosed is the ISDS Final Inspection Completeness Form. The items on this form need
to be completed before you call for your final inspection. Also, please note any special conditions
which may have been placed on the permit. If all items are not completed, a reinspection fee
of $42.50 must be paid before a reinspection is made. Your building permit CO will not be
issued until final approval has been given for the ISDS Permit.
Permit specifications are minimum requirements only, and should be brought to the property
owner's attention.
This permit does not indicate conformance with other Eagle County requirements.
If you have any questions, please feel free to contact the Environmental Health Division at 328-
8755.
cc: files
ISDS Permit # / yo 3
Date g Z3
Completeness Form
Tank is / a gal. Tank Material
L Tank is located Ift. and 31Y—degrees from
(permanent landmark)
Tank is located ft. and degrees from
(permanent landmark)
✓ Tank set level. Tank lids within 8" of finished grade.
Size of field ft2 29 units lineal ft.
R
,
Technology & 4 /i�+'r, 5 ----
Cleanout is ir,.::atalled in between tank and house(+ 1/100ft).
✓ There is a "T" that goes down 14 inches in the inlet and
outlet of the tank.
Inlet and outlet is sealed with tar tape, rubber gasket etc.
�✓ Tank has two compartments with the larger compartment closest to the
house.
Measure distance and relative direction to field.
✓ Depth of field 3- � ft.
O� Soil interface raked.
Inspection portals at the end of each trench. 3
V/ Proper distance to setbacks. OK_
_V-� Chambers properly installed as per manufacturers specifications.
(Chambers latched, end plates properly installed, rocks removed from
trenches, etc.)
Other
Inspection meets requirements.
Copy form to installer's file if recommendations for
improvement were suggested.
ACTION TAKEN:
Setbacks
Well Potable House Property Lake Dry Tank Drain
Water Lines line Stream Gulch
Field 100 25 20 10 50 25 10 10
Tank 50 10 5 10 50 10 * 10
C
ISGS PERMIT
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
LEGAL DESCRIPTION:
MAILING ADDRESS:
TYPE OF DWELLING: NUMBER OF BEDROOMS
TEST HOLES PRE-SOAKED: YES NO
TTMF. TJT mz+rT11T T1TT•
�IFA
RE
I
Mim,
Emu
Ml
In
amoll
Mirail
1
law-JIM-la
ir�°e�
IVAME
102
1 M
M
Time to drop last inch
PERC RATE: MINIMUM SEPTIC TANK SIZE: 1
MINIMUM LEACH FIELD SIZE: SCE
COMMENTS:
ISHEET NO.
CALCULATED BY
CHECKED BY_
ccet c
S -; a S?eetsi 2"5-1 cPaoaeal �x Inc.. Groton. Mass. 0::71 To 0rae! PHONE TOLL FREE I-500.224-E39O
OF
DATE
DATE
EXHIBIT A
The East half -of the'Soutneast Quarter of Tract 50 in Section 16, T nship 2
as follows: South, Range 83 West of the 6th Principal Meridian accept that Fart described
B.EGZ-�-- at a point on the South line of Tr L
fry the Southeast corner of Tract act 50, distant West 185.2 feet
37 55' East 164.7 feet to t-+ Westerly the.
