HomeMy WebLinkAbout02543 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2543
1098th Street Suite 303 \ Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945.8212
,This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Richard Weinheimer present Address 2037 CR 321 Rifle Phone 625 -1531
System Location 0851 Cedar Breaks Road, Grass Mesa Ranch Lot 17, Rifle
L
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
/DLO Septic Tank Capacity (gallon) Other
/N /90/44/Percolation.Rate (minutes /inch) N mber of Bedrooms (or other)
$ 2 S 4 0 Eve*. !Leas, Hop •00 .Pa% Fos . 6 Vic. .. fgf'
Required Absorption Area - See Attached 9 itis A 'Trice a fJ 'S eA '
9&st 8/a dbiFPaanz3 1a fl
`Special Setback Requirements:
Date" Inspector LA71cnie
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) ((//
Cali for Inspection (24 hours notice) Before Covering Installation
System Installer OM'sVCR
Septic Tank Capacity )0c0,A L
Septic Tank Manufacturer or Trade Name Cam+✓ LAN/!
Septic Tank Access within 8" of surface yY5 - ainY 02. ,24fal$ . ,o e.A'/wb
Absorption Area Ra' - - - - • 5 /ii o i - T / 1 S UN/
Absorption Area Type and /or Manufacturer or Trade Name /.NF/LTnA -' /3e.0
Adequate compliance with County and State regulations/requirements
Other 00/ 7-77 Ca
3 -27 q6 Inspector Sail P..
RETAIN WITH RECEIPT WORDS AT CONSTRUCTION SITE
"CONDITIONS:
N 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 -8
months In )ail or both). \
White APPLICANT Yellow - DEPARTMENT
r
JNDIVIDl1AI, SEWAGE, DISPOSAL, SYSTEM APPLICATION
S NER /G/ ID Gr/S',cING—i.o ?4!
ADDRESS a0S 0 4 YR / PHONE 6. - - J6 3�
CONTRACTOR OLLiAn t f C.Qf'y A HO/4A '5
ADDRESS V 1IiteLr C}i_ PHONE 9 ‘y .2(/ Y.2
PERMIT REQUEST FOR V) 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).
J ,OCATION OF PROPOSED FACILITY: COUNTY (1-A,/Cifi
Near what City or Town /r /FLF Size of Lot 2/o 1
Legal Description or Address �l4 SS vs4 5.9 r / 7
4/04' /re* of 5 t C o2f' - 7 - oo. 93 DJ
WASTES TYPE: (a) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: .S, J)
Number of Bedrooms 3 / Number of Persons .Z
SC Garbage Grinder (d) Automatic Washer (,r) Dishwasher
— PRIRCE AND TYPE OF WATER SLIPPI,Y• (A WELL ( ) SPRING ( ) STREAM OR CREEK
Give depth of all wells within 180 feet of system: 704 ,Cr ..ot oPT/ 7iT ,rT tea ,s7 hr..
If supplied by Community Water, give name of supplier ai // A
GROl1ND CONDITIONS• 9 a 7- 3593
Depth to bedrock: .30 k3' 4htII6N Af1/41 ,cj
Depth to first Ground Water Table MS
Percent Ground Slope / — Q % /9 /.M1s / f id r
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: /O
Was an effort made to connect to community system? ( ) YES (A NO
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(`) 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:
(f) ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE /A.Fi/ 74
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? -it /D
2
t
PRRC(,ATiON TEST RESULTS; (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 pugnoses 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 tnie 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
is nit granted based upon said application and in legal action for perjury as provided by law.
Signed yo ,, D ate J J 2 O 5 3
PLEASE DRAW AN ACCURATE MAP TO YOIJR PROPERTY!!
..o T 1 7 yo. IS/ Ac.
Si /777,ye-/Fis 1. 0-9/7/'5_
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