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/ GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit rN 856
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado v,
Phone (303) 945 -8212 . ,
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Vivian & Carment Crone Present Address 742 Grand Ave.. Gr. Jet. Phone ;1 - 6 1 7
System Location 0758 County Road 296. Rifle
Legal Description of Assessor's Parcel No.
rte o.c- `Encrf - a co _ --> 690 at
uorukirs 2Z 11 C ace L( IN�
SYSTEM DESIGN It it 1 8
11 II T A.erucrs -ES (me
+ r, r, fr r ) i 6 If / r ti c a) 3 ((CA? Ie M® Septic Tank Capacity (gallon) Other c '* 2 rap >s
1 r 3o µw 2
Percolation Rate (minutes /inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached � f
I Special Setback Requirements:
Date 1 " t - - C O ` Inspector A el l ` O Act
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ./
(.A
Call for Inspection (24 hours notice) Before Covering Installation
System Installer madseacyc
..,
Septic Tank Capacity /ooh •
Septic Tank Manufacturer or Trade Name
AtZfaitp/ 'C. N.
M1
Septic Tank Access withinn rc. -. 8" of surface 5
Absorption Area ,246y .t, /
Absorption Area Type and /or Manufacturer or Trade Name)60 R � / r v rnmeyiFt 5 'rU L'/ l- J /s1TJ
Adequate compliance with County and State regulations/requirements -
Other �/ pry /
Date 7A 4 R % / — Inspector Y
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 tor 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 —
months In Jail or both).
White - APPLICANT Yellow - DEPARTMENT
VI r INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER_ V1 mne
ADDRESS 14R CnttknJ RU2 . PHONE 2.(1-,s•- Col I ^)
CONTRACTOR EN-ro N 1±) c-a_t1 C�
ADDRESS (5 - 1'5? C ..n 2ALo PHONE Ir9 — 4l (�
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•
Near what City of Town i P Size of Lot
Legal Description or Address n15)R C +• Rd • aq
WASTES TYPE: X DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:
Number of Bedrooms o2 Number of Persons 4
( ) Garbage Grinder YN Automatic Washer ( ) Dishwasher
SOI TRCE AND TYPE OF WATER SI JPPLY: Y WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: : ¶
Was an effort made to connect to the Community System? NON
• :I' • 4 _•' 4 1 _1,l•S • 1 1 '1 ( 1 f1 11'1. u. lu_. u_ •• t ( •
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
1 R 1 IIPS • YTM'Au .L__ 5_
WITHOUT A SITE PLAN.
GROTJND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2
a,
;
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:
X) 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? N 0
PERCOT,ATION TEST REST TITS, (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 ofRPE 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 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 9- 10 "I
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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SEP -00 -23 10:16 AM CARMEN A CRONE 505 334 6452 P.01
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TRAYLOR, ARNOLD, TOMPKINS & BLACK, P.C.
ATICREYSATIAW
Richard W. Arnold
Peter R. Black 443 North 6th Street Of Counsel:
Jerry B. Tompkins Grand Junction, Colorado 81501 -2731 Charles J. Traylor
Robert S. Traylor (970) 242 -2636 FAX (970) 241 -3234 Phillip M. "Matt" Smith
Christopher B. Gaty
March 3, 1998
Garfield County Building and Sanitation Department
109 8th Street, Suite 303
Glenwood Springs, CO 81601
Dear Sir or Madame:
Please see attached inspection form that should be corrected.
Please show the owner's name as Viola, Linda, Todd and Carmen Crone as co- owners.
The address should be Carmen A. Crone, 915 Mountain View Drive, Aztec, NM 87410.
Very truly yours,
TRAYL , RRNOLD, TOMPKINS & BLACK, P.C.
Char s J. Tra'
CJT/bh
Enclosure
cc: Viola Crone
Carmen Crone
r Al I ' j i
nov it it..t t . , iV