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41f-;'1'..¥, \ GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
1 '•1 109 8th Street Suite 303 Assessor's Parcel No.
Permit N~ 3632
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' j i '· Glenwood Springs, Colorado 81801 -----------' , f Phone (303) 945·8212
1\ This does not constitute
a building or use permit. . INDIVIDUAL SEWAGE DISPOSAL PERMIT
· .'~~oPeRTY 10YO(' h, , :k? Co
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Owner's Name "f({\"1 tJ'I cll1 Present Address l i ..J()'l/l'S . t'C~ Phonorl'tb • l L\1)~
,__ ~. . .95JS~ .ci • .o 11. 11 ·-I J -'-t-
$. $~tem Location ;k r.:~311 51 t I w oro oO 2; I U,52
: ·a {.p &,.O.. ~ y 1(' {JI!. \J-) C o.&ti(L..
} ~tfllal Description of Assessor's Par~ ~y~--"'-="'==c::-:---.---------""-----------2·~02. U~M ~<.11 J 'SY~TEM DESIGN
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. Septic Tank Capacity (gallon) ______ •Other
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\ ' ' I _ _.\_,0"----Percolation Rate (minutes/inch) Number of Bedrooms (or other) '.j + "· {) ·
'1 If:,~ e..~.A ...P.:..O d . .,
. I .-' Required Absorption Area· See Attached '3 ~tf rJJ I A-CA~ JJ.._ ., ?0 ~0" ( '7, "l.)
4 "-'I rp [3.,. A ;; 3 ...._ ""'-~' -,..
• '::! I IA,.,..;J,<i (? ir: ~ ) ! ··-Special Setback Ro11romonts:
Dato 3/'2 '-D"2-Inspector ___ J'-\.l"""":u"')-'-''c.J·c,.._/_'-')'-'/_,U'""---"'~~· "'~:_..::. __________ _ !
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FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 ·hours notice) Before Covering Installation
System Installer ~· M
Septic Tank Capaclty•--+-D=O.,· '-'O""'-----------~--------------------
Septic Tank Access within 8" of surface -1),.!>--------rn--------------------
Absorptlon Area 1, Cl lfMJ'.a.-~ ~ J ~ re
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Absorption Area Typo and/or Manufacturer or Trade Name ..1~.IZ-1'."'<1"''-'#i"."'-'"'li..<t:ia-.-r':L __ -_,,4"',~3«"'-'~""'"':t""h. f1.0:., .... ...__-3L,C&,~---
Adequato compliance with Cou'llY and ~late regulatlonslroqulroments...j..i~~------;-----------
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Other g'
Date J./~ /k-4Zc Inspector~
I ' REtAIN WITH RECEIPT RECORDS AT co~-SITE
•CONDITIONS: . .
1. All Installation n\ust tomply with all requirements of tho Colorado State Board of Health Individual Sewage Disposal Systems Chapter
25, Article 10 C.R.S. ~973, Revised 1984. .,
2. This permit Is valid on.ly for connection to structures which have fully comp\ lo~ with Co~nty zoning and building requirements. Con·
noctlon to or use with any l!_w,l~ng <Ir structures not approved by tho Building !ind Zoning office shall automatically be a violation or a
requirement of the permtt al)dj c.-uwp,·for both legal action and revocation of the permit.
3. Any person who od'fistructs, alters, or Installs an Individual sewage disposal system In a•m-.nnerwhlch 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 fl[le - 8
months In Jall or b~th). •
White. APPLICANT Velk>\¥. DE~ARTMENT
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sent By: Rifle Premier Home Sales; 970 625 0619; Jan-22-02 5:57PM; Page 2/4
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: '.-.;qi"t lbL I INDIVJJ)UAL SEWAGE DISPOSAL SYSTEM APPLICAnoN
PHONE ;)8£-Jff"1_
PHONE ZZl-' 26da
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~BltMIT RBQUEST FOR I)<' NBW INSTALLATION ( )ALTERATION ( )REPAIR
"*" 1111P6f1ie aheetl or report llhowins entire area with respect to surrounding areas, topography of area. habitable
!Uildlll& location of potable water wells, sail percolation teet hole&, llOil profiles in test holes (See page 4).
pcAIJON OF paOPQ!IBP FACD .JIY:
iear what City ofTow•L--'-1..L..1~-r--r-=~n--=--=-:~=--¥~~.,.....,c...w~.;:: oz.-15'oo1.,...
