HomeMy WebLinkAbout264 Cedar Dr - 211106405017INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION
P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631
Telephone: 328-8755
YELLOW COPYOFPERMIT MUST BE POSTED AT INSTALLATION SITE. PERMIT NO. 1494
Please call for final inspection before covering any portion of installed system.
OWNER: Terry And Geri Friesen PHONE:_(970)524-7319
MAILINGADDRESS: P.O.Box 1158 city: Gypsum State: CO. Zip: 81637
APPLICANT: Roger Friesen PHONE: (970)524-7254
SYSTEM LOCATION: 264 Cedar Ct, Gypsum, CO. TAX PARCEL NUMBER: 2111-064-05-017
LICENSED INSTALLER: Scott Green Excavating LICENSE NO: 40-95
DESIGN ENGINEER OF SYSTEM:
INSTALLATION HEREBY GRANTED FOR THE FOLLOWING:
750 GALLON SEPTIC TANK
ABSORPTION AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED 562 SQUARE FEET OF TRENCH BOTTOM. via 16 infiltrator units
SPECIAL REQUIREMENTS: Install 16 infiltrator units as requested by Owner. Keep away from drainage
ditch. Rake trench sidewalls,and iiAstall inspection portals at the end of each trench.
Call the county f r final i ct n.
ENVIRONMENTAL HEALTH APPROVAL: DATE: July 6, 1995
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: 600 SQUARE FEET.
INSTALLED SEPTIC TANK: 1250 GALLON 2450N DEGREES 51' 6" FEETFROM the cleanout next to 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.
COMMENTS: 16 infiltrators in 2 trenches.
ENVIRONMENTAL HEALTH APPROVAL: ®� �— DATE: 1,0 31 1S_
ENVIRONMENTAL HEALTH APPROVAL: DATE:
(RE -INSPECTION IF NECESSARY)
RETAIN WITH RECEIPT RECORDS
APPLICANT / AGENT:
OWNER:
PERMIT FEE PERCOLATION TEST FEE RECEIPT # CHECK #
(Site Plan MUST be attached)
q
ISDS Permit # 1
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ENVIRONMENTAL HEALTH OFFICE - EAGLE COUNTY
P. O. BOX 179
EAGLE, CO 81631
328-8755/927-3823 (El Jebel)
* PERMIT APPLICATION FEE $150.00 PERCOLATION TEST FEE $200.00
*
*
* MAKE ALL REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
PROPERTY OWNER:
MAILING ADDRESS:
APPLICANT/CONTACT PERSON;
MAILING ADDRESSI P. 0 -Z
PHONE: (9��)'�
�a
LICENSED ISDSAONTRAC OR: PHONE:
COMPANY / DBA : (-Ricer it "b#ilt A_ ADD ES S
PERMIT APPLICATION IS FOR: ( ) New Installation ( ) Alteration ( ) Repair
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LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Building Permit # (if known)
Legal Description: Subdivision:13CfZTF-6Q--)'- Fi 1 ing f,5-B lock: Lot No.
Tax Parcel Number: /-�-2-� Lot Size•. �• %/ %�.�
Street Address: o26c>4/ 6EGDALP (!!-T
***************************************************************************
BUILDING TYPE: (Check applicable category)
(�) Residential/Single Family Number of Bedrooms _C:;L-
Residential/Multi-Family* Number of Bedrooms
( ) Commercial/Industrial* Type
TYPE OF WATER SUPPLY: (Check applicable category)
( ) Well ( ) Spring ( ) siary/�(
(j() Public Name of Supplier:
*These systems require d ign by a Registered Professional Engineer
SIGNATURE: Date: hs—
TO BE COMPLETED BY THE COUNTY.
AMOUNT PAID: RECEIPT # : I iS D DATE:
CHECK #: /S3 CASHIER:
PERCOLATION TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER:
LEGAL DESCRIPTION:
MAILING ADDRESS:
TYPE OF DWELLING: NUMBER OF BEDROOMS
59,
TEST HOLES PRE-SOAKED: YES- NO
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PERC RATE: � r►'Il � MINIMUM SEPTIC TANK SIZE:
MINIMUM LEACH FIELD SIZE: tg I-
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COMMENTS: CA,iAlG.'-A T
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PERC TES
DATE:
Environmental Health Officer
rev. 6/90ks
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ISDS Final Inspection
Completeness Form
Tank is f Z57) gal. Tank Material C-"cn—e-k
Tank is located ��? )(ft. and PC( degrees from 14MASu
(permanent landmark)
Tank is located ft. and degrees from
(permanent landmark)
Tank set level. ;/ Tank lids within 8" of. finished grade.
Size of field WU ft2 7�P units. lineal ft.
Technology
Cleanout is installed in between ,,,tank tank and house(+ 1/100ft).
t s,
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 .
,-" Soil interface raked.
Inspection portals at the end of each trench.
i Proper distance to setbacks.
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
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*
10
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1494-95 Tax#2111-064-05-017
J013 NAME Bertroch Filing#5 FRIESEN
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BILL TO
DATE STARTED
DATE COMPLETED
DATE BILLED
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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 Produgt.278 ®®
NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471
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