Weser 231.5 feet; thence North
established; thence South e 3 , '- rly line of State Highway Number 131
'-
Westerly h 47 33 East 185.4 feet adjacent to and along then now
_-ngl_ne of Sate E-igrwav Numbe 131, as new established to the point of
Also EM—E� that cart described as follows:
Beginninq at a point on the South line of Tract 50 of Section
South, Range 83 West from which Corner No. 4 of Tract 50 of Section
2
Township 2 South, Range 83 West bear 6,
il curve to the left having a radius of 853.9ast 9feet eatdistance of 132ce along t9efarc eet
°f
(the chord of this arc bears North 24'''58'30" West 132.8 feet
foot Westerly of and parallel with the Westerly Right of Way )1ine-odfatheDenver
and Rio Grande Western Railroad Cctlpany, CraigBranch;
thence a spiral curve to the left whose chord bears orth 31`'10' west feet, aro of
arc being 1 foot Westerly of and parallel with the Westerly Right of w
Of the Denver and Rio Grande Western Railroad ay line
along the arc of a curve to the left having a radius of eet�atdistance
Of 339.4 feet (the chord of this arc bears North 55J42r West 332.1 feet), said
arc being 1 foot South -Westerly of and parallel with the South
-Westerly)ri ht
of way line of the Denver and Rio Grande Railroad g
along the arc of a spiral curve to the left whose chord bears1Norrthn82`33'30ce
West 163.7 feet, said arc being 1 foot Southerly of and parallel with the
Southerly Right of Way lire of the Denver and Rio Grande Western Railroad
C':--any-Craig Branch; thence North 85- 28' West
Parallel foot Southerly of and 93.5 feet, said course being 1
F el with the Southern right of way line of the
Denver and Rio Grande Western Railroad
are of a spiral curve to the right whose rd bears NNoorrtth 82t17nWesto195.9e
feet, said arc being 1 foot Souther
ly of and Of Way line of the Denver and Rio Grande WesternaRailroad llel h the Southerly Right
thence along the arc of a curve to the right having a radius of 6 0.2�feetaach;
distance of 180.9 feet (the chord of this arc bears North 68`34' West 180.3
feet), said arc being 1 foot Southerly of and parallel with the Southerly right
of Way line of the Denver and Rio Grande Wesern Railroad
Ccm
thence North 76'14' West 174.6 feet; thence 'North3West
134.Craig Branch;
t
along the arc of a curve to the right having a radius of 283.1feet a distances
Of 0.8 feet (the chord of this arc bears North 67 1-3'30" West
West, line of the Fast 1/2 Southeast 0.8 feet), to the
e 50 of South along the West line of the East 1/2of therSoutheast QuarteSection 16; thence
of Tract So
of Section 16, a distance of 128.2 feet; thence South 750101Eastr111.0 feet;
thence South 62"53'30" East 177.0 feet; thence South 78000' East 143.0 feet;
thence North 88`16130" East 152.5 feet; thence. South 71018' East 2',7.1 feet;
thence South 63'00' East 193.5 feet; thence North 37'55' East 9.6 feet; thence
South 47°33' East 185.4 feet, to the South line of Tract 50 of Section 16;
thence East along the South line of Tract 50 of Section 16, a distance of 145.4
feet, more or less, to the point of beginning.. C jJ iry OF �E� SZ'�TF' OF
COLORP�
4466337 B-550 P-494 03/28/91 15:06 PG OF 21
OWNER.(,�'�
PERMIT STATUS
PROPERTY LOCATION: `�,
( I"" � 1 ISDS PERMIT # ���
BUILDING PERMIT # 40
PARCEL #—j j'j- j (�
1) COMPETENESS LETTER ADDRESS DATE SENT E.H. INITIAL
SENT TO:
INFORMATION CONTAINED
YES NO Concerns
1) Percolation test fees.,........
2) ISDS permit fees............
3) Site Plan .......................... .
4) Tax Parcel number..........
5) Physical Address .............
6) Legal address ................
7) Percolation test ................
8) Licensed installer.............
9) Other:
Z) ISSUE LETTER
ADDRESS DATE SENT E.H.INITIAL
SENT TO
INSTALLER #
Concerns:
3) FINAL LETTER ADDRESS DATE SENT E.H. INITIAL
SENT TO:
4) NOTEWORTHY TELEPONE CORRESPONDENCES
SPOKE WITH ABOUT DATE E.H. IMTIAL
COMMUNITY DEVELOPMENT
DEPARTMENT
(303)328-8730
EAGLE COUNTY, COLORADO
December 2, 1994
Gwen Braatz
Dear Applicant,
500 BROADWAY
P.O. BOX 179
EAGLE, COLORADO 81631
FAX: (303) 328-7185
The Environmental Health Division would like to notify you to
make a formal request to extend your Individual Sewage Disposal
System(ISDS) Permit #1403-94 into the 1995 construction year.
