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Home My WebLink About02743 .., , y 1 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permll' 2(4 ,Juy 109 Bth Street Suite 903 Assessor's Parcel No. Glenwood Springs, Colorado 811301 phone (303) 945 -8212 - This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use per"l. PROPERTY David Colvin 2090 White River, Rifle 625 - 5414 Owner's Name Present Address Phone_ System Location '3 I 3 f Highway 6 & 24, Silt Legal Description of Assessor's Parcel No. (Z LEACH F(EL.P ; Gqo t4 SYSTEM DESIGN I M F i t t ttPTOrts 04 431 0- \(3 E O 1 .4 1 4 W a s p l E cCY '• QIFFVSEns T/ LE4,CL 4 3vr k 1 73 / Septic Tank Capacity (gallon) Othe � 1 / 2 O Percolation Rate (minutes /inch) Number of Bedrooms (or 0th r) 7 , Requjred Absorption Area - See Attached Special Setback Requirements: Dat @, 1 '' .-- ( L _ �i Inspector A N"" - Cr - f FINic - S'YgT INSPECTION AND APPROVAL (as installed) ,; Call for Inspection (24 hours notice) " notiice) Before e - �-- Covering Installation �(7 System Installer (. " J' I t Septic Tank Capacity 12 $C 0 " ` / Septic Tank Maryufecturer or Trade Name (/ COP HO �( Septic Tank Access wi 8" of surface \ C v L r` A. ' ' Absorption Area -) 1 If V ' , �A A ( \ Absorption Area Type and /or Mahufacturer or Trade Name f �f 1 _ l• L. 7 IA- ,^ 7 0 4 J Adequate compliance with County and State regulations/requirements Y `- 2 Other t ( ,,,„,t4? \ Date L 7 - ` `o-- 0 1 1 Inspector A RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE i. •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 r 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 1, Petty Offense ($500.00 fine - 8 months in )ail or both). White - APPLICANT Yellow - DEP114TMENT ` INDIVIDI IAL SEWAGE DISPOSAI. SYSTEM APPLICATION OWNER ''II >I10 0-01-Vi — C�it•. r. - rft∎ \,. -ZUNI ADDRESSAS Aks1nu e.t,LL 6XeV 91.. o_ M I c,tZ PHONE (oaS -5LI ILI CONTRACTOR nil" ADDRESS 310.4.4, e PHONE ;$A*e PERMIT REQUEST FOR (t/(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. Near what City of Town :Si I Lt Size of Lot '1. j 99 A CRCS Legal Description or Address 4 9 totam- /a.NTotJCLL t �,n� - L,n 7 ' WASTES TYPE (x) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON- DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE 140rHe Number of Bedrooms off. Number of Persons oR ( ) Garbage Grinder (X) Automatic Washer (X) Dishwasher SOURCE AND TYPE OF WATER SUPPLY (X) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: Nl A DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: bonae Was an effort made to connect to the Community System? No A site plan is required to he submitted that indicates the following_MINIMUM distances: Leach Field to Well: 100 feet Septic Tank to Well: 50 feet Leach Field to Irrigation Ditches, Stream or Water Course: 50 feet Septic System to Property Lines: 10 feet YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN. GROUND CONDITIONS: Depth to first Ground Water Table Percent Ground Slope 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? DJ PERCOLATION TEST RESTTLTS: (To be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) 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 furnished by the applicant or by the local health department for purposed 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 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. 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 0 Date 3-3- `r "/ PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!! 3 N N L N O d z°? 1- U 0 rz al v, :C 51- \ U J T' 1J N N V 0 J J 111 41- J _ - J 2 O i 1 U G J N \ r � J r= e t0 U — — o z ■ - \ c7" \ N. v J o z J J CAI z � nqv _ — \ '5.3 i L 1 'l. f !J U rt K Z 4 . = N S _ O � i N U N c i - 0 O ti — z ti N N T O O O Z - U t. U _ Q r Z 2 �n u en ctE g. 0 z t