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Home My WebLink About02588 T f1i..ar i GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2588 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 945.8212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. PROPERTY Owner's Name Jason F Rahprra Rainkp Present Address 188 12th St., Carbondale Phone 963- 9 System Location 0100 - Geder -- Breaks Road. Grass Mesa, Lot 25, Rifle 00as /e 'e.Q Legal Description of Assessor's Parcel No. SYSTEM DESIGN /0(.1'] Septic a Ca pacity (gallon) 6Wea(zt7 , Other 42/ 0 t = 8// 7 0 1 / Percolation Rate (minutes /Inch) Number of Bedrooms (or other) 3 " " / " /n' /3 "4.vares , (` Required Absorption Area - Sae Attached 817 /eax 1 eA4 3e a i f! a6 5 A. ' o 4 1 Special Setback Requirements: Qe ad //y/W nve -777, -Z 4 9O ' i Date __sC Inspector Crizi - FINAL SYSTEM INSPECTION AND APPLI_QVALM installed) (•7 >r9 m \ Call for Inspection (24 hours notice) Before Covering Installation g System Instyller_ Sr Coca Sro Bey Auutil Septic Tank Capacity, �l 4 ' Septic Tank Manufacturer- otTrade Name Septic Tank Access within 8" ,of - of s yes- - 4YtD .P /. SE LAS.- -. Absorption Area /4✓ - ,3Raa.t •'9E,ic�Y, 6i.'M t ` r tV 4 Absorption Area Type and /or Manufacturer or Trade Name //(bewne47 Adequate compliance with County and State regulations/requirements f/ Other lr11L' 77) G 0PeeC Date s W - /° Inspector s 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 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 1, Petty Offense ($500.00 fine - 8 months in (ail or both). ■ White - APPLICANT Yellow - DEPARTMENT < - INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER Sbo R1ES 4 Re IN) KR ADDRESS X68 1i;ZT1.1 Sree-E-T CARER >N DALE- PHONE 9G.? — /aa CON'T'RACTOR ADDRESS PHONE PERMIT REQUEST FOR (>(f 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: COUNTY GAR FIELD Near what City or Town - -_—RI ELE_- --- -- - - - - -- ------ - - - - -- Site of I.ot HO . j'-i lir['e °5 -- Legal Description or Address SW 'W-1 _of SECTIOMI .Q9- Mu/A/514 (2 Snl r(Ti RAN b-E 93 war, Corn+ ISM, ( Lterr a5 (7RAsS Me-54) — WASTES TYPE: (X) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) D'I'NER - DESCRIBE BUILDING OR SERVICE TYPE: 1.SI AEJJIT/A L Number of Bedrooms 3 Fif DRCOM'y Number of Persons_ y RI Garbage Grinder (k) A ut��ic ( Washer ( A' Dishwasher SOURCE AND TYPE OF WATER SUPPLY' O) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: 1 If supplied by Community Water, give name of supplier GROIJND1ONDITIONS: Depth to bedrock: Depth to first Ground Water Table Percent Ground Slope DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES ( ) NO TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (J SEPTIC TANK ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAI, BY: (X) ABSORPTION TRENCI I, BED OR P11' ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) OTHER- DESCRIBE ^/ WII J. EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? / Y U 2 4 in: pro! ATI ON TEST RR UL7 .S: (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 fi 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. 1 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. �1trai ,Ntrua d . ''� :�— Date +4 7 G Sign PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY 3 T - 7 O g DROP c 2 ( N 54”) %g 3 � / 3 ' s resr 1 3C % / -t >.,✓ IQ, oft /s �� jjff 0 96 [ 1F5 30 zyo T/� _ /3 /1/ AZ- s X / ,v,C /[ tl inns 47'700