HomeMy WebLinkAbout02197 h,,
1, 21971
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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit _
109 6th Street Suite 303 A is Parcel No. i
Glenwood Springs, Colorado 81601
Phone (303) 945.8212
This does not constitute 1
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
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PROPERTY
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Owner's Name Marvin 6 Audrey MsYerspresent Address 649 Sunny Acres Rd. C.S• Phone 945- 6867
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System Location 0N34 County Road 331, Minaota Estates, Silt
Legal Description of Assessor's Parcel No. , g
3 ,i - -0a}n• ei (r; u OAA A-0 ro y -,/ r` n-l.xet f n , •.�i e / r'r „j % '
SYSTEM DESIGN ' if
1 ^ O 1 Septic Tank Capacity (gallon) Other �, 0
,d' ;^ 1 3 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 (3 f "�l F.. )
I/ )�! f /
Required Absorption Area - Sea.OfaaYad. / 7 a "�L4r , .(c . 44-. E.ry( �„ Ca•( �U �. :-
34 iV4n1ft s /3 ,2. f
Special Setback Requirements: ' 4. r;' 7 17' ' IN'ri ) t NA r!' ri r S T
) i )^ I {v 3 C r , / C-C °!
Date 2-/ /ij Inspector 9 rc°n1 () r rn'6-
installed)
FINAL SYSTEM INSPECTION AND APPROVA L (as
Call for Inspection (24 hours notice) Before Covering Installation
System Installer C c / 7.. /. ,c. e`Yi' - 1"`‘
w
Septic Tank Capacity 4 COO ll
Septic Tank Manufacturer or Trade Name C. 0 qf) ? a 17 c/ I,
Septic Tank Access within 8" of surface 1' )6
Absorption Area 2 A 4 ° b 12 (-.t a e"ir /
r
}
Absorption Area Type and /or Manufacturer or Trade Name 1” , `;r Y �-,.. k( ! A v
k
Adequate compliance with County and State regulations/requirements y < y
{
I Other
s
Date 7 -/ / Inspector 1 f
)
I RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
I *CONDITIONS: 1
1 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.R.S. 1973, Revised 1984.
i 2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con -
1 nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a r
requirement of the permit and cause for both legal action and revocation of the permit. F,
( 3. Any person who constructs, alters, or Installs an Individual sewage disposal system in a manner which involves a knowing and material
3 variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense (5500.00 fine — 8
months In )all or both).
Applicant: Green Copy Department: Pink Copy
e
Application
- - INDIVIDUAL SEWAGE DISPOSAL SYSiEll APPLICATION Approval by
-- — — -- — — County Official:
OWNER Marvin M. & Audrey A. Meyers — --
ADDRESS 649 Sunny Acres Rd. Glenwood Spgs,_ Co I'lIUIIL' 94576847 7;156
CONTRACTOR_
ADDRESS - -- - -- — — -- -- PHONE— — — ��1
PERMIT REQUEST FOIL: (X}) New Installation ( ) Alteration ( ) Repair
Attach separate sheets or report showing entire area with respect to surrounding areas,
topography of area, habitable building, location of potable water wells, soil percolation
test holes, soil profiles in test holes. (See page 4.)
LOCATION OF PROPOSED FACILITY: Cuun1y__Garfield
Near what City of Town Silt Lot Size 16.65 Acres
Legal Description piling 2 Lot 7 Mineota Estates
WASTES TYPE: ( x).) Dwelling - -- ( ) Transient Use
( ) Commercial or Institutional ( ) Non-domestic Wastes
( ) Other - Describe— — — — — -- — — - - - --
BUILDING OR SERVICE TYPE:
(lumber of bedrooms_ 3 _(lumber of persons —_ 2_
(Xi Garbage grinder (xx) Automatic washer ( xt Dishwasher
SOURCE AND TYPE Or WATER SUPPLY: , ( ) well ( ) spring ( ) stream or creek Comm. Water
Give depth of all wells within 180 feet of system: __.___— _:__— _ ________
1f supplied by community water, give name or supplier:_ Mineota Estates _ —_ —__
GROUND CONDITIONS:
Depth to bedrock: - -. - -- - -- — — — '— —
Depth to first Ground Water Table: __ _ _ _ � -- ----
Percent ground slope: -- --- ---- _ -- - -- - - -- —
DISTANCE 10 NEAREST COfll1UNIIY SEWER SYSTEM: 3 Miles
Was an effort made to connect to community system?_ NO ^ —
TYI'II OF IIIDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( Septic Tank ( ) Aeration Plant ( ) Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pit Privy ( ) Incineration toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FILIAL DISPOSAL IIY:
(xx) Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater fond
( ) Other - Describe: - -- - -- —
WILL EFFLUENT BE DISCHARGED UIRECILY 11110 WA1ERS OF 111E STATE? No
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P400 2
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, 501L PERCOLATIO11 TEST RESULT'S: (To be completed by Registered Professional Engineer.)
Minutes per inch in (role No. 1 Minutes _ _ per inch in hole ilo. 3
Minutes per inch in hole Ilo. 2 Minutes _ per inch in hole tlo._
Nance, address and telephone of ItPL who made soil absorption tests: — _
Name, address and telephone of ItIE responsible for design of the system:_
•
Applicant acknowledges that the completeness of the application is conditional upon such
further mandatory and additional tests and reports as may be required by the local health
department to be made and furnished by the applicant or by the local health department for
purposes of the evaluation of the application; atnd the issuance of the periaft.ls'subdect lo
such terms and conditions as deemed necessary to insure compliance with rules and regulations
adopted under Article 10, Title 25, C. It. S. 1973, as amended. the undersigned hereby certifies
that all statements made, information and reports submitted herewith and required to be
submitted by the applicant are or will be represented to be true and correct to the best
of my knowledge and belief and are designed to be relied on by the local .dcparttnent of health
in evaluating the same for purposes of issuing the permit applied for herein. 1 further under-
stand that any falsification or misrepresentation may result in the denial of the application
or revocation of any permit granted based upon said application and in legal action for per -
Jury as provided bylaw.
Date —_ Signed • J— — —
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PLEASE DRAW AND ACC MAP 10 YOUR PROPERTY
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