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Home My WebLink About02641 , .t r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit �' f 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 Norman 6 Lori Antone11 Address 356 Will Ave., Rifle Phone 625 -2067 Owner's Name 1977 County Road 210, Rifle System Location Legal Description of Assessor's Parcel, o. sue _ , y,.%a�v'1 �� q tit R air' i nil s i BA ebnye SYSTEM DESIGN .s 7B — NF / t rRn rr" Q �7 578 V 0/e.- /,lids attar a/ h l a Septic Tank Capacity (gallon) Other If rvl / 3 /N 24C Percolation Rate (minutes /inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements: • Date Inspector `4o. !?/ FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer le fe 1 t v r Septic Tank Capacity /000 Septic Tank Manufacturer or Trade Name evpari/1kl Septic Tank Access within 8" of surface l TES Absorption Area 5 / o Absorption Area Type and /or Manufacturer or Trade Name. 4-. B a 1 OL 1 /TS nF ..N,tJ'947445 �� Adequate compliance with County and State regulations /requirements e re- 5 Other 11 4114111.11--,& Date ' .. AR q 6 . e 1) -) Inspector 14 /Q 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 —6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT d/ • INDIVIDUAL SEWAGE DISPOSAL,SYS'I'13M APPLICATION OWNER kO ` sa t � 'R t 'A t aL e c ADDRESS : e . • - ' _S PHONE e P ' • ' • • CONTRACTOR (5& if' ADDRESS PHONE PERMIT REQUEST FOR ( - )�11;W 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 t holes (See page 4). LOCATION OF PROPOSED FACILITY: COUN'T'Y axe Near what City or Town + t e • - _ 1 _� '^ M'1, A Size of L Lot 9. .R>_S Legal Description or Address 3 �IeAkir)r 1 5 L .__'' _ 3 WASTES TYPE: ( WI;LI,ING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUS'T'RIAL ( ) NON - DOMES'T'IC WASTES ( ) OT'I1ER- DESCRIBE BUILDING OR SERVICE TYPE: Te5 Number of Bedrooms a Number of Persons 3 ( ) Garbage Grinder ( 9 Washer ('-1 $OIIRCE AND "fYPI: OF WA'T'ER SUPPLY; ( ✓)'Wfa,l. ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: acne 1f supplied by Community Water, give name of supplier GROUND CONDITIONS: Depth to bedrock: 37 lg Depth to first Ground Water Table r ib — Pt Percent Ground Slope DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: oC />7i teS Was an effort made to connect to community system? ( ) YES (-1 rv0 TYPE OF IT$DIVIDUAI, SEWAGE DISPOSAL SYSTEM PROPOSED: (4' SEPTIC TANK ( ) AERA'T'ION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) P11' PRIVY ( ) INCINERATION '11)11,11' ( ) RECYCLING, OTHER. USE ( ) CHEMICAL TOILET ( ) O'1'11Nt - DESCRIBE FINAL DISPOSAL BY: (✓j ABSORP'T'ION TRENCI I, T3ED OR P11 ( ) EVAPOTRANSPIRATION (✓( UNDERGROUND DISPERSAL. ( ) SAND FILTER ( ) ABOVE GROUND DISPEItSAI, ( ) WASTEWA'T'ER POND ( ) O 13lt- DESCRIBE WILL EFFLUENT 13E DISCHARGED DIRECTLY INTO WATERS OF TI Ili STA'T'E? r 2 ', PEICCOLATION TI3ST RESULTS:. (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 tnte 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 criAM-ew 64 9 Date 1 '" 1 9 ' -EASE DRA A AN 'U tATE MAI' TO YOUR PROPERTY!! ____±___ CwurraRD 210 . C a 0 N (/4 k 1 St C' To RIFLts, Ht {0 3