HomeMy WebLinkAbout02795 ••--= ....+.n++wa �,. . —.n; a+u.v- �� , _a•....:.F,..... ,.. _,_.., -.. , .,a..., ,' � , —.. .. s ._y. yw
•
•
t n
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Perpilt 2 7 9 5 --O 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 ( E (
Owner's Name lrles E. Griffin present Address 3925 CR 233, Rifle Phone_ 625 -2058
1 3921 County Road 233, Rifle
System Location
Legal Description of Assessor's Parcel No. -
ROCf <- L1 he -( - I "l[b ) r () z f 1 4 ; ,`f:, -
SYSTEM DESIGN
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms j¢LAther.) l: if,
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 D�' ✓ ?
Septic Tank Capacity // / a
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surfed
Absorption Area �/ ` /�/-y. �G� ,. /
Absorption Area Type and /or Manufacturer or Trade Name G2 K G 7 // / i A"9 (` 226 a t"■••
Adequate compliance with County and State regulations/requirements I
Other /„.11 nd el `
Date � ... � 97 Inspector 1. ,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 andbuldingnagor 9 Ms. 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 thjpermit.
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
. ,�yy J . INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER_ I__._ Qi `/
ADDRESS 2 9'd, 5. 2 3 3 1 d His c n . g/65O PHONE 67 5 • . o 8
CONTRACTOR
ADDRESS PHONE
PERMIT REQUEST FOR (I/c 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:
Near what City of Town yet O Size of.Lot a r //9 A
Legal Description or Address 3 919- 9 3 3Rd
WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: i,15 X .55 nn.. /.la r <j JJ i.
Number of Bedrooms 3 Number of Persons
()<) Garbage Grinder (X) Automatic Washer Os) Dishwasher
SOI TRCE AND TYPE OF WATER SUPPLY: QO WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: IT M//4 c
Was an effort made to connect to the Community System?
,t site plan is •r. •r r • !ri h, ir!' t' .in• IN_ 'VIoi in •
Leach Field to Well: 100 feet
Septic Tank to Well: 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet
Septic System to Property Lines: 10 feet
YOIJR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED
WITHOUT A SITE PLAN.
GROIN') CONDITIONS:
Depth to first Ground Water Table C//V/i'o4riN
Percent Ground Slope 14/0
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(X) 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:
(SO 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? I/O
pF,RCOLATION TEST RE- SI11,TS: (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test)
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 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 purposed 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
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 !. ` Date 7Z' d i ^ y
PLEASE DRAW AN ACCURA E MAP TO YOUR PROPERTY!!
3
. •
•
r
%
a - ' a . % .
/\
.3 /k
0 c o
.> 6 s%) 0 E
7 -° 3 . —
4 1 u
.� .\
. / /
\ «\
, \ \ \®
® — k \ \ \/
I
j 0 / 2// \
\9 '/ \ _!
• 4 a ƒ
vc �� Iti
\ , \
—r b% —
_
o \@@ «
• /\ 1 1i19 , ,,4, % , y = 2 I cu
. . '�z _
~ )
% ctl \
\ � f ° _
3 )
/ � .2
t " r » :
Z t /\ \
±k t- §
. § ) i
/ @ 2 ,
COUNTY OF GARFIELD - BUILDING DEPARTMENT
CORRECTION NOTICE
109 8th St. Suite 303 Glenwood Springs, Colorado
Phone 945 -8212
Job located at 7 q ( C • t-
Permit No. 2 7 9 S
I have this day Inspected this structure and these
premises and found the following corrections needed:
F' TES SEPPV(&t( ( 1y
-Tu &Ncc1(, p( PC p„.(.001-O tMkr
't N E row S 11-c c
tt\c`t- covPUKC
e` z ~-- TAMIS
You are hereby notified that the above correction must be Inspected before
covering.
When correctlon(s) have been made, call for Inspection.
Date $ -21 ,9 4-4.4s
Building Inspector
Phone 9454212
3!2 5 an
B l e 4- Aot vc,,.4.4 303
. vG5
Cam.
4 & 7» /2 -9P
e. _ a '
i 3W _ -233 Ed
G int C._ .. a te.. -_ v .o„ a..
CL /0 0o gal Co - i _ St-di
reeztria,L ..pear-e-ce _-zenn-c-xe4„, set _
Q .e4o
9416 open,. >J
rAreee
me a- /d .f
1 - , _
d d -7--nate:ertu
c_c -, 8- 8 -9'7 % '_Q -e .mid
Quo slue _ Cavu - D �
,emu- g - vn ,cunt,, ,,
C o zQ _ '-
e „ u - but2
adra-
X498 _
COPELAND' (
SHIP TO U p pc Le 5 /----, L
v1 o
CONCRETE INCORPORATED l� Le{T --- c '' 1 o f v-, v
Manufacturers of Precast Concrete Products .
Also Distributor of Related Items
28803 U.S. Hwy. 6 Rifle, Colorado 81650
625-1112 . - a .. .,
JUL 0 1 1993 y
DATE C.O.D. RESALE MOSE. RETD JOB NO. - /
BFIT� -�"-
- S - 0/ ✓ C-KIFtlli ODUN Y
CUSTOMER NO. SALESMAN PHONE NO. PER NCALLING JOB NAME
n. �I (i9 S -Z5�S (h (4 c l _ - _<•,, _ t..:. .. Aga. .
WEIGHT ITEM
Shipped DESCRIPTION UNIT PRICE EXTENSION
92W (97 1 /000 r1 1 P c- S eqf� Jp -l?c �-Qr fj- 5F-fCi
7Ff O 12 1Q g(.0 E c V G _.L fie I J 1.6, / c fr- a `f 7C (943 50
r2 0 /,20 y coot P to t cs (p 75 .. i7 co
2012
VIVIAN JSGRIFFIN FIN • -
23-7/1020
3925 RD 625 -2058 2 a 1 .�J
RIFLE, , D CO 81650 C1 � (/ � "('// /
X Pay to the J , ( /' /Jt � 1 $ ( l �
-r l W r' n
D � B a Q Dollars W p mr+.
//\ IN Nonvesl Bank COIOISSO. N.A
flilb
NOIIWFfT BANS (970) 525 • 1542 Railroad Avenue
Rilb. COlorsdo 8: 550-330 2
s // //® No sI Phone Bank 1801}556- N CO
1
I: 000076 703916 2012 '1'000 2221'1 VCHARGE _._,_/..-- _ seu, rnn ID a aV YYLlh51 IS LIMITED
TO T I 36762
TI-6 'PROVI•E WHICH ARE AVAILABLE .
D BY THE MANUFACTURER, COPIES ••F W LABLE PON RE QUEST
DRIVER'55 N.T.•E /i - 1 _ 'V ER- S I4NATUR - E `' - ,A___,
/1 V / . 1 364 .
f ETAX
GARFIELD CO. TAX
o)ai
THANK YOU TOTAL I `12 a 21
OSH / 9 A FINANCE C HARGE OF 1 PER MONTH (WHICH IS AN ANNUAL PERCENTAGE RATE OF 18 %)
/ ,\, 1s1VOICE WILL BE ADDED TO ALL ACCOUNT BALANCES THAT EXCEED 30 DAYS. / /
J