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Home My WebLink About02599 �. _. . • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 3- U 9 109 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 Kep & Stanley Wailes 1101 Arnold Court, Rifle 625 -0470 Owner's Name Present Address Phone_ System Location 0486 Mesa Drive, Rifle Creek Estates, Lot 9, Rifle Legal Description of Assessor's Parcel No. SYSTEM DESIGN aso Septic Tank Capacity (gallon) Other 3 V Percolation Rate (minutes /inch) Number of Bedrooms (or other) 4 / " ,� 3r Ar /y6' LC Cft 43 Required Absorption Area - See Attached 1 9 7 fro - 8 a- 1 Special Setback Requirements: Ot S/7 bYF /e 7774 rp,QS 115,a- 4 Date S YO ' 96 Inspector SAse FINAL. SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation /` System Installer eND.P /L,C ,XC / Septic Tank Capacityla .SO ( Septic Tank Manufacturer or Trade Name /A/7I7 • Septic Tank Access within 8" of surface yes • Absorption Area A .0 V2/,v/ /°7A2A7,c4e 5 Absorption Area Type and /or Manufacturer or Trade Name 3,Cc 4J /i YaE NRi+• /L /*/ /0,44pc- //, S AIc, /S = « Adequate compliance with County and State regulations/requirements /FS Other (➢.t' 7Z Oat Date �.�' y " inspector '37%"C 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 — 6 months In Jall or both). white- APPLICANT Yellow - DEPARTMENT , IEIVIDIJAI_f?WAGl DISPOSAL, SYSTEM APPLICATION OWNER - -- K lO 574W1 -E' WAIL ES ADDRESS t'i 0 I AeNoLP C °uET - R1FLE PLION]L (o Z- 6 b 470 __ CONTRACTOR 6 / f/Foe& Pe 11760 COvv..Sr ADDRESS Of F /ewA y 1.19 00e C . PHONE 9gs 6 S - '/ _ PERMIT REQUEST FOR (-b(NI W 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 PROBED FACILITY; COUNTY 6'4 FIELD Near what City or'Town , e/FL E _Size of Lot 7.. 3± A-c et's Legal Description or Address tor 9 i 1 FGE cegek ESrA WASTES TYPE: (l�DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTI IER - DESCRIBE BUILDING Olt SERVICE TYPE: E /OENr/gL �. Number of Bedrooms 4 Number of Persons ( ) Garbage Grinder (*f Automatic Washer (/-1 Dishwasher SOURCE AND TYPE OF WATER SUPPLY; ( ) WELL ( ) SPRING ( ) STREAM OR CREEK Give depth of all wells within 180 feet of system: If supplied by Community Water, give name of supplier RI FLE c-ec6e ESre i CS GROUND CONDITIONS Depth to bedrock: UA)rA)OUA) Depth to first Ground Water Table t) A) VA) o W d Percent Ground Slope "G 3 % DISTANCE TO NEAREST COMMUNITY' SEWER SYSTEM: Was an effort made to connect to community system? ( ) YES ( OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (kr ( ) AERATION PLANT ( ) VAULT ( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL, TOILET ( ) OTHER - DESCRIIBE FINAL DISPOSAL BY: (ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION ( ) UNDERGROUND DISPERSAL ( ) SAND FILTER ( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND ( ) O'FIIER- DESCRIBE _ WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? 2 rH&COItATIONTEST RESULT& ('fo 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 fitrnished by the applicant or by the local health department for proposes 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 proposes 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 4L PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! ff773C4eO 7'0 0OIL0 /AJG pc-emir St; TS of Arms z 2 1 5 14 /11 3 S /o ye Mot 7'04 77,4te // 3' 4/ OR0P-1 3 `/a S % 17g r 7 7 30 =arc : )- f ,3 / /v,.z / /3. toe, 9/8, 5, .SO Jot-n- " 8 7i 7 r 9 = a3 -3 = 7 1 .54 . 4 �.t, - 6q , Ge,. ce /2 s, /y6f4 R- tencd 88 - 97/3/40�e5