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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit Nr 2429 iit
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945-8212 _'
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
IThis does not constitute
a building or use permit.
Owner's Name Alan ` Sue Akin Present Address 351 Chateau Way, SnowmaesPhone_ 921-6228
System Location 1185 Seneca, Mineota Estates, Filing, 1, Trot 13, Silt
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
if� L f! Septic Tank Capacity (gallon) Other
e& v irueBP- F,ot'
/Oilerkik 7",k.-- Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date
3
Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer hef ,07t!y Com` 5T
Septic Tank Capacity i 1706
Septic Tank Manufacturer or Trade Name =dr�.Pi d
Septic Tank Access within 8" of surface C -)F
Absorption Area 944 q a4.1. h ex fe a-•
1 �;
Absorption Area Type and/or Manufacturer or Trade Name t a i,r�' J'= T`I ; c; i' e
Adequate compliance with County and State regulations/requirements SAES
Other C6
Date .3- /j'-9
11iUK
Inspector
RETAIN WITH RECEIPT RECORDS AT CON TRUCTION 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 jail or both).
Applicant: Green Copy Department: Pink Copy
INDIV1DUALSEWAcE DISPOSALSYSTEMAPPLICATION
OWNER 1'1 n4-\ 9— �().-Z c \ y1Q 1(i
ADDRESS - 4, ,.• -4 HONE cka,L.
CONTRACTOR
ADDRESS PHONE /8 3 3S-752
PERMIT REQUEST FOR (V) NEW INSTALLATION () ALTERATION O 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 OE PRQP OSIII.LACILMY: COUNTY GaAr-n e1
Near what City or Town Lot /3
Legal Description
WASTES TYPE: /) Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non-domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms: 2 Number of persons
0 Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
$QCIRCEAND TYPE OEWATER SUPP_LY: () WELL () SPRING () STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by communtiy water, give name of supplier: Cr f
0RQUNE) CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent Ground Slope:
DISTANCE TONEARESTCOMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system?
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 9ISPOSAL BY:
} Absorption Trench, Bed or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLIJENTBE DISCI 1ARGED DIRECTLY INTO WATERS OF THE STATES /jam
•
PERCDLAT]QN TEST RESC JLTS: (To be completed by Registered Professional Engineer)
Minutes per inch in hole No. 1 Minutes per inch in Hole No. 3
Minutes per inch in hole No. 2 Minutes per inch in Hole No.
Name, address and telephone of RPE who matte soil absorption tests:
Name, address and telephone of RPF responsible for design of the system:
Applicant acknowledges that the completeness oldie appliction 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; and the
issuance of the permit is subject to such terms and conditions as deemed necessary to inusre compliance with
riles and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby
certifies that all statements make, 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 bre relied on by the local department of health in evluating the same fro purposes of issuing
the permit applied for herein. 1 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
Date 3
P_LEASEDRAW_AN_ACCLRATILMAP_T'n DUll_BIDPLRTY_