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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT. "eP . N., ;. 2 4 7 5 t
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109 8th Street Suite 303 Assessor't*at'cel No. ,
Glenwood Springs, Colorado 81601
Phone (303) 945.8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. +
PROPERTY M
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Owner's Name Mike Rasp Present Address 0748 R. Vista Dr., Silt Phone_ 876-2333
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System Location 4,3$1 County Road 321, Rifle ;
Legal Description of Assessor's Parcel No. w:.
" a AcQ% °ot Ste t-.-sr -, < i 74
SYSTEM DESIGN ` j 4(v j vt
urit 7r 7� Jo tt
6'4 €$i8 2 »rit/Sc 00 d
/ 640 Septic Tank Capacity (gallon) Other `
1111/ 9A 1 M'e4colation Rate (minutes /inch) Number of Bedrooms (or other) 3 '
Required Absorption Area - See Attached kt'
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Special Setback Requirements: ' .
2 • Gf SDate 1j'bi1
Cep Ate
-a — Inspector k"
II r;
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) 1 ;
Call for Inspection (24 hours notice) Before Covering Installation 9'`
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System Installer_ /'y / /cE kii/oP - 'P
Septic Tank Capacity / 2-r a
'•� r!AL I 01
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Septic Tank Manufacturer or Trade Name Cr.
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Septic Tank Access within 8" of surface /('.
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Absorption Area r; R[XN$ /. ' < -1, 7 ,7 / i P rk /S i, /7t7 A _ 1(/.71 ,✓ F
Absorption Area Type and /or Manufacturer or Trade Name y //' .3/4 z
s
Adequate compliance with County and State regulations /requirements kif %
Other (3. 62/ it'
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Date // ViiiS Inspector %t 4.,
fit:
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 a
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 - 999
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 jail or both).
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Applicant: Green Copy Department: Pink Copy
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I)IVII)UA I <.SIiWAr�Is I'�)' / ��� —
1N S A I._SYSTEIVLA PP_LICATInN
OWN 1
21 8 -- E 1 tStB - --� Jilt/ P1 I ON 1 i 1 74' - 2333
CONTR. AC1O12 Cr) fc& /1,, ,
— le _Ad g;c 421",_ 1'1 I O N E
PER MI I'ItISQIJIESI' I:OIt (X) NEW INSTALLATION
Attach separate sheets or report showing, e r I O ALTERATION ( RI'sPAiR
ect to habitable building, location of potable wafer wells, soil percol Lion nest holes, soil profiles in�t sl of
oles
(See page ,1).
LOCA'I'ION_OF 1'ROPOSED.FACILITY: (()tJNI'Y "/J
Near what City or Town _ of it 1
1.tiga Description __ei
WAS'I'I'.STYPE: (X) I)wellint —ra
O'Transient Use
( ) Commercial or Industrial
( )Noa- domestic Wastes
( ) Other - Describe
I I III.DINGOR SIiRVICIj TYPE: r S A� s�c et/
Number of bedrooms: __ 3
_ - _ Number of persons
(X) Garbage Grinder (X) Automatic Washer
SOURCE - AND :FYN& ULNA/ATER SUPPLY: Dishwasher
Give depth of all wells within IRO feel of system: OSPRIN ING ( S'I'RRAiv1 OR CREEK
Ilsupplied by community water, give name of supplier: ___ --- - -
.ORQUNI) CYNI) — _
Depth to bedri;cic_ -- �
Depth to firs! (;round Water Table: -_ - - - - - - --
Percent (round Slope:. /� —
DIS'I'ANCI3'I'O NEAREST (OM M11Nl'I'y SEWER SYSTEM: _ .5/77/7
Was an effort made to connect to community system?.__
TYPE (W IN1) IVID IIAI. SEWAGE DISPOSAI.SYS'l'IiM PROPOSED:
(X) Septic Tank. ( ) Aeration Plant
( Vault
( ) Vault Privy ( ) Composting Toilet ( ) Recycling, potable use
( ) Pii Privy ( ) Incineration Toilet
( ) Chemical Toilet ( ) Olhcr- Describe: ( Itccycling, other use
FINA1. DISPOSAL. BY: - --
X) Absorption 'french, Iled or Pit
( ) Underground Dispersal ( Wast ewater ( ) ( ) S and Filter
ration
( ) Above Ground Dispersal Writ ew wll al e
r Pond
( Other - Describe:
W11.1. 13 1I ? I.I11 ?Nf IlI; DISCI IARGlil) DIR l C"I'I.l' INTO WA'I'ISItS Of' TI I E ? _Ap --
Piel . .
\ l.A'1'IQN'I'1iS'I' I
.RES!_1:1'S: (To be completed by Registered Professional Engineer)
Minutes __ .__ per inch in hole No. 1
Minutes Minutes per inch in Hole No. 3
per inch in hole No. 2
Minutes per inch in dole No. _
Name, address and telephone of R IF who made soil absorption tests:
Name, address and telephone of It PE responsible for design of the system:
Applicant acknowledges Thal I hecontpleleness of Ihe appliction is conditional upon such further mandatory
and additional tests and reports as may be required by Ihe local health department to be made and furnished
by the applicant 01' by the local health department for purposes of l he evaluation of the application; and the
issuance of Ihe permit is subject to such terms and conditions as deemed necessary to inusrecompliance with
rules and regulations adopted under Article In, Title 25, (2.12 .S. 1973, as amended. The undersigned hereby
ccrlilies that all statements make, inform 't ion cuul reportssuhntil herewith and required to be submitted
by the applicant are or will he represented lo he true and correct to Ihe best of my knowledge and belief and
arc designed to bre relied on by the local department of health in evlualing Ihe same fro purposes of issuing
the permit applied for herein. I furl her 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 taw.
Signed __ l -
/ _ . _ _ _ Dale__ i_ o -9.5
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