.epl Deloription or Address
VASTBS TYPE: ~ DWBLLING
( ) COMl\$letAL OR INDUSTRIAL ( ) NON-DOMESTIC W ASTBS
( ) OTimll -DESCRJBB --J
IUJWING OR SERVICE TYPE: /tfeidtcrtJdli Jld//Jt<
lumber of Bedrooms .-3 Number of Pel'llOllS ___ a ___ _
~-Gmbage Orlnder 9(} Automatic Washer ()0 Dishwub«
OUR.CE AND TYPB OF WATER SPPPLY: .p(} WBLL ( ) SPRING ( ) STREAM OR CRB'BK
f supplied by Community Water, give 11111te of supplier:. __ ..,..-___________ _
•JSTANCB TO NEAREST COMMUNlTY SBWBR. SYSTBMl ..... ia,,,iftu:i...._/i..,.~.-.<'------
~as an effort Jllllde to connect to the Community System? _ __.1:1"1-110"-----------
• •tttlU 11 mp1nc1 ton Wmlttttlflt!t lpsllstt• die &U,tt•• MINIMUM d!•enm:
.eadt new. tt Well: 100 feet
epde Tak a. Well: . 50 feet
.eada Field te lrrlaadon Dltdlel, Stream or Water Coune: 58 feet
epde Syltlln to Pnpeny Lines: (septic tank &leach field )10 feet
'OJJR INDMDJJAL p;WA§I'. WfillOSr\L SYSTDJ PERMIT wp,1. NOT BE ISSUED MlllOUI
·UDJMN.
ll\OUND CONPITlQNS: 1-h I I
................ w-T~ 120 IJ t/I'. {)? 4r we4
eroentOround Slope_~...c"JJLf;IL,~~O--------------
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-g o 625 0619 Jan-22-02 5:58PM,-Page 3/4 sent By: Rifle Premier Home Sales; . 7 ;
· ...,OF INDMDUAL SBWACiB DI!tFOSAL SYSTEM PR.OPOSBD:
~ ~C TANK ( ) . AEllATJONl'LANT ( ) VAULT
[ ) VAULTPRIVY ( ) · COMPOSTlNGTOILBT ( ) llECYCLING,POTABLEUSE
: ) PIT PRIVY ( ) . INCINERATION TOILET ( ) RECYCLING, OnmR USE
) CHBMICAL TOILET ( ) OnmR-DESCRIB,.,__ _________ _
IJNAL DISPOSAL BY:
t> ABSORPTION TRBNCH. BBD OR PIT ( ) EV i\J>oTRANSPIRATION
) UNDERGROUND DISPBRSAL ( ) SANDFILTBR
) ABOVB GROUND DISPERSAL ( ) WASTEWATER POND
) OnmR • DESC!UBB
VILL EFFLUBNT BE DISCHAROBD DIRBC1L Y INTO WATERS OF nm STATB?_""'l1~IJ1<---
BRm1.ADON TBSI BESULTS: (To be complet:od by Registered Professional Bnal"otr, if the ~does the
ercolatioo Test)
Minutes per inch in hole No. I Minutes -----...11>« incb in hole NO. 3
Minutos per lnohin hole No. 2 Mimne8 per inch in hole NO._
lame, addnlss and tolophono ofRPB who inade soil abaorption tests:. ___________ _
rwe, addre&s and telephone ofRPB respol!lible for cleaigu of the system:. __________ _
pplioast acknowledgea that the comPlet•ess of the application is conditional upon such ~ mtndatory and
lditiollll llllltl i$lld repona 11mayberequiredbytho1ocal hellth department to be made and Amiilhed by tbe applbnt
r by the local health department for purpo• of the evaluation of the application; and the~ of the permit is
abject to u:b tcnna and oonditioos u cleiiined neceaary to insure complianoe with rulce aad rosufati.ona made,
bmalioo llld reports submitted herewith Md requirod to be submitted by the applicant are or will be repreeeated to
twellld wuect to the best of my knowledgo llld Wand ara desianed to be relied on by the locel clet*t1111wt of
tilth in evaluatioa the Mme for purpotee of laaui.ng the permit applied for herein. I 11.uther Wldentand that IUI)'
1'1&.:1Mlon or milreprelleatll may re.ult bi the denill of the applkiatlon or ~n of any pecmlt gnnted buocl
>OD aid application and in legal action for perjury u provided by Jaw_
Date /-,;l. ;)-();;,.....
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TO Yot1RPROPBRTYll
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