HomeMy WebLinkAbout1459 County Rd 102 - 239121400014Department of
Environmental Health
Eagle (970) 328-8755
P.O. Box 179
Fax: (970) 328-8788
500 Broadway
El Jebel (970) 704-2700
Eagle, CO 81631
TOLL FREE: 800-225-6136
www.eaglecounty.us
r.ar] i-no INITv
APPLICATION FOR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
ISDS Permit # l(Q($-O 7- Building Permit #
INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED (SITE PLAN MUST BE INCLUDED)
FEE SCHEDULE
APPLICATION FEE $350.00
This fee includes the ISDS Permit, Site Evaluation (Percolation Test, or Soil Profile Observation) and
Final Inspection. Additional fees may be charged if a re -inspection is necessary, or a pre -construction
site visit or consultation is needed. The re -inspection fee is $55.00. The pre -construction site visit fee
is $85.00. Make all remittance payable to: Eagle County Treasurer.
Property Owner: DaV2 pl-45ek / MoL gar-ei Cord 6 Phone: Q o 763 q Sb Z
Mailing Address: j q.�- q C R (0 2 Ca rl6ov►da.lt CC S 1 to 23
Applicant/Contact Person: bo, V-e Phone: 970 q -t$ 3 6 z 5'
Licensed Systems Contractor: StitFzvv,an- isi?rl�ctz- License #
Company/DBA:
Phone: 1-7G- 913 -43-7q
Mailing Address: 5037L i-iv,'y S-2, Co Ms-LL
Permit Application is for: r New Installation Alteration r Repair
Location of Proposed Individual Sewage Disposal System:
Legal Description: R-a' it �� S�1 � 6
Tax Parcel Number: (;MI al�Da 0/d2 Lot Size: 4 S" e.
Assessor's Link: www.eaglecounty.usjpatie�/
Physical Address: ILfS L1 (�u���� �-tiC 102 car,660dlict C U 16
Building Type: (✓Residential/Single Family Number of Bedrooms:
J 3 rno��
Residential/Multi Family Number of Bedrooms:
Commercial/Industrial* Type of Use:
*These systems require design by a Registered Professional Engineer
Type of Water Supply: Private Well r Spring F- Surface F- Public
r
If Public Name of Sup'tier
Applicant Signature
Office Use Only
Amount Paid: U °{' Receipt#: 13�3 Check#:� 3 �; Date: ��
EAGLE COUNTY
FAX COVER SHEET
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPARTMENT
P.O. BOX 179, EAGLE, CO 81631
Ph: 970-328-8755 Fax: 970-328-8788
TO:
COMPANY:
FAX#: y1�3
FROM: �k
NO. OF PAGES INCLUDING COVER SHEET:
REGARDING:
L,JALi
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If you do not received all pages please call our office (970) 328-8755
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I INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT
EAGLE COUNTY ENVIRONMENTAL HEALTH DIVISION
P.O. Box 179 - 500 Broadway • Eagle, Colorado 81631
Telephone: 328-8755 P �� 8
YELLOW COPY OF PERMIT MUST BE POSTED AT INSTALLATION SITE.
Please call for final inspection before covering any portion of installed system.
0 �
PERMIT NO. 1565
OWNER: Miguel & Kathy Sherman PHONE: (970) 963-6111
MAILING ADDRESS: P.O. BOX 1269 city: Carbondale Sta1a: CO ZIP: 81623
APPLICANT: Same PHONE:
SYSTEM LOCATION: 1777 County Rd 102,CarbOndale TAX PARCEL NUMBER: 2391-214-02-012
LICENSED INSTALLER: Stutsman/Gerbaz, Inc. I ICENSE NO: 14-96
DESIGN ENGINEER OF SYSTEM:
INSTALLATION HEREBY GRANTED FOR THE FOLLOWING:
1000 GALLON SEPTIC TANK
ABSORPTION AREA REQUIREMENTS:
SQUARE FEET OF SEEPAGE BED_ 1046 SQUARE FEET OF TRENCH BOTTOM. Via 34 infiltrator units as requested.
SPECIAL REQUIREMENTS: Install in serial distribution in 1-rancb configuration Tbp fact trAnrh nppdS
to be in loam material. Do not install in wet weather. TnsfP11 inspection
en o each trench. Install a cleanout between the tank and the house. Cal Eagle County
for final inspection prior to back -filling
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: 1n46 SQUAREFEET. Via 34 infiltrator units
INSTALLED SEPTIC TANK: 1 000 GALLON 260 DEGREES 23 ' 1 Opt 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:
ENVIRONMENTAL HEALTH APPROVAL: DATE:ie}ltember �Ci 199
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)
ISDS Permit # LLLO r t-
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
* PL.v S S �C S-.`" S �;j''w S � j Ci J e4— —r > > ± o•s 3 J *
*
* MAKE ALL.REMITTANCE PAYABLE TO: "EAGLE COUNTY TREASURER"
PROPERTY OWNER:
MAILING ADDRESS:
i'j ! (9ve,L. Ay,d k t7l, y 15iLe(-/1,1W
P, v . L0c-, A' / a
PHONE : (970)
� 16 Z-�
APPLICANT/CONTACT PERSON: AlIGve.% PHONE: (27,) %3 6/1 %
MAILING ADDRESS: P-" ,s,:k V_4,__hd--�.Q 0,e k1 Z3 C Vz C-�-7,Cli 7c,-L-M
LICENSED ISDS CONTRACTOR: ;��j/Y1L�ifL / ff(�1, ,(/^,, PHONE: GI�j" �f J 7�
COMPANY/DBA: ADDRESS: .
