HomeMy WebLinkAbout02720 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2720
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945 -8212
ti This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Robert & Janet McNutt Present Address 1304 Riverview Dr., Glenwomd,ne_ 945 'R067
System Location— 1078 Ruebinger Drive, Weatbank Mesa, Lot 39,_Glenwood Sprints
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other) 5
Required Absorption Area - See Attached.
Special Setback Requirements:
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity 1 v c
Q �
Septic Tank Manufacturer or Trade Name C f 7T C £ 'A M (!
�5
Septic Tank Access within 8" of surface
Absorption Area r— 41 0 `U N ( T S l' O (^ 2
Absorption Area Type and /or Manufacturer or Trade Name 1 hl F I L- T RN T O ►\ S
Adequate compliance with County and State regulations/requirements
Other
Date L I - i 7 Inspector A ." --.T`
RETAI N-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 Zoning office shall automatically be a violation or a
requirement of the permit and cause for both legal action and revocation of the 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 ($500.00 fine — 6
months in )ail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER - r . ? . fir ry -/ k i
ADDRESS \305 '1 kQrfvi rt2 F)f . PHONE gi D•9 2 g - gx71
CONTRACTOR 'R6: x l P
ADDRESS _W3'& \\tc1 'c$ CC kIt . t PHONE 17 D - 1'a 5' rig t'F,
PERMIT REQUEST FOR ('O 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:
Near what City of Town C, t_E,J krtnro Stitt 0 Size of Lot 3 t -
Legal Description or Address \ O, A bk. V F 13 1 xi i r "IL luL •
WASTES TYPE: (DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: "RESIt ctJ JAL -
Nummber of Bedrooms Numy of Persons I v
( ✓) Garbage Grinder ( 4utomatic Washer ( Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ( ) SPRING ( ) STREAM OR CREEK
W
If supplied by Community Water, give name of supplier: V'5T1 sft1Fs 1-v» iem.JAf?ttS ASSOC.
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: ^' m 1 la s
Was an effort made to connect to the Community System? ti o
i il;ni r•1.ir•I i• emi s inti • h• fill, Ain: NIM u t • •
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED
WITHOUT A SITE PLAN.
GROIIND CONDITIONS:
Depth to first Ground Water Table > S 1
Percent Ground Slope ^' 1
2
ma •
TYPE OF INDIVIDUAL 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
FINAL DISPOSAL BY:
(c) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
(// ``) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? N O
pF.RCOLATION TF,ST REST 11.TS (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test)
Minutes ?i' per inch in hole No. 1 Minutes - 1 per inch in hole NO. 3
Minutes 3S per inch in hole No. 2 Minutes per inch in hole NO. _
Name, address and telephone of RPE who made soil absorption tests: TM - �av =Z.�C o��
C ptV C�.. Gvs.vv°Rrtfv.n I rJC.• . I
Name, address ark telephone ofRPE 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 purposed 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
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 further
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 c,74 72li Y slit Date - ag 9
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
3
7
/Can
/ •• ner HIGH COUNTRY ENGINEERING, INC.
•
NGWCCRNVO , 923 Cooper Avenue
? Glenwood Springs, CO 81601
• (970) 945.8676 • FAX: (970) 945 -2555
T .
TO( ELD l.N 1y 1SLP& DATE 5/ 117
II SUBJECT Wk. /VU IT g e s •
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JOB NO. 95oo7• v )
ATTN
FAX NO Sheet of
We are sending the following: $Herewith U Under separate cover
photocopies Zerints U Documents U Mylars U Shop Drawings
U
NO. OF LATEST ITEM
COPPIIES� ITEM DATED REMARKS
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If material received is not listed above, kindly notify us at once.
Transmitted by:
U First class mail
U U.P.S. Next Day Air
U Federal Express
• U U.S. Express Mail
U U.P.S. Std. Service
2dOssenger By
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