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Home My WebLink About02277 el GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N 2 2 2 7 7 9 109 8th Street Suite 303 Assessor's Parcel No. 7, _ Glenwood Springs, Colorado 81601 ,t* i Phone (303) 945 -8212 , a This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. t . PROPERTY Owner's Name Jess & Cindy Robineon Present Address P.O. Box 492, Rifle Phone_ 625 -9019 1 System Location 0450 County Road 251 • Rifle 5 k Legal Description of Assessor's Parcel No. 1 SYSTEM DESIGN / , k + / 7 j , !^i '(� Septic Tank Capacity (gallon) Other / /. ? / .i /.'' k ,,(2 t "' I7 , % I Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 � ' � f ' 6 � 3 RV c4 - {._4L� ( , r>, o - f C,✓ /u A' /'0 tx3'f ,'-I. CIS r Required Absorption Area - See Attached ' ' � F' ' f! l e, ,-4-' .;CA 7 1 1 r 4 (r�)i •� •`/ J.n.; F- Special Setback Requirements: lr it PI Ca - f :ei y'°7 :s-✓ tr G' [ s ' t 4 Date 2— 2 � '7• Inspector `+/ G'` j '+s -- t FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation ( System Installer_ OA.n) W c Septic Tank Capacity O Qr`g fi „p•[. hts U 5 Septic Tank Manufacturer or Trade Name 6 1e - !' t Septic Tank Access within 8" of surface 4ES ` t'^k 7 % Absorption Area 3 R k / twnar 4- ' - /r- 7qQ ` 4': i/) S u i A + Absorption Area Type and /or Manufacturer or Trade Name A. 1 0FL. (7 Q /?/p/ Jq. e A Adequato compliance with County and State regulations /requirements /k's 4 t Other r � Date ---,?R "7T Inspector --)- 40.01 4 ...... + RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE 4 i. • •CONDITIONS: 1 ` 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. .i 1 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 tor both legal action and revocation of the permit. 4 1 3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which involves a knowing and material g variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — months in jail or both). C: Applicant: Green Copy Department: Pink Copy 1 4 r Application INJ)IVIDTJAT, SEWAGE DISPOSAL. SYSTEM APPI .ICATION Approval By County Official OWNER -Je is nv4 ''"ay gnl,ie tee ADDRESS Q 4 SO Crux y Pro,/ p,,c 1 Rg le, PHONE t.2- V 1)50,' :ONTRACTOR O wnne.r .s ( n nikhotAsls < StA�• con +rnc'inr ADDRESS 0.Q. aox H 2 4 pi +L.. Cn RI PHONE (.2S AQI 'ERMIT REQUEST FOR: OQ New Installation ( ) Alteration ( ) Repair all separate sheets or report showing entire area with respect to surrounding areas, topography of area, tabitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes See page 4). .00ATION OF PROPOSED FACILITY : County 6�r -Ctie c i gear what City or Town R:. I* Lot Size ..<1 6 A C I -egalDescription f Li ct-l.na4vd• �p 4I.c N w 1) 4 NE 1 I/ �I .C S e4 ;on ;n, TOwe[A .� Se‘+4-1, Rs%%bp 42 Wrs+ n 16 A'S P. TA 6,254;• )d CA lw n4y GiA,.Jn :BASTES TYPE.: Oq Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe 11 :UILDING OR SERVICE TYPE: S;* St' Fp miiy Twf IcvPlc dumber of bedrooms 3 _ Number of persons. y )Q Garbage grinder 04 Automatic Washer QQ Dishwasher 'OIJRCB AND TYPE, OF WATER 51 JPPT.Y: OQ well () spring () stream or creek Jive depth of all wells within 180 feet of system: No Arp1∎ en b L if supplied by community water, give name of supplier: No 4 n p 1 it A tole 3RO1 JND CONDITIONS; Depth to bedrock: EliI% npber\ — Stinr)s DOA C11501113 zrprA ". 7n' Fact A'1,• sr.-k" Depth to f i r s t Ground Water Table: Apt, e x 80 4. a }' Percent ground slope: Appr R DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM`S n,.; \ e s ± Was an effort made to connect to community system? N n TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: pQ 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: pQ it Absorption Trench, Bed or Pit ( ) Evapotranspiration ( ) Underground Dispersal ( ) Sand Filter ( ) Above Ground Dispersal ( ) Wastewater Pond 04 t Other - Describe: 'TN F T t T RA TO R C Are TA a Lon rin Sy al. n WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? )'3 n 3011?fsERC01.ATI0N TEST REST JT.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. _ Name, address and telephone of RPE who made soil absorption tests: [Name, 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 � W WI ay i a chi Signed h G / l l e P1.EASE DRAW AN ACCT IRATE MAR 3D Y01 1R PROPERTY tut C.ak -o M 60 I Ce M N T C, R, zs I +/ Par (4.\ ° y S, b (its b Across is: O''IS0 Cr,uv,1 Road. 2. B ):., All, Rile, p1,OT PI AN AND DESIGN FFATI JRFS Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications statements and commitments. N Scale X00 p t00 Eas Lara) 1" = 1001 / o f R;tle c �..k (O SP canoh 05;4 k 0 S AIN 1l 0o- de nn om. / J r� { \ • / r ro�ryy Ll \ C ^ r p fro - N\ ,kv &p4.cn j Pr 11 a eoL n�i+ fly L1 1eatk�elp��'� H pu�c PO4061t. I I Wo%<r S.,�p 3rs F1ay.tt 1 weu)i 1 L. Well `"� 1/ D " ~ a3 to Q1 le S .0-7f 8 3 G A- il i — 7" 4 t, ,3 3 1? g g 11 n 7 11 50 ir - 5 7 a r> Ii ,,q_a ; ,2/. S o —v 2 - r I1 c • a 41 M -dei