Loading...
HomeMy WebLinkAbout02606 e_ -- i 4 • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 26 0 6 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Michael Metheny Present Address 711 Oak Court, N.C. Phone 984 -1114 System Location 0739 Huebinger Drive, Westbank Mesa, Lot 28, Glenwood Springs Legal Description of Assessor's Parcel No. SYSTEM DESIGN R6 Septic Tank Capacity (gallon) Other /ee:^'I O Percolation Rate (minutes/inch) Number of Bedrooms (or other) 4 - Required Absorption Area - See Attached Special Setback Requirements: Date 6 "//^ 94 Inspector ... ¢ -e G. -. e i .ri w .:f( i., a -..t.4 .t4 e .2* -4.,Ar r (Paste, FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer D " - N CA -� Septic Tank Capacity / 25 0 - // y `v�'� Septic Tank Manufacturer or Trad i Nane _, � r C_ 7 .e - A/cc Tank Access 8" of surface CC' ' _y CC A/c c" I /� c 1 �f S "c !t an TM /sr Absorption Area (` Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements k Other - �.q,c./'.. teie L J C..ir I 1?-444_ • Date C -/ 1 - 7 F Inspector / ;,../ 2 f q-r RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: 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. 2. This permit Is valid only for connection to structures which have fully complied with County zoning and building requirements. Con - nection to or use with any dwelling or structures not approved by the Building and oning office shall automatically be a violation or a requirement of the permit and cause for both legal action and revocation of th permit. 3. 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 contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 months in )ail or both). While - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION ' OWNER /J /G ADDRESS 7// 04e. (17 , /t4 2i -4`74 , CO- PHONE 970) 98¢ - 33/¢ CONTRACTOR /7e/12C0 (2nNS7EziG(TW/ / ADDRESS 0/37 n n.. � O • SP� /o PHONE (97Q) 9a3 PERMIT REQUEST FOR OO 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: COUNTY c*, P/F Near what City or Town (/ FiacnoD .'9?Ctaa's Size of Lot /. o ,9t/L2S Legal Description or Address 40 S e j/_, /Fe— 1 0Q A/0-SL 0739 /4'eiv v-- Dr, 6 /�(atop .S9r,:✓ Co. WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: . e s/tofit/Ge_ - S /AJScCE /5".-77, Number of Bedrooms ¢- Number of Persons / (0 Garbage Grinder ().Q Automatic Washer pO Dishwasher SOURCE AND TYPE OF WA'I'EIt SUPPLY; ( ) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of ' all wells within 180 feet of system: 4JO/0£ If supplied by Commtpity Water, give name of supplier e 2&57Bc //G /221:5 /76w-7f�wdc'6 C 5 ASS0C. GROUND CONDIT'IOI4S; Depth to bedrock: 4/6T Refs a - 7 Depth to first Ground Water Table Nor & $Aivr Percent Ground Slope Z 4 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /t/Dnfil2-E5f'7u7 Was an effort made to connect to community system? ( ) YES (X) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: OO SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: " z3j0 00 ABSORPTION TRENCII, BED OR PIT to /ftVS1- " ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( Ai OILIER- DESCRIBE 0/0 D,A,'vse€ WILL EFFLUENT BE DISCIIARGED DIRECTLY INTO WATERS OF TIIE IE STATE ?_/11O 2 'PERCOLATION TEST RESUI,TS (To be completed by Registered Professional Engineer) Minutes 30 per inch in hole No. 1 Minutes Zr) per inch in hole No. 3 Minutes 20 per inch in hole No. 2 Minutes per inch in hole No. T (/.Se. 30 /Jl.%v /max/ Foe t7 /CA/ Name, address and telephone of RPE who made soil absorption tests: C7Z �ia•22, - �C - • Q j' a c , - J :i .¢r .Oi^ ♦ ahlHi urr 52v.) f CO. 95 28o y Name, address and telephone of RPE responsible for design of the system: Dinar /17- /17e?go v` Aliplicant acknowledges that the completeness of the application is conditional upon such fiurther 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 proposes of the evaluation of the application; and the issuance of the permit is subject to such terms and conditions as deemed necessary to insure compliance with rules and regulations adopted under Article 10, Title 25, C.R.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 department of health in evaluating the same for purposes of issuing the permit applied for herein. i finther understand 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 perjury as provided by law. Signed Date P1. IA : DItA . AN ' RATE MAP TI YOUR PR PERTY"I L.aT �il 0739 %4Ve6. - Dr 4 0 2 Oe.h,rls S t v �iEi ,✓:UG �s C.,P. \" Nn'Ak.l2 cse. In 3 0 ! i1 �. I O O / l\P k0 I V J '` kl 1� 1 11 k Q ki E- 0 N - U v �ui I, C I\ hp �i V I U a J, c t k. ct \ • \9 * O p O N ` U • Q 1 1 c‘i 0 E4 i I), I Ln \q — 7 - - - S1 1 �, i \ v % i � / kJ V- ' 1 r l4 'c• 11 N ,. LI \C V k. v M W 17 4.I i t_' 1 J . -- , 9 \� - \\ / \ § . &® � . :x . \ \ co o4 \ k ) - \ \ { C.) 7 ) ( G } \ g , \ ash! \ % / [ • CI / _ � _ K 1 7 ( ( :: \ / \ � ] \ (1 R 2 2 A ¥ . ~ q I 1, ® - -- - = - -� - - -- \ —,» @— %. I °^© Ill \ f �� \ \ } - \ < % .v \ \ 2 \ ,2 \ /( { a »\ § % \b (§ ‘,.. \ �� / � `� >> \\ / - L. % /) / ' \ %\ ®/ & L K w \ ' 2 \� / ( .\\§\ �\ [> / \ \ \ \ ( mg x4 w •