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Home My WebLink About02579 _. a 1 / GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 23 19 109 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 Don Hultquist Present Address c/o Bell Country Homes Phone 876 -3500 System Location /02.x$" County Road 226, Rifle Legal Description of Assessor's Parcel No. - SYSTEM DESIGN /000 g /N Septic Tank Capacity (gallon ) Other w • 3 r0 -t,1 3 r Percolation Rate (minutes/inch) Number of Bedrooms (or other) + "`rR Required Absorption Area - See Attached - - S - - - - 1/4Speclal Setback Requirements: 68'1 a 00,01€ 4Lilc0 $40 480 a sb.ls amigos Ss - e , Ada • 04.4 -9G gag tr TAP r-TP groin di R. m,. ,,,t Date � `� •�'�a Inspector •" fr(das+ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Otviveg Septic Tank Capacity �l� y'jie Septic Tank Manufacturer or Trade Name COAGG/!ND Septic Tank Access � 'Y --gowns 8" of surface g.i/Y$' ! 2/N65 7 Absorption Area /a Cownj tv IFCP n1Y'HP� '��CYtiS /3 Absorption Area Type and /or Manufacturer or Trade Name J/0 Tilt ATA.e Adequate compliance with County and State regulations/requirements /C. Other _(fit 7z, /Cove< Date S� f - '6 Inspector TAge ' 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 - months in Jail or both). White - APPLIGANT Yellow - DEPARTMENT • Application JNDIVIDUAT. SEWAGE DISPOSAL SYSTEM APPT.ICATION Approval By (� County Official OWNER /Al( . u_t-e tern 7 ADDRESS i to ./t i�'1• i " / o PHONE CONTRACTOR 10/../ dry M7 ` 5 �n ? ADDRESS 'i 'o -d clio% , eb�/ ' g D6 PHONE << " 3 S 7)- J PERMIT REQUEST FOR:4, 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). LOCATION OF PROPOSED FACILITY : County Near what City or Town ; /A Lot Size AC' F- Legal Description E ?S' //V 32.cf 's T r 4v aJ a.' 6 7T»2 WASTES TYPE : JDwelling () Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: /C?s irIxtt li Number of bedrooms 3 Number of persons Ki- (71 Garbage grinder (Y Automatic Washer Q Dishwasher ,SOT JRCE AND TYPE OF WATER ST JPPT.Y. O well / ( ) spring () stream or creek { Give depth of all wells within 180 feet of system: C ,%sre ✓� If supplied by community water, give name of supplier: GROUND CONDITIONS; Depth to bedrock: Depth to oust Ground Water Table: Percent ground slope: / DISTANCE TO NEAREST COMMUNITY SEWER SYSTE% Was an effort made to connect to community system? TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM 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: 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? /1/6 1 TOIL PERCOLATION TEST REST TT .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. �/' i Date _ 7 � � l/ Signed i% PLEASE AW AN ACCT RATE MAP TO YOTJR PROPERTY 7-1 1 11 1, \; :! . -/ \\ {\5 8 ?, - - \ -A 7 ) - - - a E \ \« ° } \ \ \ \ , 0 ` 1; ----- ---------- ---_______77 --- o . .�� WelaWeer 3 Democrat .5 wig 6.a4ac P +sox:(c 004w(d to Tina /0,1/42 57?*er 30 /atat Ter /0 d 40444 X ,30 / o � ' S X V2 '/v / /N� a 9 ` % �9 1a 3 0 I Mr /i / " =3 = ,V8 ,A,r6E GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 25 l 9 109 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 Don Ilultquist c/o Bell Country Homes phone -3500- Owner's Name ___ __ __- ____ ___ Present Address ____ -- _ -'c County Road 226, Rifle System Location_ _ _...._ _._._ Legal Description of Assessor's Parcel No. --- - - ---- SYSTEM DESIGN Septic Tank Capacity (gallon) -__- __ Other 3 Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: Dale__ _- ___._. .Inspector_ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Bel System Installer__ /11/1 C / {- Septic Tank Capacity __ - / - __ - - -- _- - " - - -- i Septic Tank Manufacturer or Trade 1 ------ -- Septic Tank Access within 8• of surf Absorption Area - __ - - - - -- - - " - " - " - -- Absorption Area Type and /or Manula - -- Adequate compliance with County at �/� // /J - - - - - - --- Other ___ - _.__ -_- [� a( /279 t Dale_. _._ —_— _- --- - -__ -_ wapec,vr 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 1, Petty Offense ($500.00 fine - 6 months in )ail or both). White - APPLICANT Ye'low - DEPARTMENT