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Home My WebLink About02607 1 •w : -- GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2607 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 Wayne & Roseman Gilbertresen Address 306 Aragon Rnnt N,( Phone 984 -3805 System Location 1714 Mineota Drive, Mineota Estates, Filing 1, Lot 4, Silt i Legal Description of Assessor's Parcel No. SYSTEM DESIGN /(y /4rx2 Septic Tank Capacity (gallon) NO £1i14.014/ND Other 1 � I � Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 , rip .e 6esTe . 779iftk°rxIe cw &o — /2 ' X44'5! 3 ' Q —10 Required Absorption Area - See Attached 12 0 28 t9N //s iere-a rnn roil as e /3.o Dii=re see = 5L844 Special Setback Requirem nts: In/ Bey) A""fl6 Date r/ -74 Inspector„ %ke- FINAL SYSTEM INSPECTION AND A VAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_.[) Le) A ULF Septic Tank Capacity 1 DOo Septic Tank Manufacturer or Trade Name tnpi e' A,J Septic Tank-Access within 8" of surface yE s Absorption Area y'LR ye Absorption Area Type and /or Manufacturer or Trade Name 446 Zr..F /LT.C.¢T6 C )z{ t Adequate compliance with County and State regulations /requirementsS� - Other • Date. '70 /R - 9‘ , Inspector i'�bi✓ rte., 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 opecifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 6 months In jail or both). White - APPLICANT Yellow - DEPARTMENT Application INDIVIDI JAI. SEWAGE DISPOSAJ. SYSTEM APPJ.ICATION Approval By f � ' 77 N ,, �� // County Official OWNER U/Ck C f �, c,1 c' lvia ry G �J7ev ADDRESS 30 C' Prc , 1 n„ 60oi PHONEfl1Jf ONTRACTOR 0 CJ 'VC 1 ADDRESS 3 ,1/1 PHONE ERMIT REQUEST FOR: (e-r&w Installation ( ) Alteration ( ) Repair .ltach separate sheets or report showing entire area with respect to surrounding areas, topography of area, abitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes iee page 4). f .00ATION OF PROPOSED FAC'J ITY : County 6C,,-i- " lea" what City or Town S ,./ Lot Size /0 7 .- erf .egal Description =' Cc . 1 �� [ � `+��f l[) 4s. y R a a p ,{ F tut ` i r Cc4b A uU tti /9,(, ar a: \ ie /O( 4 p hek G -, l ll7h� ft VASTF.S TYPE : (V) Dwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - D scribe tU1LDING OR SERVICE TY E: e3 • n c 11 ' Dumber of bedrooms N umber of persons Z a 'tarbage grinder (X) Automatic Washer (rQ Dishwasher ;Ol MCP. AND TYPF. OF WATER St JPPI.Y: ( ) well ( ) spring ( ) stream or creek Jive depth of all wells within 180 feet of system: f supplied by community water, give name of supplier: / Pm - ` r^ F States :ROIJND CONDITIONS; )epth to bedrock: )epth to first Ground Water Table: 'ercent ground slope: )ISTANCE TO NEAREST COMMUNITY SEWER SYSTEM;. vVas an effort made to connect to community system? .4)4 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (I) 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: (73, Absorption Trench, e or Pit ( ) Evapotranspiration (w Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond ( ) Other - Describe: WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 210 • MI. PERCOT ATION TEST RESI II .TS: (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. _ lame, address and telephone of RPE who made soil absorption tests; fame, address and telephone of RPE 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 amended. 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 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. � Date 4 M 2- ft - �� Signed %j d l J ��. ''`' t pi RASE DRAW AN ACCT MATE MAP TO YOI JR PROPERTY / �� wee .31 . /4/ r7/ F S/ x7 3 7 i3 3/ : / 3 --7 /347 13, 30 aro % 13.6 7 /2, No 61/4646e e li': .3 fi,ce/ /art) Cgs 771 ,ct god Irt 2C /o4.-7-74 /KmitsC / /41