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Home My WebLink About02563 e t... f r GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 5 6 3 109 8th Stlept •. Suite 303 Assessor's , Parcel No. Glenwood Springs, Colorado 81601 Phone (303) 945-8212 ..� ' - Thisdoes not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a blinding or use permit. PROPERTY Owner's Name Paul Embrey • Present A\1dtes' C/a ‘Bell‘ Country HnmPA Phone_ 9R4 - 9500 System Location /20,r County Road 252, Rifle Legal Description of Assessor's Parcel No. SYSTEM DESIGN /004 Septic Tank Capacity (gallon) , - Other • w / /Af /d /yll/'� 3 ercolation Rate (minutes /inch) Number of Bedrooms (or other) & S9.94Pecic tt cacti ,boo APP dzo% pubAyc A.de. 7r Required Absorption Area - See Attached t/l at -f . r,s - , AY ft ° s as in �� e Nab 4 $•a- fi/f'FivSGfa , Date y� Special Setback Requirements: �- ii �� Y /4' 9�o Inspector gazer -q �ica • FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installerl / / et peg, Septic Tank Capacity 10,70 Septic Tank Manufacturer or Trade Name 0 -0,1-4/02 1 Septic Tank Access within 8" of surface __Ye t O+ • Absorption Area _4 2 a Absorption Area Type and /or Manufacturer or Trade NameA J43 F/<7/cir S Adequate compliance with County and State regulations/requirements ( r i E--C Other Date14 • N' yL Inspector SC.-. S! Q /�s ro" RETAIN WITH RECEIPT RECORDS 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 -8 months in jail or both). White - APPLICANT Yellow - DEPARTMENT Y INDIYII)UAT.EEWAGE DISPOSAJ, SYSTEM APPLICATION OWNER Ern bro. , t?L / 1 C . I ADDRESS ao _ ` i• • PHONE • CONTRACTOR t Cor,.nfrtl ADDRESS Rer e&AasheJ k'I G'47 PHONE 4ty -3SZO PERMIT REQUEST FOR ANEW 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.00ATION OF PROPOSED FACILITY: COUNTY Near what City or Town image Lot Legal Description .See dar Ste+ oe.t/ W ASTFS_TYIE: Dwelling ( ) Transient Use ( ) Commercial or Industrial ( ) Non - domestic Wastes () Other - Describe BUILDING OR SERVICE TYPE: FaSiciat ikt./ Number of bedrooms: Number of persons f- _ (>o Garbage Grinder (X) Automatic Washer (X) Dishwasher COI JRCE AND TYPE OF WATER SI JPPI X. )4 WELL () SPRING () STREAM OR CREEK Give depth of all wells within 180 feet of system: /S If supplied by communtiy water, give name of supplier: CiROI JND CONDITIONS: Depth to bedrock: .0 Depth to first Ground Water Table: Percent Ground Slope: in DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 474 Was an effort made to connect to community system? 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: 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? Ain ,,C:OI ATION TIi,ST IILI Sill 'S: ('I'o be completed by Registered Professional Engineer) Minutes --- — _- --_, - - per inch in Bole 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 ILPIi who made soil absorption tests Name, address and telephone of RPIF, 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 fin pu 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.It.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 niy knowledge and belief and are designed to be relied on by the local department of health in evaluating the same Ior purposes of issuing the permit applied for herein. I further understand that any lidsification or misrepresentation may result in the denial of the application 01 revocation of any permit granted based upon said application and in legal action for perjury as provided by law. ar All A r Signed I)ale J f$ PLEASE D 'O RAW AN ACCI.MATE MAP "It) PR L UP RTYP / 3 ();36- 9,rso „To .n.,,, / s 3 * 1(.0 16 i s ---, D 7R 5' r1 13.2 . a _ 14° a 8 51 a 14- ap ce= �/,0 g /a i Z l ,N 10 /n in. priatJSff I -- J J / P lrtiJ Ls 0 ,I._ (...)? rigs