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Home My WebLink About02587 f ..� I 4 Vary(' .M ,.....t Wy : Y/- T GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2587 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 • Phone (303) 945 -8212 This does not constitute .INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Doug Buckham Present Address 0139 Shotgun Drive, Rifle Phone_ 625 -3789 � /a .v TC.Cz2 L-N System Location Oa // County Road 225, Rifle Legal Description of Assessor's Parcel No. SYSTEM DESIGN MID Septic Tank Capacity (gallon) Other 1 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 9 Ay`N e67.0 kat Le D Required Absorption Area - See Attached in /8 omits Lj'ic A -- z-, 4 3`✓0 Special Set back Requirements: /8 tars ' . 7t 3Y0 46 ,/ Date `y - / -y1, Inspector 96 FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours rkptice) Before Covering Installation System Installer_ Septic Tank Capacity AP Septic Tank Manufacturer or Trade Name QnpL.9x'eG. Septic Tank Access within 8" of surface “f a Absorption Area .5 090 Absorption Area Type and /or Manufacturer or Trade Name J ivFiG 7ftfla-t Adequate compliance with County and State regulations/requirements 44e C Other. Date Cte I ' 91. Inspector /1'9ni,.0b k) ( c>fO k.G 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 br 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 )ail or both). White - APPLICANT Yellow - DEPARTMENT IN1)1VIDLJAI, SEWAGE DISPOSAL SYSTEM APPLICATIO OW N I tt L1 c- /Xli' / c <7, J /�✓ r / 63, /AZ -- I ADDRESS 0 / 3r / / � _s ,. T / ..._ A ^rl,- , PHONE (C 37,99 CONTRACTOR /L. ��1 �� - 7 ADDRESS / /V7> C5- j '" "3 3 / _S;2'T P II ONE 97C ? e /S PERMIT REQUEST FOR 24 NEW INS'T'ALLATION ( ) 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). LOCA_TION OF PROPOSED FACILITY' COUNTY Near what City or Town ✓(�'/ . — - - -- — Size of Tom. ri 2 %1e c -S Legal Description or Address WASTES TYPE: DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: _ — Number of Bedrooms_._ 3 Number of Persons ( ) Garbage Grinder Q Automatic Washer ( Dishwasher ,SOURCE AND TYPE OF WATER SUItLY (K WELL ( ) SPRING ( ) S'T'REAM OR CREEK (five depth of all wells within 180 feet of system: 790 z If supplied by Community Water, give name of supplier /7�4' GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope DISTANCE TO NEAREST COMMUNI'T'Y SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: pSEPTIC'I'ANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER LJSE ( ) 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? 2 v MNitt;O't.A'1'ION TI ST_RESULTS (To be completed by Registered Professional Engineer) Minutes _ _ per inch in hole No. I Minutes per inch in bole 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. Signed r 791 . } y- c, Date ' 9 � _ 3/3 6 An) o.,ea PLEASE DRAW AN A 10 LATE MAP 'ID YOUR PROPERTY!' i9 / ca -4 /4 / /9 vreees °zap BP4' !!/F t: e coo ,4,ae'S Oaf I p x ,ai9 �l. \ itint y /vs 0 di 3 r 7 a I / s � / IT /D 7 4 /y g N y,,.9G y�8 7 Six MOP= u 8 0, 7--p" /0- / 3)/47 / S 74 y P A peefbe Alp 2SP ?Pj6 = 77 73 ° 2S•67ova ,QE tS X 26 3 teedn,ons A Ow e gy, s�/ m ,eemiL ieocie & / 3 / nt 2,e,o ,.4s ese c&o IldieCcede,45 • • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT A's Parcel No. 2587 109 8th Street Suite 303 Assessor's Glenwood Springs, Colorado 81601 - -- Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL. PERMIT a building or use permit. PROPERTY Doug Ruckham Present Address 0139 Shotgun Drive, Rifle Phone 625-3789 Owner's Name - g System Location County Road 225, Rifle — Legal Description of Assessor's Parcel No. SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes /inch) Number of Bedrooms (or other) . 3 Required Absorption Area - See Attached Special Setback Requirements: Date Inspector - -- - -- - - -- FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ Septic Tank Capacity Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area Absorption Area Type and /or Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements — — 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 variation from the terms or spec fical ons contained n the application on of permit a Class 1, Petty Offense ($50 material 0.00 fine6 months in )ail or both). White • APPLICANT Yellow - DEPARTMENT