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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit ,NYC , i 2 4 8 3
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'' 169 $th Suite $03 k t 4sessor's Parcel NO%
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212 s' \ :, •
.. - > This'tloes not constitute t .
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building of use^Periglt.
PROPERTY s...,......;. " v` tn\ %t ‘
?7G -2,703
Owner's Name Robert & Amp Snow Present Address 2015 Blake; G.S. Phone 45
System Location 0284 Mineota Drive, Silt s
Legal Description of Assessor's Parcel No.
zip a 2ceKcjz cgen Mao n CA.(AW a t�'pja1et •7 94 -
SYSTEM DESIGN .4 0.01 / g wra 7BI/7`1 $ Al C 3 WI-
7, e rn-orr rusta , D rc'S t .
J.:{.Cf Septic Tank Capacity (gallon) Other t`
/ h IN .20 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 4
Required Absorption Area - See Attached
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Special Setback Requirements: . J o ai
Date /M he t, • 9S Inspector �y .- i .yyn..1 ”
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FINAL SYSTEM4NSPECTION AND APPROVAL (as installed) Y r "
Call for Inspection (24 hours notice) Before Covering Installation At
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System Installer_ C,544Q / /./ L [,U4.5
Septic Tank Capacity e tz6t3 4'9L
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Septic Tank Manufacturer or Trade Name (00B44 j1 o
Septic Tank Access within 8" of surface f/ e>
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Absorption: Area .3 Oa," jj / ?!a %; /!J 7 T7S/?4c 4 - .:i /,tp�f.' /� -�•c. /y ,/ ,if'�'NY�
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Absorptio6 Brea Type and /or Manufacturer or Trade Name J/VA /t 47e JQTC2'< k i
Adequate compliance with County and State regulations/requirements `/e"...) #
Other _ 2k, 777 e� / ir'‹ ii
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Date_/_(279 `>r Inspector .7 if
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RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE �v
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•CONDITIONS: l 4
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. C 3
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 F S
requirement of the permit and cause for both legal action and revocation of the permit.
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3. Any person who constructs, alters, or installs an Individual sewage disposal system in a manner which involves a knowing and material i
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6
months in )ail or both). 1
Applicant: Green Copy Department: Pink Copy
1NDI.VIDUAL_SI3WAQL 1)ISP_DSALSY,STRIYLAPPT,ICATTON
OWNER et, be -� finn 5vV$
ADDRESS gel rim &sin. op 5,/1- C? PI LONE ?4 ? 296
CONTRACTOR p (1r n5 Y
ADDRESS fyPtit�rJJ' ,a-, (' .h gist( PI!ONE jee o ,
PERMIT REQUEST FOR ( +N INS'T'ALLATION ( ) 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). ,�
LOCAIION_OF PROPOSED_FACILITI: COUN'T'Y (12 0 /L Alt e
Near what City or Town S r / / Lot .Z f , (/ cti 4 2
1.ega Description
WAS'ITAS_TY.PE: ( Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING Olt SERVICE TYPE:
Numb r of bedrooms: ,, Number of persons r
( Garbage Grinder ( utomatic Washer a shwasher
SOURCi_AND T OI_WATEICSUPPLY_: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 1 K() feet of system: ,,/�
If supplied bycommuniiy water, give name of supplier: O [ nen /-a 4 ' rntc aL.svic ea' s Ass
GROUNDSQNDITIONS:
Depth to bedrock:
Depth to first Ground Water Table: _
Percent Grdiuul Slope:
DISTANCE To NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system?
TYPE OF ITJJ)IVIDUAI. SEWAGE DISPOSAL SYS'T'EM 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 D15 ' SAL BY:
( Absorption Trench, Bed or Pit ( ) Evapotranspiration
( *derground Dispersal ( ) Sand Filler
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCIIARGED DIRECTLY INTO WATERS OF THE STATE?
, , :
PERCOLA1]ON_ ESTJ,ESUL]'S: (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 made soil absorption tests:
Nance, address and telephone of It PE responsible for design of the system:
Applicant acknowledges that the completeness of the appliction is conditional upon such further mandatory
and additional tests and reports as may be required by the local health department to be madeand 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 suhject to such terms and conditions as deemed necessary to inusre compliance with
rules 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 furt 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 G��O" '/
Dale _____T4/9-5
PLEASEBRAV_AN_ACCLRATILMAY'11) YnLILPRO.PERTY
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