The URL can be used to link to this page

Home My WebLink About02590 • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 25 109 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 John & Nila Parrington Present Address 0145 CR 825 Rife Phone_ 625 -02084 System Location 0145 County Road 225, Rifle Legal Description of Assessor's Parcel No. SYSTEM DESIGN 7 Septic Tank Capacity (gallon) Other y 1 • 2 rot % /,(ni c it 0 ^4 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 1 #i tY {¢ HOB Required Absorption Area - See Attached 7N D I "b C h P S 2 y r i PCP S Special Setback Requirements: / Date #'"' C r - 7 ir 4 Inspector ( -�'w _.. - FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer t W A) r z- Septic Tank Capacity J. CO Septic Tank Manufacturer or Trade Name a opc-'gn' Septic Tank Access within 8" of surface 1 '0 1 rw 6e Absorption Area .'y Absorption Area Type and /or Manufacturer or Trade Name L{4f-0 Vie 24 DAt IY-S o e` 1 .4471-71 41D'6s Adequate compliance with County and State regulations/requirements S Other Date /b - r * 96 Inspector i/ .4 -1 Q 1tiCS 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 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 —13 months in jall or both). • White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER foH� 'vtt - PAt2Rt^ ADDRESS 6 I I CA ' t° Q 2 . 5 PHONE 6 2--C 6 ]._-OR CON"1RACTOIt - SE_h,,F ADDRESS _ _ PI -IONE PERMIT REQUEST FOR (EW 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). LuCATION OF PROPOSED FACILITY; COUNTY (p#rR FrLJD Near what City or'fown_____ Fl F LC -- Size of Lot Legal Description or Address 01 44-c em WASTES TYPE: (WELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Ho — Number of Bedrooms_ Z- ate- Number of Persons_ ( ) Garbage Grinder ( utomatic Washer ( -- )-Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( -'WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: I 1 t,J I= Ll_ I S / bo FT If supplied by Community Water, give name of supplier GROUND CONDITIONS_ Depth to bedrock: CA-pi 'r P t kw rl'fi--C) IV (i 14otom Depth to fast Ground Water Table_ Percent Ground Slope_ DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_ 1'2' ate S r✓I 14-G Was an effort made to connect to community system? ( ) YES (—) TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (.EPTIC 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: ( AIISORPTIONTRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER-DESCRIBE_ OS. I at- I >\S' I L t0-k i o -- WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? NO 2 'PR a v l o u s.c., 1 D ora E 1.3 ea 0 tj - PI3It I. S'f RESULTS: (To be completed by Registered Professional Engineer) ft'►a- -tj Minutes per inch in hole No. I 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 ofRPE 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. 1 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__ _�_ Date µ 3 — ci r L PIJ ASE DRAM/ AN ACCURATE MAP TO YOUR PROPERTY!! wPaauc M tcaT \ Sue_Ut: n1/4.1 Cw0 =.D cJi ) PH P1-1 a Pen o.J 3 •