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• GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2617
109 8th 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. David Pinkerton Present Address CR 226, Rifle Phon! 876 -5783
/
System Location _ as Op County Road 226, Rifle
Legal Description of Assessor's Marcel No.
( h. O C - K 1, d C Mf ` t- I G L 0 ■•'..._.' f
SYSTEM DESIGN (/ 0 / ,A • D C 4 d_4 L.. 30 u N l i$' s c
/ 0 0O Septic Tank Capacity (gallon) O ther
/ 2 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3
Required Absorption Area - See Attached „
Special Setback Requirements: .
Date
t er - Z Z ' ` Inspector
�C
FINAL SYSTEM INSPECTION AND APPROVAI. (as installed)
Call fdr Inspection (24 hours notice) Before Covering Installation
System Installer 00 U'' f`.1 C rt
Septic Tank Capacity 1 Z . O "
Septic Tank Manufacturer or Trade Name Co V' (.% t A t- I'
✓
Septic Tank Access within 8" of surface
6 "00 I R 4 (t v3 U4 g fJMIt$ If, A j
Absorption Area (3 Absorption Area Type and /or Manufacturer or Trade Name 1 N I ` I t ran 7 0/.5 ` 3 r ^�
Adequate compliance with County and State regulations/requirements
Other p �1
Date t ( 9
r – z " 9 Inspector ,4 ft t-r7
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
*CONDITIONS:
1. All installation must Amply 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 10 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 materiel
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
•
-- INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
/9
OWNER �J Au , C /n/,C' e,2Te /V �,t r
ADDRESS 23o o 2Zlo � PHONEM S'%ki -5.7 P
CONTRACTOR Sgme
ADDRESS S 2 PHONE —
PERMIT REQUEST FOR (341FW 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 profiAs in test holes (See page 4).
LOCATION OF PROPOSED FACILITY: COUNTY 1 / 40 A-r ,C,et d
Near what City or Town � , s -1 i Co Size of Lot 20, a C/ /-i c re 5
Legal Description or Address '2330 t 2Z 6 2- O� ,t,t c Co
WASTES TYPE: (tom► 6WELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE: Noksc-
Number of Bedrooms -3 Number of Persons 3 '
( ) Garbage Grinder (1-) Washer (t-)--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
GROUND CONDITIONS:
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 INDI IDUAL 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:
(ki ABSORPTION TRENCH, BED OR PIT L e �_� ( ) EVAPOTRANSPIRATION
( .-) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER- DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? ` 2 -'
2
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer)
• Minutes per inch in hole No. I 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 purposes ofthe evaluation of the application; and the issuance of the
pennit is subject to such tenns 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 connect to the best of my knowledge and belief and are designed to be relied on by the
local department of health in evaluating the sane for proposes of issuing the pennit applied for herein. 1 further
understand that any' alsification or misrepresentation may result in the denial of the application or revocation of any
permit granted bas d upon said a rplication and in legal action for perjury as provided by law.
•
Signed 4 Date 4 /
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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ENGINEERS
__ SURVEYORS
(970) 945 -1004 SC,MGESER G - 118 West 6th, Suite 200
FAX (970) 945-5948 GORDONMEYER a Glenwood Springs, CO 81601
DATE; 05/11/96
PERC TEST FOR DAVE PINKERTON
2300 226 RD., RIFLE, CO.
PERC HOLES WERE DUG AND PRE - SOAKED BY OWNER. HOLES WERE
APPROX. 3 FT. IN DEPTH AND WERE DAMP FROM PRE -SOAK AT TIME OF
TEST.
TIME HOLE #1 HOLE #2 HOLE #3
2 :35 P.M. 13" 14,5" 16.5"
2:45 13.5" 15,25" 16.75"
2:55 14" 15.75" 16,88"
3:05 14.5" 16" 17.25"
3:15 15.13" 16,38" 17.62"
3:25 15.62" 16,75" 17.75"
3:35 16" 17.13" 18"
TOTAL 3" 2.63" 1.5"
DROP
AVERAGE PERC = 2.376 " /60 MIN. = 25.25 MIN./INCH
HOLE #1 23' HOLE #2
--CIA , P 9 i ?d
HOLE #3 7+, ��$s, c ries - , r'
tO.r
TEST PERFORMED BY; RON MITTLEIDER I.o r v 0 957 C.R. #250 r SILT, CO. 81652 7 .- ,,:.
(876 -2867) HOME
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(945 -1004) WORK i