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Home My WebLink About02501 a^o ,r. aai p .. A I` ' 2501 ' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945-8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Phyllis A. LeMay Present Address P.O, Box 761, Silt CO Phone 876 -2341 SysteriL Location 1514 Mineota Drive, Mineota Estates, Filing 1, Lot 2, Silt Legal Description of Aylessbr's Parcel No: SYSTEM DESIGN / 660 Septic Tank Capacity (gallon) Other 1 1 mnN Percolation Rate (minutes/inch) Number of Bedrooms (or o)her) 3 aid RoCK¢ t64c-■4 a e4 C IJO D, c-) Required Absorption Area - See Attached 44 ,69 - r 1970 la av °er. 4/o9 t3.o P FV 6SB 2 as Special Setback Requirements: Date II ";fi Inspector "4-e. l V ANAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer e/S lL Septic Tank Capacity / coD Septic Tank Manufacturer or Trade Name e09 Septic Tank 'Access within 8" of surface Q E 5 Absorption Area 1 1 O9 b t! Absorption Area Type and /or Manufacturer or Trade Name if-iOt J-,t/Fi G flZr1-7Z (2 22 sP 14- Adequate compliance with County and State regulations/requirements W Other ,,(j Date log- '4 - "gS Inspector arz_ ( . 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 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 INDI.Y.IDUALSEWAGG_DISPQSAL Y_STENLAP_PI,ICATION OWNER pk /// .5 4. &C M ADDRESS ('. o_ o x f PIIONE F7& a X5 CONTRACTOR ADDRESS PHONE PERMIT REQUEST FOR) 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). LOCAI'!ON__GE PjtQI!QSIif? 1 1CIL.1TY: COUNTY 1 � - = ' Near what City or Town J i /f Lot I.egal Description WAS'173S1'YPE: l Dwelling ( )'Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: / _.. 1 . i _ . , 4/ S_ ,_ • Number of bedrooms: \-3 Number of persons ( ) Garbage Grinder M Automatic Washer (s) Dishwasher SOUItCILANDILY_PEDI WATEILSUPPLY: () WELL (, SPRING () ST EAMM OR CREEK Give depth or all wells within 180 feet of system: / If supplied by communiiy water, give name of supplier: GROUND_CONDITIONS: Depth to bedrock: Depth to first Ground Water Table: Percent Gro and Slope: DISTANCE TO NEAREST COMMUNI'T'Y SEWER SYSTEM: Was an effort made to connect to community system? TYPE OF INDIVIDUAL. 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 DISPOSAL BY: 0. Xbsorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filler ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WIL.I. EFFLUENT BE DISCI IAItGED DI It liCI'LY INTO WATERS OIL THE STATE ? _ • 'P_ERA OLA'L11:2N_TEST_RESLL'1S: (To he 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 R PE who made soil absorption tests: Nance, address and telephone of RPE responsible for design of the system: Applicant acknowledges that the completeness ofthe 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 ofthe application; and the issuance of the permit is subject 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 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 . �,i _ � Date 772490 PLEASE _DRAW_ANACCURATE MART YQUIL.PROPERTY • s ft fig 5�4� 2501 ma � A GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit t/� � Assessor's Parcel No. 1' ,? 109 8th Street Suite 303 t l Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute e building or use permit. INDIVIDUAL SEWAGE DISPOSAL PERMIT PROPERTY Owner's Name Phyllis A. LeMay Present Address P.O. Box 761, Silt, CO Phone 876 -2341 1514 Mineota Drive, Mineota Estates, Filing 1, Lot 2, Silt System Location Legal Description of Assessor's Parcel No. SYSTEM DESIGN / fJEuJ Septic Tank Capacity (gallon) Other 3 / /N !9/i7itdercolation Rate (minutes /inch) Number l - o1�B ` dro & (eit other) Re Absorption Area - See Attached 4oq# y L r�'-.4-ra c 4 a sir den FyrGiarF'A J' et Attic Special Setback Requirements: Date /1 -78=9 S- Inspector � ( FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity — Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface _ Absorption Area Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and Stale regulations /requirements Other Date Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE *CONDITIONS: r I t n s l C.R.S. tio comply Revised with l requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter 25, 2. This ction t o use valid with dwelling onnec nogt approved by f the Building and of ice automatically be a requirements. a requirement o requirement use the p any t andcaus e sfor both eap Y f the permit and cause for bh legal action and revocation of the permit. 3. rial on from the terms or specifications ntained in the cation of permit commits a I, Pety ($500.00 fine an va months In )ail or both). White - APPLICANT Yellow - DEPARTMENT Y 9.e0 - /bt /o - v n w d g f /a = s4 - • (0" Vt. S 4 • 3= 11.4 o R i 9 7 '/ �)G " -4g' /a %4 V B $ z c ?c/D ij i9 mi,v 9 I D i 3 / � � ab