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Home My WebLink About02681 P WIC Y.^.. i0 ' J I . . f .. • 4LA- • // GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2681 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 it) -Ste / Owner's Name Charles Griffin Present Address 3925 CR 233, Rifle Phone 625 -2D5R System Location —1 County Road 233. Rifle , Legal Description of Assessor's Parcel No. SYSTEM DESIGN /� ) . 01 0 00 Septic Tank Capacity (gallon) 0 61/7 6140 0 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 P1/4/ (23 f//,v $06 4*"oar /arc// ,8e-k AP = x 7< Required Absorption Area - See Attached L - ..3 r /8' X.to O2 ,2 9urin, /n's'WWm/f tow oC L3'o - 44.-,- syro Special Setback Requirements: p Taste Date ` '.�`1 ' S'6 Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer_ w Septic Tank Capacity / U 0 0 5-J'-� pp _ /y, Septic Tank Manufacturer or Trade Name ( /�/ `(/ n /i T LJ j '"2•y- L�(�C Cr'� ?EN r Septic Tank Access within 8" of surface VCS / !2 )C 7 G Absorption Area 7 Absorption Area Type and /or Manufacturer or Trade Name N F f ` 'r R A- r V vv. Adequate compliance with County and State regulations/requirements 1/C5 Other. /] Date (0 2 ( . _` c Inspector A ^^-- 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). O White - APPLICANT Yellow - DEPARTMENT ' INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER ADDRESS 2 9 , 7 , 5 ^ 2 ' " Ed p / - r e , PHONE 4 2. s a6 c g CONTRACTOR ADDRESS Qw4?1- PHONE PERMIT REQUEST FOR (> 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 t T curet% Near what City or Town (o, . Size of Lot 3 / 4i Legal Description or Address 774,/1.103 T2a.4 6/, 4. hap/ REF t Sri 33.7 6S R V Gv C h p.r4 WASTES TYPE: (>C) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON -DO STES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: 0 /f A'S6 TJt GrI� Number of Bedrooms .� Number of Persons ,t ( ) Garbage Grinder (>4 Automatic Washer (S<) Dishwasher SOURCE AND TYPE OF WATER SUPPLY; ( ) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: /V0/1/ e. If supplied by Community Water, give name of supplier GI/ fF /w 5 / Y /N9S - 34 / d 1- GROUND CONDITIONS ✓ Depth to bedrock: UN froGoit/ Depth to first Ground Water Table ON/rot-0/1/ Percent Ground Slope • - . . , � - � / 5 _ DISTANCE TO NEAREST COMMUNITY SEWER SYS EM: G�y/p i(La Was an effort made to connect to community system? ( ) YES (‘--(NO 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: (>4 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? fr o 2 PERCOLATION TEST RESULTS; (To be completed by Registered Professional Engineer) 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 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 ofthe 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 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. 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. r Signed / n r 2 i Date 7— /0 — 9 �/ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! E - j - a . rec. 1' L 5O -50- 1ogck re I \� n 3 GAS LINE EASEMENT SURVEY PARCEL #3, TRACT 61, 4.0.1) PLAT #1 SECTION 33, T 5 S, R 92 W, 6th PM CARFIELD COUNTY, COLORADO O } srAa o {r rs• rs• Gas line Easement • I rr Parcel #3 N.T.S. Parcel #2 Parcel #1 County Road ##233 LEGAL DESCRIPTION A gas line easement, contained in Parcel #3 in Tract 61 of the Antlers Orchard Development located in Section 33, Township 5 South, Range 92 West of the 6th P.M., being 15 ft wide, lying 7.5 feet on each side of a line described as follows; Beginning on the west line of said Parcel #3, whence the NW corner of Parcel # bears N 06'09'37'E 12.69 feet, thence, along an existing oadway, S 88'08'02 "E 174.20 feet, thence S 0721'54 176.17 feet, thence S` W 174.53 feet to the southerly line of said Parcel #3, whence the SE corner of Parcel #3 bears N 5713'52 "E 209.97 feet. Prepared by; Jerry Bauer Prepared for; Charles E. Griffin P.L.S. #9009 Rifle, CO. Rifle, CO. • --. S7)W7 N37 Eva // s7 r 8 , c1/2 re / 0% ^/ =�b, = = 6. 6 ��8/3+�i O7 6 y06 o? P writ men205 -syv rp