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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Nr_ Permit
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Asaesaor'a Parcel No. !
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Glenwood Springs, Colorado 81601
Phone (303) 945·6212
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' I f INDIVIDUAL SEWAGE DISPOSAL PERMIT
I PROPERTY
TRis does not constitute
a building or use permit.
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' • ~ Owner's Name_Je_e_f"_f-'l..j'-'\-JC~o_h-'-V'\-'-----PresentAddress e 0. f36t ,¥(,(,, (\if(t:, (i,~fb~hone
f systemLocatlon 000,;). Grass t1fes;q M. ~·'f'le. Qg'/bW
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'·· Legal Oescrlption of Assessor's Paroel No. Lr;f sJ /(Jf>sa St.</al •
I SYSTEM DESIGN • I !
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looa Septic Tank Capacity (gallon) ______ ,Other
_LJ_,Y~--Perc~latlon Rate (minutes/inch) Number of Bedrooms (or other) _ _,,3=---
Required Absorption Area • See Attached
Call for Inspection (24 hours notice) Bel(>re Covering Installation
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System Installer Cat £.-.,"'.:')
Septic Tank Capaclty_µ,dole>()~-------------------------------
Septlc Tank Manufacturer or Trade Name _,,fWo<Z,"1C'-'-"'°'"'==------------------------
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Septic Tank Access within 8" of surface !/oA
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Absorption Area f q ~ £,1'\ · ~ '"\~i
Absorption Area jpe a1~or Manufacturer or Trade Name _.,.0 .. Lwi"'j#IL'°'""~"'"""'"'.=""""--------------
Date_1L__-~3~-..::t'J"-"'Z:__ _____ lnspector t'f,,;_ ~ ~ Other-----------------~--~~-..,..c...,~---------------
RETAIN WITH RECEIPT RECO~·~~C ~TION SITE
•coND1T10Ns: r , · ·
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 for both legal action and revocation of the permit.
3. Any person ~ho constructs, alters, or installs an Individual s~wage disposal s~tem In a manner which Involves a knowing and material
variation from the terms or specifications contained In thel application of ptfrmlt commits a Class I, Petty Offense ($500.00 flne-6
months In jail or both). '
White· APPLICANT Yellow· DEPARTMENT
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Sent By: Rifle Premier Home Sales; 970 625 0619;
DEC-18-2001 10145A FRL'M:ElLDGPL~ 9703843470
Feb-25-02 2:54PM;
T0•9F'6250619
INDIVIDUAL SBWAGB DISPOSAL SYSTEM APPLICATION
Page 4/6
P•3'10
PBRMITRBQUESTFOR JX} NEWINSTALLATION ( ) ALTBRATION ( )REPAIR
Attadl 90Plll'lte &heels or report showing entire area with respect to IU!TOllllllins .-, toposraphy of area, habitable
lnrlding, location of potable water wells, ll(>jJ percolation teat holes, llOll proftlea ill tat holes (See page 4).
LQCADQN OF PROPOSED FACILITY:
NcarwhltCityofTown ~~ • · SizoofLot '/!) 'fC.KeJ
Lep!Dotcription or Address f()(JJ Gnu; Afes11 &I
WASTES TYPE: 9cf DWBLLINO ( ) TRANSIBNT USB
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC W ASTBS
( ) Onmk -DEJCRIBl-
BUUDINO OR SERVICE TYPE: /!fquflr;cn/t'e(/ f/Uile/
Number of Bedrooms ·-·-3' Number of Persons,_.:.;..· ·.,If:._,.·-----
( ) Garbage Grimier ( ) Automatic Washer ~ DishwUher
sougg;: AND TYPE OF WATER SUPPLY· .O({ WELL ( ) SPIUNG ( ) STREAM OR CRBBK
Jf supplied by Community Water, give name of supplier:. ____ __,,-,.-----------
DISTANCB TO NEAREST COMMUNITY SBWBR SYSTEM:.__,_J1?:....u.>tw'ZwC:-. • ..i.s ______ _
Wu an effort made to conncet to tile Community Systcm?_-..A./).,,IJ.__ __________ _
A llte" II rr.nulred to be agbmlfUid tut igdieatet tilt Mn'"' MINIMUM 41ttrPrnl
IMdl Field to Well: lit feet
SfJlldc Tak to Well: 5t feet
1-da Fidd tc. 1.-rlgadoa Ditches, Stteam or Water Coanez H feet
Seftle Syitem to Property Lbrea: (~eptic tank 'lea.oh field)lt feet
xoUB1NDIVwuAL SJWAGE RJStQw. sxSDM mwrrwq.r. NPTBE evm wrmoUT
AsmjPJAN.