The Environmental Health Division discontinued percolation tests
on November 15, 1994 and final inspections on December 2, 1994
due to climatic conditions.
ISDS permits are active for 120 days after the date of issue if
no Building Permit has been issued for the same property. If a
Building Permit has been issued for the same property the ISDS
will expire at the same time as the building permit.
If you still plan to apply for a Building Permit this year or in
the early months of 1995 you will need to have a percolation test
conducted before your Building Permit will be released. You will
have to contact a Registered Professional Engineering(RPE) firm
to conduct your percolation test.
If you have had your permit issued and have not had your final
inspection completed, but plan on constructing the system in the
next few weeks, please give our office a call and we will
evaluate your permit on a case by case situation.
Please give the Environmental Health office a call at 328-8755,
if you have any questions regarding your permit extension
process.
cc: ISDS Permit #1403-94 File
I � ?� leaq
/�1,9�57
Community Development Department
(970)328-8730
Fax: (970) 328-7185
TDD: (970) 328-8797
EAGLE COUNTY, COLORADO
December 12, 1995
Dear Applicant,
Eagle County Building
P.O. Box 179
500 Broadway
Eagle, Colorado 81631-0179
The Environmental Health Division would like to notify you to
make a formal request to extend your Individual Sewage Disposal
System(ISDS) Permit #1g03Aginto the 1996 construction year. The
Environmental Health Division discontinued percolation tests on
November 15, 1995 and.final inspections on December 2, 1995 due
to climatic conditions.
ISDS permits are active for 120 days after the date of issue if
no Building Permit has been issued for the same property. If a
Building Permit has been issued for the same property the ISDS
will expire at the same time as the building permit.
If you still plan to apply for a Building Permit this year or in
the early months of 1996 you will need to have a percolation test
conducted before your Building Permit will be released. You will
have to contact a Registered Professional Engineering(RPE) firm
to conduct your percolation test.
If you have had your permit issued and have not had your final
inspection completed, but plan on constructing the system in the
next few weeks, please give our office a call and we will
evaluate your permit on a case by case situation.
Please give the Environmental Health office a call at 328-8755,
if you have any questions regarding your permit extension
process.
cc: ISDS Permit File
BRATZ 1403-94 17021 Hwy 131 Bond 1689-164-00-001 zL-- wv.� e-7/tet-0
JOB NAME ,� Q� • JOB NO.
JOB LOCATION
BILL TO
DATE STARTED
f
DATE COMPLETED
DATE BILLED
-- --
F
42
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
re Z C 7 -9 S--
TOTAL LABOR
INSURANCE
SALES TAX
•1 -BY _ _ [ l
MISC. COSTS
- e� c. o 5i
TOTAL JOB COST
-7 �y,
7�
I �i G� 2K
GROSS PROFIT
J
LESS OVERHEAD COSTS
% OF SELLING PRICE
/
/
NET PROFIT
JOB FOLDER Produ9t 278 ® NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471
1SDS#-I qo 3 f3raalz� se-P lam-., l�
?IZ31 n #-S
JOB FOLDER
04
�c -s /z 3 / 9r,
Ilk
4,5, ! J A/40 3Ilk
IsDS
Printed in U.S.A.
e'3 f
EAGLE COUNTY DEPARTMENT OF ENVIRONMENTAL HEALTH
Box 811 6th & Broadway
Eagle, Colorado 81631
Owner Ed Peterson
System Location
Licensed Contractor
PERMIT O (this does not constitute
N . 84 a building or use permit)
Pour House at Bond, Colorado
* Conditional Construction approval is hereby granted for a 1800 gallon extension
X Septic Tank or Aerated treatment unit.
