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GARFIELD COUNTY BUILDING AND SANITATI9N DEPARTMENT Permit 286 9
109 8th Skeet 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
Owner's Name Allen & Joey Ball Present Address 425 Salt CO Phone8 - 2325
System Location (p &9• 0 CR 319, Rifle
Legal Description of Assessor's Parcel No. t, ti O O yc — L C- A c /•.r (3 C 7
2y elects It caMMbc -c ?JtL) 7 S6 Bi
SYSTEM DESIGN 3) 2 O (r fr " T/t Erre HES 7y
N) 18 r (yrri 0 0
0 0 Septic Tank Capacity (gallon) Other
Ir ea ICS
- ' G. Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3 y
Required Absorption Area - See Attached
Special Setback Requirements:
Date ( Oet7 Inspector A/ - EdCr
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer rte; 4ormnt
Septic Tank Capacity /404
Septic Tank Manufacturer or Trade Name 0f11af,Z/.al�
Septic Tank Access within 8" of surface 5, rPS
Absorption Area ocrer 36r°
Absorption Area Type and /or Manufacturer or Trade Name 410 1A eti,4& (s7Q09
Adequate compliance with County and State regulations/requirements 9 /
Other
Date /4 ` /i-97 Inspector 4,27., ( 41.21 - 74/
RETAIN WITH RECEIPT RECORDS AT TRUCTION 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 off Ice 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 mannerwhich involves a knowing and material
variation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
•
INDIVIDl1AI, SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER ,.944L%__aig4L - --
ADDRESS ld z5 . E. 7 c5i277,) eo - -- PHONE 82I - Z ref
CONTRACTOR Ay -- - —
ADDRESS 5432 E /'T _ e4?4- C. P1iONTi 6er ,L7
PERMIT REQUEST FOR OO NEW INS'T'ALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area,
habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town__ Size of Lot /D, 894t '.e$
Legal Description or Address /Net_ 9% re S40,O /dtJto,d _
WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES
( ) OTHER - DESCRIBE - -.
BUILDING OR SERVICE TYPE: 4f 6
—
Number of Bedrooms s3 _.- Number of Persons `3
( ) Garbage Grinder (X) Automatic Washer (X) Dishwasher
SOURCE. AND TYPE OF WATER StJPP1.YL_(X) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: u,✓¢
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:_ Was an effort made to connect to the Community System? 4//42
ASitt piatatteitttireitu re stdmittted that.indicates tit 1 .11' ► 1‘4 t : r •
Leach Field to Well: 44z Fr 100 feet
Septic Tank to Well: 495 FT 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: 44. 50 feet
Septic System to Property lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPQSAL, SYSTEM PERMIT WILL. NOT LIE ISSUED
WITHOUT A SITE PLAN,
GROUND CONDITIONS;
Depth to first Ground Water Table - — --
Percent Ground Slope F 47 - - --
2
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
( ) OTIJER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE?
PERCOLATION TEST RESULTS (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test)
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 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 flintier
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 »4J i t tr o Date 97e6/9
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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