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Home My WebLink About02586 ten^ GARFIELD COUNT?l AND SANITATION DEfARTMENTj $*nit '∎ 2 5 8 x 1 109 8th Street Suite 303 - Assessor's Parcel No. Glenwood Springs, Colorado 81801 Lc \ 1<1 %., Ph��te'f363) l45 -8212 G:: -'` h. - tote. r \ Thiisdoescptconstituto ' L t , <. - _. a building Or use erinit. ' )l (S INDIVIDUAL SEWAGE DIS��SdL P�F�IAI�' .,; . PROPERTY LA \ t o Lt LA t 1 1 Owner's Name Roy E . Savage P resent Address 5953 CR 320 Rifle Phone 625 -1675 System Location 4450 County Road 320, REd Apple Orchard, Lot 28, Rifle Legal Description of Assessor's Parcel No. 7SL .. A / oL c S / tt B rvi 1 .spmSA 7d6 ' 90TH. SYSTEM DESIGN g a I Uri4-T/e,trOn si y•6A /000 Septic Tank Capacity (gallon) Other •-.. n1 . 1 - 1 .4 h `LL. R 1 / 4 no I VVArcolatlon Rate (minutes /inch) Number of Bedrooms (or otheri'l v 'c 'lc , ,\ Required Absorption Area - See Attached Special Setback Requirements: 6 . ( / 2 i. Date en Is ,Po "jf(o Inspector _ ,r ' _ . FINAL'�SYSTEM APPROVAL installed) t a Call for ' (24 hours notice)before Co¢ering Installatfoh 1 OWN ' System Installer_ - -- Septic Tank Capacity /Dees Septic Tank Manufacturer or Trade Name ea Get 4.0fit .1 Septic Tank Access within 8" of surface YES Absorption Area 9 G1 Absorption Area Type and /or Manufacturer or Trade Name 9 p iAir,LTgl0Tar5 G A Alf Adequate compliance with County and State regulations /requirements L,4, Other • Date 6 - '�v Inspector /jf>, mr of RETAIN WITH RECEIPT RECORDS T CONLTRUCTION 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 off ice 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 ($500.00 fine — 6 months in jail or both). White - APPLICANT Yellow - DEPARTMENT - • INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER 4'y C 5Av ADDRESS 595'3- 3020 Rd. e ed PHONE 425 AOOC CON'T'RACTOR SO ADDRESS lace PHONE PERMIT REQUEST FOR ( NEW INSTALLATION ( ) ALTERATION ( ) REPAIR Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable building, location of potable water wells, soil percolation test holes, soil p in test holes (See page 4). / LOCATION OF PROPOSED FACILITY: COUNTY Critnicia Near what City or Town ) Sim of Lot 'VII 5 ankJ -- I .egall)escriptiouor Address _ 4 1; , /1d/rp�iif 41; ,C1i6∎6 of) I WASTES TYPE: (14 DWELLING / ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE — BUILDING OR SERVICE TYPE:__ Number of Bedromus -_ - -- 1' —_ Number of Persons J ( Garbage Grinder (t/j Automatic Washer 64 Dishwasher SOURCE AND TYPE OF WATER SUPPLY ( ) WELL (4 SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: — lf supplied by Community Water, give name of supplier OltOUND CONDITIONS i Depth to bedrock: 0 __ -- Depth to first Ground Water Table Oo Percent Ground Slope SJ„ DISTANCE NEAREST COMMUNITY SEWER SYSTEM: tat Was an effort made to connect to community system? ( ) YES (i/j NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL. SYSTEM PROPOSED: (A SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER DESCRIBE FINAL DISPOSAL BY: (4 ABSORPTION TRENCH, BED OR P1T ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL. ( ) WASTEWATER POND ( ) OTHER-DESCRIBE WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OE THE STATE? 4/$ 2 PERCOLATION TEST RESULTS• (To be completed by Registered Professional Engineer) Minutes per inch in hole No. I Minutes per inch in bole No. 3 Minutes per inch in hole No. 2 Minutes per inch in hole No. Name, address and telephone ofRPE who made soil absorption tests: Name, address and telephone ofRPE 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 miry 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 ofhealth 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 Date 11 4✓t/0 /in — -- PLEASE -DRAW AN ACCURATE MAP TO YOUR PROPERTY!! M, �G3 ta g t,i.>t Coo� Rd „ Coy .94 01 a 91 i Art o LJ 3 5 Stet' 4 g, # 6 , gip la m .,u I- - Dirr-. t9 lit 80¢ a a A/ F r $ 4 s 19�rF 4 /!0 30 6.; tb !S tS'M /N r t riot x4762. �� 0 1)5 / 48" i A;r11 -r