PERMIT APPLICATION IS FOR: ( New Installation ( ) Alteration ( ) Repair
***************************************************************************
LOCATION OF PROPOSED INDIVIDUAL SEWAGE DISPOSAL SYSTEM:
Building Permit # L'� q (if known)
Vi - svi N �= � 5,,j 7-N w S e N N�= S� u S�t(� 01 1To- ^ (P �7 S, UTk awe v -)
Legal Descripp. on: Subdivision: Filing: Block: Lot No.
vj e S � a� lv-e b - P1-
Tax Parcel Number: > `i - j �/ -(� Z - ' Lot Size: ?0.71t
Street Address: 1-7 7 7 102- C I�,n�,Q C�, -L3
$TTILDIlYG TYPE: (Check applicable category)
(aQ Residential/Single Family Number of Bedrooms
( ) Residential/Multi-Family* Number of Bedrooms
( ) Commercial/Industrial* Type -S 12,2�ro(2L
TYPE OF WATER SUPPLY: (Check applicable category)
(X) Well ( ) Spring ( ) Surface
( ) Public Name of Supplier: ( N, N,���
*These systems require design by a Registered Professional Engineer
SIGNATURE: �� Date: -�
******************* ******************************************************
TO BE COMPLETED BY_ THE COUNTY _
AMOUNT PAID: i '��� , t� �:.� RECEIPT #: 16j (-3 DATE: Fb
CHECK #: S-DD aCASHIER:;:.'/
Community Development Department
(970) 328-8730
Fax: (970) 328-7185
TDD: (970) 328-8797
EAGLE COUNTY, COLORADO
September 25, 1996
Miguel & Kathy Sherman
P.O. Box 1269
Carbondale, CO 81623
RE: Final of ISDS Permit No. 1565-96 Parcel #2391-214-02-012.
Property location: 1777 County Rd. 102, Carbondale, CO.
Dear Mr. & Mrs. Sherman:
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,
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: April 15, 1996
TO: Stutsman & Gerbaz, Inc.
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. 1565-96 Tax Parcel
#2391-214-02-012. Property Location: 1777 County Rd. 102, Carbondale, CO,
Sherman residence.
Enclosed is your ISDS Permit No. 1565-96. 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.
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 /J
i
�P(
PERCOLATION" TEST
EAGLE COUNTY ENVIRONMENTAL HEALTH DEPT.
OWNER:
LEGAL DESCRIPTION:I'7TI 6)uarfy R( /0,- (I bOY04
CQ
MAILING ADDRESS:�ngbmddo (h'9'Lo_:�
TYPE OF DWELLING: NUMBER OF BEDROOM
TEST HOLES PRE—SOAKED: YES NO
TIME W21T1'D nL'DTV r�•��.,.n ..r,
SUlL YROFILI
1
2
3
1
2
3
1
2
3
1
2
3
p"
�4�
lo:12
S�
�'1
I '1
-
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2' �(
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I N
'/4-
,M6
4
v
4 )
3' r:
41
600
5-
ct
Time to drop last inch 36m,r, - -j yA.
PERC RATE: MINIMUM SEPTIC TANK SIZE:
MINIMUM LEACH FIELD SIZE: �~J�-j CJ� I � �OrUYt�S owyw-r
COMMENTS: ; gu yu �vrhP� . 4,s�z�1 �,nln -tnP c�Q. ar> 1,P tip fit^ o Cam
, i'.�,. n ins a `v1 vO& We *kW. 1%imle..0. C +- io w, u se . (1194
PERC TEST DONE BY:
rev. 6/3'Oks
DATE: 1�
al Health Officer
t`MI1 da
i
t%3 , 54+g
3^7R -- Z� 4-
ISDS Permit # /SAS' qG Date
is Final Inspection
completeness Form
V Tank is ®a a gal. Tank Material 6h C-�
Tank is located ft. and degrees from
(permanent landmark)
�✓ Tank is located Z3L�ft . and 2 �� degrees from
(permanent landmark)
✓ Tank set level. L Tank lids within 8" of finished grade.
✓ Size of field 10q(- ft' 34 units lineal ft.
Technology Avn '/-s
Cleanout is installed in between tank and house(+ 1/100ft).
V There is a SIT" that goes down 14 inches in the inlet and
outlet of the tank.
✓ Inlet and outlet is sealed with tar tape, rubber gasket etc.
_I 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.
�/ Proper distance to setbacks.
_ Chambers properly installed as per manufacturers specifications.
(Chambers latched, end plates properly installed, rocks removed from
trenches, etc.)
Other ki G, S"I h-;�44 _ A'ln A. a,�//
✓ 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
p n.dfofon. mass. 0:4,1 7: C.,.erP.VJE TOLL FREE 1-600-22.-M
. - IJ.. -_ -
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1565-96 Tax#2391-214-02-012 _,j/o ���_ / �����•zSS fNs
1777 County Rd.102 SHERMAN /" "� p
JOB NAME
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JOB LOCATION
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DATE STARTED
DATE COMPLETED
DATE BILLED
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MISC. COSTS
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LESS OVERHEAD COSTS
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JOB FOLDER Product 278 ®@ NEW ENGLAND BUSINESS SERVICE, INC., GROTON, MA 01471 .JOB FOLDER Printed in U.S.A
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