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' r ' GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N2 3 K 1 4 , •
� / ' 109 8 th Street ' Sulte 303 Assessor's Parcel No. i
\ / Glenwood Springs, Colorado 81801 f R
\i / Phone (303) 945 -8212
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/ This does not constitute t,
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY )� doe/ S125 !' ) a
r = I C p /3 0 C l / u _G2(. Phon:
! : Owner's Name IA Present Add ate U.
3 System Location J V 1 w , ?I ( U C ( -" / T `) re,'" ,
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1 A Legal Description of Assessor's Parcel No.
f ? SYSTEM DESIGN n / // r� ) 3 i, (� ^! //►Y/ E- c k Septic Tank Capac f
n) Ot er S7/74V M
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Percolation Rate (minutes/inch) Number of Bedrooms (or other) 1'.
' Required Absorption Area - See Attached / /. ' / � /1 / e ` �^ k
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' j Special Setback R uire ts: / , / 97��
Date GJ �✓� Inspector j
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f 1. FINAL SYSTEM INSPECTION AND APPROVAL (as installed) • • ' ��' / i # e
• . Call for Inspection (24 hours notice) Before Covering Installation
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1 .Bystem Installer
a �,$eptic Tank Capacity , -- . j ! f r • T
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, Septic Tank Manufacturer or Trade Na e �(, ;
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:t ' Septic Tank Access within r of surface �IE' .��
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Absorption Area ��
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Absorption Area Type and /or Manufacturer or Trade Name ! / t7
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Adequate compliance with County and State regulations/requirements !
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1 Date Inspec� i f
i - ETAIIJ WITH fl 4IPT RECORDS AT CONS1'MdTIO! SITE ,4
•CONDITIONS: rr�� tt ,// L p�� // ee� r / i i u/ C • p j
4 c- 1 All in st l o qiu ggt M Wwitrall g guirement¢af the Coldradg4tate7oard of He&Ith Individual Sewage Disposal Systems Chapter i
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i 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 5f
requirement of the permit and cause for both legal action and revocation of the permit.
disposal Y knowing •
t 3. Any person who constructs, alters, or Installs an individual6 seWage dis oasis stem In Involves and materiel
variation from the terms or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine — 8 'j j
! months in jail or both). + {
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t - White - APPLICANT Yellow - DEPARTMENT
FROM : DAVID RIPPY CONSTRUCTION, INC. PHONE NO. : 945 2710 Dec. 10 1999 04:49PM P1
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; ` Fp nI. DR 1 b � 1e_\ • Ngvember 23; '1999 n r -k' iV `12 13 f. I T,v
Garfield County Building and Planninp 9 1 N - oil ) 01
10.8" StrkeL' �l�elnle�25 v 0,
"; S'rlentagd Sprir►gs, C{)I 81601 52 c_ `J( ,� `��� Y� .
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To .Arn
On No 1999 High eotirifry Engineering personnel observed t11e consiniettoh of the,
ISDS located 438100 R.iver•Frontage Road in Oaffield Countyi One :l g affon sept:c'tank
and'ar''''' .tidgmtely 7000's f ey4p`otransptratjon bed hatl and o&- backfilling had
taken place. Tfte installation .cf she systcm.was in confon*a ice witli tine• intent gf the,desi.gii.
if yoti have any questions,. need additional information, .please contact us. . ' c.
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I3IGH COUNTRY EN �� ING, INC.
Deric J Walter, EI
besign,Enginee
DJW
•
•
92S,000PER•AVENUE • OL S PRINGS COL 81601
' . 4 Telephone (97O) 945 867 • F ax 1970) 945 2555
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
a v dc_ Li( (� rrl
L / , / s PHONE - G ::
ADDRESS _ ; i. � � .• _ �[
CONTRACTOR h i> C 1
ADDRESS colti., -. PHONE L f
PERMIT REQUEST FOR VNEW 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;_ 1
Near what City of Town �- r1 - II Size of Lot q
✓ V l t � ''(%PJ
Legal Description or Address 42 " 4 i .tnh � Si/6 /44RG L... 4° ,
WASTES TYPE: ( ) DWELLING 11 ( ) TRANSIENT USE
(COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - pESCRIBE
BUILDING OR SERVICE TYPE: 1. At iQ ILI/4 — f
Number of Bedrooms 0 Number of Persons
( ) Garbage Grinder ( ) Automatic Washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: P.11 Wh,r .. _ 1
DISTANCE TO NEAREST COMMUNITY SEWER SYSTE :
Was an effort made to connect to the Community System? VJ- c P (Jtc Q
A site plan is required to be submitted that indicates the following MINIMUM distances:
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
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
/
Depth to first Ground Water T i
I le 6 0
Percent Ground Slope / Z
2
± INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: •
PTIE TAW ( ) AERATION PLANT ( ) VAULT
( VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) , PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE
FINAL DISPOSAL BY:
( ) ABSORPTION TRENCH, BED OR PIT QX) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL (�) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? AM
PERCOLATION TEST RESULTS: (T be compl ed byR d egister Prgfessi nal Engineer, if the Engineer does the
Percolation Test) SQ V` h Y y I i Qc p'o V C
Minutes per inch in holeo. 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 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 7 Date 7/7/1
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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ADAIR RIPPY EXEMPTION
z SECTION 5, T6S R91 W, 6TH P.M.
j :, GARFIELD COUNTY, * COLORADO
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