Absorption area (or dispersal area) computed as follows:
Pere rate 1 inches in 10 minutes 1800 sq. ft.
absorption area perYOKUNX )(35H 1 .n sPlt rastolirant and one cabin
# of bedrooms
May we suggest
x
Date May 4 , 1976
FINAL APPROVAL OF SYSTEM:
sq. ft. minimum requirement
Inspector
Erik W. Edeen, R.P.S.
No system shall be deemed to be in compliance with the Sewage Disposal Laws until the assembled system
is approv prior to covering any part.
Septic Tank cleanout to within 12" of final grade or aerated access ports above grade.
Proper materials and assembly.
;2equate absorption (or dispersal) area.
'Adequate compliance with permit requirements.
Adequate compliance with County and State regulations/requirements.
524
/Date t�' Inspector i/
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
* CONDITIONS:
1. All installation must comply with all requirements of the County Individual Sewage Disposal Regulations,
adopted pursuant to authority granted in 25-10-104, CRS 1973 amended 25-1-614, CRS 1973
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 structures not approved by the building
and Zoning office shall automatically be a violation of a requirement of the permit and cause for both
legal action and revocation of the permit.
3. Section III, 3.24 requires any person who constructs, alters, or installs an individual sewage disposal
system in a manner which involves a knowing and material variation from the terms or specifications con-
tained in the application of permit commits a Class I, Petty Offense ($500.00 fine - 6 months in jail or
ENVIRONMENTAL HEALTH
P.O. BOX 811
PERMIT NO. EAGLE, COLORADO 81631 PERMIT FEE $25.00
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT N/O 265
Name of Owner: �/ Phone: l�l�� �
Address of Owner: l�d>L. rr ; ,�y� � i �, �/`J �'li�5 e�i
Is facility within boundaries of a city/town or sanitation district?
Distance to nearest sewer system:
Location of Proposed System:
Legal Discription:
Type of Structure: Single Family Dwelling (
Water Supply: Private Well ( ocation:
Size of Lot:
14~
Other: U 4 OL No. Bedrooms -'----
Distance From leach field:
Public Water Supply:
An appropriate plat plan must accompany site inspection for this application showing required information. (See
attached sheet.) The individual sewage disposal system will be constructed and installed in accordance with the
regulations governing individual sewage systems within Eagle County, and shall comply with House Bill 1553 CRS
66-14, 1973. Payment shall be made to the Eagle County Treasurer. Permit, upon approval of this application, may be
obtained at the Eagle County sanitarian's office.
Appointment for final inspection must be made prior to construction by contacting the inspecting sanitarian. [Phone
328-7718 between 8:30 and 9:00 AM.] Refer to permit number. No approval will be given on any system without final
inspection.
Name, address, and telephone of person responsible for design of system:
The undersigned acknowledges that the above information is true and that false information will invalidate the
application or subsequent perm,; %
SIGNATURE OF APPLICANT: `` ��- Date:
(This application becoriKes invalid 6 months from above date.)
HEALTH DZEARTMENT USE ONLY
d—
Percolation Information: / / Permit No. EY
Tank Capacity: i561 gal. (minimum) Fee Receipt:-4/7 J6,),1 p
Absorption Area: Sq. fY (minimum) File:
17:1J1,r-M 3►-j
APPLICATION IS: APPROVED ( v ) DENIED
The above individual sewage disposal system was installed by
AND HAS BEEN INSPECTED AND APPROVED BY A REPRESENTATIVE OF THE EAGLE COUNTY HEALTH DEPT.
Date: Sanitarian:
. ,ALE COUNTY ENVIRONMENTAL HEALTh
INDIVIDUAL SEWAGE. DISPOSAL SYSTE14 PERIMIT
ROUTE SLIP
Name
Date Reterred reriatt i
umber -
Location
Please review the attached application and return it and this completed form to the
Environmental Health office within 6 working days.