QROUNQ CONDITIONS: . ,
Depth to first Ground Water Table.__..• ... £S4~"P-----------------
Percent Ground Slope._..1.l..11f:...1·~~-;:;;..'d ____________________ ~
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Sent By: Rifle Premier Home Sales; 970 625 0619;
IJEC-11iM!El01 10•45A F"Rl.'11~ 9703943470
' TYPB OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM l>ltOPOSED:
Feb-25-02 2:54PMj
TO: 9f'625111619
p<f SEPTIC TANK ( ) AF.RATION PLANT ( ) VAULT
Page 5/6
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( ) VAUI. T PRIVY ( •). COMPOSTING TOll.ET ( ) RECYCLING, POTABLE USE
( ) l>lf PRIVY ( . ) INCINERATION TOn.BT ( ) RECYCLING, OnlBR USE
( ) CH.8MlCAL TOILET ( ) OTHBR • DBSCRIBE. __________ _
lilNAL DISPOSAL BY:
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ABSORPTION TRENCH, BED.OR PIT ( ) EV APOTllANSl'JltATION
UNDERGROUND DISPF.llSAL · ( ) SAND FILTER
ABOVE GROUND DISPERSAL • ~ I_/ ( ) WAS1EWATBR POND
OTHER-Dns<:RIBE. _ ___.L ..... f,...q.._.(Jt.~__,f.__1=--=t::;;..,;h-i~~----~__,-
WILL BFFLUBNT BE DISCHAllOBb DIIU!CTI.Y INTO WATBllS OF nm STAT6?_.,.t/.-a'"-----
JIRROOl.ATIQN TEST RESrn.rs: (Tobe completed by Regiatered Profenlonal Eqineer, if the Bnslneer does the
Percolation Test)
Minutes ____ per inch in.hole No. I Minutes ~---__,per inch in bole NO. 3
Minutes per Inch in oolo No. 2 Minutes DCll' inch in llole NO. _
Name, ollklm;s and telephooe of RPE wlio made soil ablOtption testt: ______ ~------
Name, address and telephone ofRPE reap0nS1"blo for desip of the system: ____ _.,. ______ _
AppliQallt aclu1owledges that the comp~ of the ipplication is conditionll upou IUdl tbnber mandltory and
1cldki«.wlt1 test~ and rqx>rts as may be requircid by the local health departmeat to be llllde and fumiahod by the applicant
or by the local health department for purpolOd of tho ova1uation of the application; and the iuuance of the pennit Is
JUbjeot to sudt terms and conditions u deemed necemry to illlufe wmpliance with rules and regulatiom made.
lnfbln..&n and reports submltt.d herewith and required to be IUbmittecl by the lppliclnt are or will be repr1n1rtecl to
bt ave llld correi:t to the belt of my knowlOd(le llld belief' llld .,. dftlsned to be relied on by the loc.l department of
health in evah•Rting the same for pu~ of ilSuing the permit applied for herein. I tbrther \llldtmand· that any . '
fti!s!Wkm or rniltO)lresentatlon may re.Ult in the denial of the llpplication or teYOOltion of 1111)' permit granted baaed
upon laid application and in legal lllltion ft>r perjury as provided by llw.
PLBASB PR/\. WAN ACCURATE MAP TO YOUR PROPER.TY!!
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Sent By: Rifle Premier Home Sales; 970 625 0619; Feb-25-02 2:55PM; Page 6/6 •
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