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Home My WebLink About04101/4/o 1. /or GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT 108 Eighth Street, Suite 201 Glenwood Springs, Coloradof 81601 Phone (970) 945-8212 INDIVIDUAL SEWAGE DISPOSAL. PERMIT PROPERTY Owner's •NamySCk'u 1U -CSC:) jsrr`� (Qrwl1Soo System Location `A' Legal Description of Assessoj's Par el No /a/ 28o S 2? --/-e* 7144-1- — ,S7 S Permit 4101 As essoor's Parcel No. This does not constitute a budding or use permit Present Address I7ct k I Phone (:),•ZJsc� 1 t �f q R€fl 0e2'/C& /74?- /o3 -o6 -oa/ SYSTEM DESIGN Septic Tank Capacity (gallon) Other Percolation Rate (minutes/inch) Number of Bedrooms (or other) Required Absorption Area - See Attached Special Setback Requirements Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer Septic Tank Capacity Septic Tank Manufacturer or Trade Name Septic Tank Access within 8" of surface Absorption Area Absorption Area Type andlor Manufacturer or Trade Name Adequate compliance with County and State regulations/requirements Other m\ {y' ,o'' ,.�1 ()ate -135/ Inspector ffyy 4444 �12T"'i".Q��y S'Sf/'`.a�sot RETAIN WITH RECEIPT RECO 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 for 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 —6 months in tall or both) INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER �p.k' 1 S H/n U ESE ADDRESS @,f fe/ /Cipts Co PHONE L25 -Y27/ 0 // CONTRACTOR O cc ) iv E Droved ADDRESS / /9 -1-7 /,a &no% /4. ,(%3Ft & PHONE C.ZS• Y77/ PERMIT REQUEST FOR (X) 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 %er Fte Size of Lot i9 , �a $ 4GS, Legal Description or Address C.QC li M.1-1.4-. Cno — s Et. C; 11 -E- PLAN WASTES TYPE: (X) DWELLING %k 0'/ 52a1 X61 ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: PESipE'✓ct - 5i ctE FA»" ) Number of Bedrooms I Number of Persons (/) Garbage Grinder 0 Automatic Washer ( x) Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: d, i y or FSE DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Lr ry or /cr rLl" Was an effort made to connect to the Community System? VE5 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 (septic tank & disposal field) 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 Table Percent Ground Slope 2 TYPE OFINDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (�O 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: ($) 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? AJO PERCOLATION TEST RESULTS: (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 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 VW Atli Date .--23-05 PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 6 SCHMUESER GORDON MEYER MEMORANDUM TO: Garfield County Building Department Glenwood Springs, Colorado 81601 FROM: Jefferey S. Simonson, P.E. DATE: 11-16-06 SUBJ: Schmueser ISDS, 68 Wilson Lane Rifle, Colorado To Whom It May Concern:, The purpose of this memorandum is to provide confirmation of the installation of the individual sewage disposal system (ISDS) for the Schmueser Residence located at 68 Wilson Lane, Rifle, Colorado. This ISDS has been installed in accordance to our report of November 14, 2005 wherein we have described the installation requirements. 118 W. 6'h Street, Suite 200 Schmueser Gordon Meyer, Inc. (970)945-1004 Glenwood Springs, CO 81601 (970)945-5948 FAX .ejM Memo alcompletion (:mored Monday Nowak! 20. 2006 12 50 P14 NORTH LINE OF THE SE 1/4 SW 1/4 SECTION 10 COUNTY ROAD NO. 294 S89'43'13"W 165.00' 116.5ci EDGE 01 PAVEMENT FOUND REBAR AND CAP CAP ILLEGIBLE 013 Ail Pfr E ��I1�� 150 �pN 00061 La FOUND #5 REBAR 1 z ET 30 WC. L S15110 1a -4 5ET ]0 W C L 5 15110 SUBJECT PROPERTY WE';TERLY 10 RODS OF THE NE 1/4 SE 1/4 SW 1/4 ',ECTION 10 108,833 sq. ft. 2.498 ocres z Z O 0 v i w N v 3 v1 15• N 8 559'43'10"W 1 165.00' -t,.,, SEI 16 50' • L L _ I : ! 1 U \w 0 0 a 0 0 0, W. V a FOUND x5 REBAR AND PLASTIC JOH\ 0 0 A 0 rn u TD1 569'45'32-w 220.19' DA= CEL A SOH EXEVPTI N89'44'22"E 220.19' �— 16.50' E 1 G 508 PAGE SOU IN i INL 1/4 SE 1/4 SW (02S- o Sol `:R, 13c-,lFt° (2_,rte./C.o FROM f REBAR TO p5 FEER AND YELLOW PLASTIC CAP L5 15710 SET ON THIS SURVEY = 585'3'.'57"E 0.73'