The URL can be used to link to this page

Home My WebLink About02620 Wa r i :4e"rR'R7f f?a n 9 +e'{ +GZF 7 \ J GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2620 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945 -8212 This does not constitute INDIVIDUAL SEWAGE PERMIT a puilding or use permit. PROPERTY / Owner's Name Orrin & Shirley Helgels ant Address CR 259 Rifle Phone 625 -4738 System Location 0796 County- Rf)ad. 259, Rifle Legal Description of Assessor's Parcel No. II! i SYSTEM DESIGN /06n Septic Tank Capacity (gallon) tCARBA! i T lci, / M 111 /.4 kl (minutes /inch) Number of Bedrooms (or o4oej) Rczzx 4 LEm nerd-. 020 % t Ufa Required Absorption Area - See Attached g ry h CI • BO uc srr 6' ) 8 Y \ pH r0`3 Special Setback Requirements: . a' Data /0'/ `4 ii c Inspector g.ii&i..J.:„±4ire FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer yrv— O $ E Septic Tank Capacity / .2.CA Septic Tank Manufacturer or Trade Name etr ' 1 i_opetp y 0 Septic Tank Access within 8" of surface e Absorption Area 7 R? J6 J.)/ rill NE PS Absorption Area Type and /or Manufacturer or Trade Name 7, taw • 1 PrJ$ BeaS Adequate compliance with County and State regulations/requirements VE3 Other Date 1-- 4f'- 97 Inspector RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION *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 (8500.00 fine — 6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Oi R / CSNIF. j 74.16E/4/06 ADDRESS ;/l /. a.ci _ ✓ • PHONE 6 ice. i CONTRACTOR ' ' / 1 (,/azse '- ZS 7 ADDRESS G -1 ,I/ ' - G/ P • s _ _ ifr7 PERMIT REQUEST FOR (K)_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 FA ILI Y COUNTY 0/cfrePillb _ Near what City or Town / P E, / �'J Size of Lot /0 /7 Ci2a Legal Description or Address WASTES TYPE: (V) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) 0 HER - DESCRIBE BUILDING OR SERVICE TYPE: l /4 ._;l ar4e. Number of Bedrooms .3 Number of Persons ( ) Garbage Grinder (Al Automatic Washer i'C Dishwasher s5fE SOURCE AND TYPE OF WATER STIFFLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREE � ->s Give depth of all wells within 180 feet of systenr e1/416 COd(/&/4'Zc /f/( /47) If supplied by Community Water, give name of supplier GROUND CONDITIONS: Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope /71722( DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES ��NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: A) SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CIIEMICAL 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? y'1.° 2 / Z sq R' v2 i e>P,c' /n .i /b •/` % ‘• 5 4" ), /\:' IL N /N_N i e Elj z) 0 4 v — c2 1 1 : t 6 44. '07 _ • /9 3 � ' " 8 rG e v 0 7 5//% 4 0 a ';ZO _ /c9 1 /N /o2 /y]/ N PERCOLATION TEST RESUI TS (To be completed by Registered Professional Engineer) Minutes per inch in hole No. 1 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 repots 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 terns 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 tnie and correct to the hest 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 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! i0 /-1 €.> . c— • r °y f , • • M o G - fir: • LAL oda i (970) 945 -2233 .ill H ❑ CHARGE . '�w�,,wF, (. _.(]"CHECK ❑C.O.D g MgteUfa • '•�'•^"�>r 9 sc• REFERENCE NO. 0033 MARAND ROAD • P.O. BOX 248 • GLENWOOD SPRINGS, CO 81602 • FAX (970) 945 -2300 PIPE • VALVES • PUMPS • FITTINGS 5 0 WATER SUPPLY & DISTRIBUTION DRAINAGE & STABILIZATION SEWAGE COLLECTION & DISPOSAL LAWN, TURF & AG IRRIGATION INVOICE DATE O H DATE ORDERED L I D P / / T T Q O JOB • /NAME DATE PICKED UP OR SHIPPED 1 ., / i // .7 CUSTOMER - SALESMAN FILLED BY FREIGHT TERMS TAX EXEMPT NO. SHIPPED VIA / DELV. BY PO NO c _ (i J Prepay J Collect '. + + r COUNTER BY J Add J Allow I ORDERED SHIP'D BACK INVENTORY DESCRIPTION UNIT AMOUNT ORO'D NUMBER PRICE , 1 1 1 i -t • , . 1 1 _ — , • • • GOODS RECEIVED BY DATE SUBTOTAL ;',yin / 6'V TERMS: NET 30 DAYS FROM INVOICE DATE. A finance charge of 2% per month (24% annually) will be COUNTY TAX added to all past due unpaid balances on the end of each month and will appear on your statement. If the STATE TAX z. '' account is referred for collection, buyer or signer agrees to pay cost of collection including reasonable attorney's fees. RETURN MATERIAL SUBJECT TO A 20% HANDLING CHARGE. LABOR WARRANTY ON ABOVE LISTED MATERIAL IS LIMITED TO THAT PROVIDED BY THE MANUFACTURER, CHARGE COPIES OF WHICH ARE AVAILABLE UPON REQUEST. Dodson's "Standard Conditions of Proposal & Sale" shall apply to this transaction. FREIGHT TOTAL ..— • .vy2 PACKING LIST Rapt roc( for oar Order,/