Planning: File Number Yes No Reviewed By Date
Complies with:
Subdivision Regulation
Zoning Regulations
Recommend Approval : _, . U 7
Comments:
County Engineer: Roads
Grading:
Drainage
Recommend Approval
Comments:
Building Department: Set Backs
Site
Access
Other
Recommend Approval,
Comments: V
Comments:
Building Department: Set Backs
Site
Access
Other
Recommend Approval,
Comments: V
Comments: V
HOLE
xEaCOL,'TION TEST
Fer:: $_10.00
! nlicption No. Permit No.
Owner:
Lega:1 Description:
Tyne of Dwe11in�: !�'�6�-, No. of Bedrooms:
Date of `Pest: ✓7 /7�' Denth of.Holes:
f
Diameter: ( Tyne of Soil:
Locvtion of TeS"t holes: )6 / 6-d
Test hole tiva.s presoaked from:4 _Z '�;_ To:
Time Dote Time D�:te
`WATER
TIME
DEPTH
j INCISES OF FALL----
RATE
l
2
3
1
2`
3
1
2
3
1
2
3'
�i/15 U
61,5Y
"f (1a3
l
SSG
058
T
Y-2
Percolation Rate: ` 0 IIPI
Site ,'las been
reviewed. and
for
./teess
Y,ercolation
rate,
We recommend:
IPPROV�L
DISIj1I'ROVPL
DI Tom.E;
c
Ex il� r. EA0,11,,r, S.
11 S L Environmental IIe4 lth
i Ea;lc County
v
COLORADO DEPARTMENT OF HEALTH
GENERAL SANITATION SURVEY REPORT
FOOD AND DRUG
FIRM NAME
LOCATION
OWNER
ADDRESS
MANAGER COUNTY
INSPECTION OF YOUR AT THE ABOVE LOCATION REVEALED THE FOLLOWING
ESTABLISHMENT TYPE
DEFICIENCIES:
1. PREMISES: DUST CLEAN OTHER
2. WATER SUPPLY: ADEQUATE SAFE TYPE
3. TOILET -LAVATORY: FACILITIES GOOD REPAIR CLEAN
4. WASTE DISPOSAL: SEWAGE
5. VECTOR CONTROL: RODENTS
6. BUILDING: CONSTRUCTION
7. EQUIPMENT: ADEQUATE
8. CONTAINERS -UTENSILS: CLEAN
9. REFRIGERATION: CLEAN
10. FOOD: OPERATION
OTHER
TYPE REFUSE PRODUCT WASTE
INSECTS VERMIN PROOF
MAINTENANCE CLEAN
GOOD REPAIR CLEAN STORAGE
SANITIZED STORAGE
TEMPERATURE THERMOMETER STORAGE DRAINAGE
STORAGE TRANSPORTING NON-FOOD HANDLING
11. MISCELLANEOUS: ANIMALS `DRESSING ROOM PERSONNEL HAZARDS OTHER
✓P UNSATISFACTORY - EXPLAIN IN REMARKS SECTION
REMARKS: ,
S
DATE: RECEIVED SANITARIAN:
0084-17021 Hwy Bond eua"- k0�1
JOB NAME- Peterson 131 J, ,at �- JOB NO.
c �� ��((hc c
BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
JOB COST SUMMARY
TOTAL SELLING PRICE
TOTAL MATERIAL
PER IT # 84 �J� oL i
OWNER: Ed Peterson
LOCATION: Pour House at Bond
INSTALLER: not listed
SIZE OF TANK: 1,800 gallons (extension)
DWELLING: Bar and Restaurant- one cabin - 150 people
PERC RATE: one inch/10 minutes (1800 sq.ft.)
�^
1„
TOTAL LABOR
INSURANCE
SALES TAX
MISC. COSTS
TOTAL JOB COST
GROSS PROFIT
LESS OVERHEAD COSTS
% OF SELLING PRICE
NET PROFIT
JOB FOLOE Fi nal i zed: 7-6-76 By: Erik Edeen Printed In U.S.A.