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HomeMy WebLinkAbout02249 .. � FTr RI,, .aesm- .rr- .,�,_. _ _ GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit '`f- 2249 109 8th Street Suite 303 A is Parcel No. Glenwood Springs, Colorado 81601 ,0•- Phone (303) 945 -8212 • This does not constitute. INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Marill Kephart Present Address Dewwar, CO Phone System Location 2 7 / S County Road 525, Rifle Legal Description of Assessor's Parcel No. _ SYSTEM DESIGN 00 0 1' Sep c Tenk Capacity (gallon) Other in-41.1 ✓ 0 Percolation Rate (minutes /Inch) Number of Bedrooms (or other) , L . / a' ne-c -914 Ledo F4 13c d--- /f"X � Required Absorption Area - See Atrrl Sd J ar re .7'M ±' 1 Z r- R Ai r A 33 Special Setback Requirements: 3 41 a /L t✓+t �q- « 7 : 1 `,. 7 s 2,.. j/ Date / ^ 71 Inspector ! /' . nom.. AS .s s FINAL SYSTEM INSPECTION AND APPROVAL (as installed) R Call for Inspection (24 hours notice) Before Covering Installation System Installer RAr E xC A VAI / N !+ C ' r Septic Tank Capacity 41Z 0 7A t >> /^ 1 Septic Tank Manufacturer or Trade Name Cope 2 a lid l o'h c n C e Co 1/ Septic Tank Access within 8" of surfa a �l' e 3 e e �j ir ['''' rt �� Absorption Area ` scuts 32 ■ p i ` S H O U L D �f ec e s 33 P / - 7N PC P 2 (14 t )' es to EsquA1 CJ ARtL I Absorption Area Type and/or Manufacturer or Trade Name �^ Adequate compliance with County and State regulations/requirements /-A'e)J W as C. o (1 ` ' 1? e Jy, ' 7 other ' l+f o u 16 + S • me 7 • e FY • 1,1 _ a v o,, - (`+Copy fir :nrrr Date �" 9r' q7 Inspector / .�A�r " -� • �g 7 WITH RECEIPT RECORDS AT • - TRUCTION SITE i •CONDITIONS: 1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter e �" 25, Article 10 C.R.S. 1973, Revised 1984. f 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 requirement of the permit and cause for both legal action and rev/cation of the permit. 3. Any person who constructe,alters,orinetalis enindividual sewage disposelaystem In a manner which Involves a knowing and materiel, variation from the tare, or specifications contained in the application of permit commits a Class I, Petty Offense ($500.00 fine months in Jail or 004 4 Applicant: Green Copy Department: Pink Copy i Application JNDIVTDTJAT. SEWAGE. DISPOSAL'', SYSTEM APPTJCATION Approval By 711/4-1/1/ County Official OWNER ADDRESS. 1) ell\V P.r t V PHONE /5 CONTRACTOR �eAee)tt SfQ-O \ C t^ Sitvclic ADDRESS F0 .`2U ( Cat no ^A(Y ch in PHONE g65' PERMIT REQUEST FOR: 0()_. New Installation ( ) Alteration ( ) Repair Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4). n n Gt,a( , J,OCATION OF PROPOSE, FACIT JTY : County r Near what City or Town � 1/4 F C Lot O 0 Ac c e5 Leal Description G O� �"e, I 6- E �y Or Sew %4 S e c {�'o" 2 +LAT 7 kw qy w sL P WASTES TYPE : 00, Dwelling () Transient Use ( ) Commercial or Institutional ( ) Non - domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms — Number of persons S ( ) Garbage grinder R'CL Automatic Washer () Dishwasher ,$OI IRCE AND TYPE OF WATER ST JPPT X: h well () spring () stream or creek Give depth of all wells within 180 feet of system: If supplied by community water, give name of supplier: GROTJND CONDITIONS; Depth to bedrock: CS $ C9 Depth to first Ground Water Table: Percent ground slope: 1 DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM :P/0 l Meant\ Was an effort made to connect to community system? . 