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1 V GARFIELD - COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2542
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 SJv {iPg2
Owner's Name Ste.VP & Nampa Biker Present Address 6385 CR 335, Silt Phone 9R4 - 9500 \,
System Location 1014 Mineota Drive, Mineota Rotates, Lot 8, Silt
Legal Description of Assessor's Parcel No.
/vas r_a0,6 FOR G.nao ASP )03S t - / 0
SYSTEM DESIGN
00 Septic Tank Capacity (gallon) Other
�
q 3 .- Percolation Rate (minutes/inch) Number of Bedrooms (or other)
3
Required Absorption Area - See Attached .+)ry)C1"7•j• /a y ai, Ra4eI eA4/ Bee ,
o yD /NF/Lne/yrpe5 7 x 9 1 1
Special Setback Requirements:
at 0 B/ 3 4 PFVSe.0 . 1
Date / 24') 3-7-96 Inspector tines :Mae:
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer tl T.5 Coe/5
Septic Tank Capacity )a.527 6 Z.
' Septic Tank Manufacturer or Trade Name ( 0/Cle /ANO
Septic Tank Access within 8" of surface y 5 a �s
,r.,/ �,y
Absorption Area yo /i/F/L- 7/j/47Y1/1 7 / „4
Absorption Area Type and /or Manufacturer or Trade Name /NFi.' (r -
Adequate compliance with County and State regulations/requiretiients y`b f
Other OX re CaleP -�
Date 3 "J! ty -el Inspector �/Lr//L
k - 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 Syslems 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 — 8
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDT JAT. SEWAGE DISPOSAT. SYSTEM APPTJC.ATION
OWNER T--y1 �e
ADDRESS &238 rou - f. "Fd . 33S PHONE 984 3 soo
CONTRACTOR DALE A /coiiv �
ADDRESS 7oX c o . /Veto Cast /e. , Cr, PHONE qxq' S S o
PERMIT REQUEST FOR ( 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 CAW 4 L-n
Near what City or Town �� Lot 8
Legal Description Se-e- Age,
WASTES TYPE: (Dwelling ( ) Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Nu ber of bedrooms: 7hgee Number of persons 7 c ,z
( 4Garbage Grinder (,Automatic Wisher (v(Dishwasher
,SOT RCP AND TYPE OF WATER SIMPLY: (c4WELL () SPRING () STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by communtiy water, give name of supplier:
(TROT JND CONDITIONS:
Depth to bedrock: U
Depth to first Ground Water Table: a, /:
Percent Ground Slope: 5 %
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to community system?
TYPE OF NDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(VI 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:
a 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? Ain
•
,r'EItCOLATION TEST RESULTS: (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 ItPE who made soil absorption tests:
Nance, address and telephone 0 f RYE 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 purposes 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 ascended. 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 niy 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 Dale b 7 Y - 1 3
PLEASE DRAW AN- ACCIJRA_fI_ MAP _ I O YOUR PROPERTY!!
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12-01C
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 5 4 2
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 Stems& DeAnna Baker Present Address 6385_02 335, Silt Phone_ 984 -3500
system Location 1014 Mineota Drive, Mineota Estates, Lot 8S_a Silt
_._
Legal Description of Assessor's Parcel No.
N , N4 . 9•'/ )1/47 4
SYSTEM Legal D •
I. , 0 • Ate 4,/4 _ - /vita-,
i000 Septic Tank Capacity (gallon) Other /7LOD / e-- / 5 '� ^ Al - - •-• Ast
V h i Q 3
Percolation Rate (minutes /inch) , Number of Bedrooms (or other) _
NE F d s N g to 16. 1 d-. - a 4 - Cytot-e 042 .C_
Required Absorption Area - See Attached s,ys riZ fA-7 , A4 ' 4 ea'so , x)
A- Na -ace... Ft- — item . /, • 1 /aa -
Special Setback Requirements: /F• fine r: */ 7 /7/e- B .-ce *Ave
• I y . .• ire ..»y a nave
Date _ =e' Ce _ Inspector ' J as' / -,. _ _ ._ —. __.___ —__—
AP
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) SAG K444..i, Q
Call for Inspection (24 hours notice) Before Covering Installation 0+ sal/ -)1 - .. 6c ' •
System Installer_ - Y-4,{- - e '
L
� _
Septic Tank Capacity — -- V
Septic Tank Manufacturer or Trade Name /2-
Septic Tank Access within 8" of surface
Absorption Area _ —j
,
Absorption Area Type and /or Manufacturer or Trade Name ����yyyy ____
Adequate compliance with County and State regulations /requirements— / 41 _
Other __ — - / —
Date — Inspector
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 tine — 6
months in )ail or both).
White - APPLICANT Yellow - DEPARTMENT