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: El 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? N 0 SOIT, PERCOT,ATION TEST REST IT .TS: (To be completed by Registered Professional Engineer) 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 purposes 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 adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby certifies that all statements 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. Date 4 1 — IS - S igned ivy ' '!� MG WIGC a_L V cp1-0A - ?LEASE DRAW AN ACCT JRATF MAP ;T'O YOT JR PROPERTY G1 a '1 s- € te 9- w C ou v X1 U 32 0 Ihs \l/ 4, r yr ,lT PT.AN AND DESIGN FRATT JRF„S Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings, property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by direction and distance from dwelling or other fixed reference object, and additional submissions in support of this application such as data, plans, specifications statements and commitments. ro e /;1c © 0600 A> e ;. i , ne Seek la eck ao fi x. x a 1 x 1 0 et et 3- N c ... spysgrr�v"' nrrwxaT 'Y°'1�re�l.TC1p,1FYF' ►T'�av��r w% COPE LA D SHIPTO ThMS kCh •C4U' • CONCRETE INCORPORATED 11 1- -fine end O Porr N ko111 F Manufacturers of Precast Concrete Products \ 1, Also Distributor of Related Items C vet , 28803 U.S. Hwy. 6 Rifle, Colorado 81650 -9452 Phone 625 -1112 Fax 625 -1110 rn4 4 tl or I q • SOLD TO R , FXCo a I vi r-F- VI G (30x • t)000l y Cr , CO f- 5 DATE CHARGE RESALE MDSE. RETD. JOB NO. P.O. NUMBER ' 5 q � V CUSTOMER NO, SAL 7- 1 rYi PHONE 925-3337 PERSON / Now v / JOB NAME � — WEIGHT ITEM OI DESCRIPTION UNIT PRICE EXTENSION Shipped _ 11100 1,6 1 12-50 getll0}1 Selo +ic_ - 'UPI'\ N 6 “ots CIt10 /17 33 2 +Ya -I vv' @ 5z ob /A S'G'ea 20 II C 4- 1 C IOSed cod P la - I-- es C G 7r .27 .60 J0 11q ' O ID en e ii rA P(cff cS do GK'S 17,00 1 1a-O `- I 5 t (of sA to fal e 5 L / zS s 1 )2-I `/ Scv -- ec..tcs 61 os - • R,oa 1,6 5 bp ft 303H '4' PVC Secvcf-- pI / c) ' 4.r 52 • 3 so 3 y " PVC Tees s ' Av Na /a 90 Z y PVC_ 90S Cr, l / 4 goo 4 1 91/ y '1' PVC coca li in .3 ea v. co _,2- S P � ... 1 ' 1 ' ‘41, i 2 5e 1 !� .( Cap +- SS' p oce of t o 1 to f olv5 hole a .4/ aa -0 2-' 101/103 1/1 rivo Prrn l er / % fr o, frl 1 of 6lgj9 le:- t-, tit ii ,/ K''n 1 $RR ,co . � DELIVERY CHARGE 1 .1" ,:; DELIVERY WARRANTY ON ABOVE- LISTED MATERIAL (INCWDING NEW MACHINES, PARTS & SUPPLIES) IS LIMITED TO THAT AS PROVIDED BY THE MANUFACTURER, COPIES OF WHICH ARE AVAILABLE UPON REQUEST. DRIVER'S SIGNATURE CUSTOMER'S SIGNATURE NOTICE 7:4 EyeYY STATE TAX 9 o� -5 yy [eRFIELD COUNTY TAX LESS to S. l o IF PAID BY g4z -r y NO DISCOUNT AFTER THIS DATE. THIS IS A CASH DISCOUNT AND MUST BE PAID ON TIME TO TAKE DISCOUNT. - 9�3 � I THANK YOU TOTAL Please pay on Invoice. Statement will be sent on request only. 13 ,4 A FINANCE CHARGE OF 1 PER MONTH (WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%) WILL BE ADDED TO ALL ACCOUNT BALANCES THAT EXCEED 30 DAYS.