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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2773
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
Roy E. Savage 5953 CR 320, Rifle 625 -5278
Owner's Name Present Address Phone_ .
4440 County Road 320, Red Apple, Lot 37, Rifle
System Location
Legal Description of Assessor's Parcel No
R OCK- CE'4c e ECO (Sgi? �C 1 . 2) - 7 /8' 'Z
SYSTEM DESIGN LA AC (-I - C /4oanOE4S(BC0 � . fy - (-1 �91S)
c N� 7
1000 Septic Tank Capacity (gallon) Other 3 GC
19
mod 45 cHAMB ACU 7, Platt
1 3 2
_ 1 Percolation Rate (minutes /inch) Number of Bedrooms (or other) o
1 8 ( NEI"' FT)
Required Absorption Area - See Attached f u T IZ CI.rc M E$ to 1 /.I. & F r. A PAK'r
- $pecial Setback Requirements: C at
Date v 2_ -9 7 Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer- OW La ER
Septic Tank Capacity J0o0
Septic Tank Manufacturer or Trade Name C eptn f&Jat
Septic Tank Access within 8" of surface Va S ••
Absorption Area Row - A, - -
Absorption Area Type and /or Manufacturer or Trade Name 3 w 4 g / /(! A MAO N / B U t r'S
1
Adequate compliance with County and State regulations/requirements Yes
Other
Date 7- /'� q 1 Inspector %;t'
RETAIN WITH RECEIPT RECORDS AT CONSTR CTION 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 ($500.00 fine - 6
months in fail or both).
White - APPLICANT Yellow - DEPARTMENT
v - A
Application
INDIVIDI JAT, SEWAGE DISPOSAT, SYSTEM APPLICATION Approval By
County Official
OWNER Rt y . a tJ t
ADDRESS r + ,+ • • PHONE
CONTRACTOR L . e
ADDRESS ,$'i. S — Z 20 804 ( PHONE frZr'1
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 profiles in test holes
(See page 4).
LOCATION OF PROPOSFDXA TJ.ITY : County �G� e. e / �1
Near what City or Town Pki e Lot Size 9.3 3 act`(5
Legal Description # ed Ape <- S 47 c(; J i`sMn La f- # 3 7 Sec 3 if 1-6 s
WASTES TYPE • p() Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms 3 Number of persons
0O Garbage grinder (9 Automatic Washer (k) Dishwasher
SOlJRCP. AND TYPE OF WATER SUPPLY: 09 well () spring () stream or creek
Give depth of all wells within 180 feet of system: PC n o
If supplied by community water, give name of supplier:
GROIN') CONDITIONS;
Depth to bedrock: 2O6
Depth to first Ground Water Table: 13 O �
Percent ground slope: r
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 7m tics
Was an effort made to connect to community system? Ml7
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
Og 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:
(`F) 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? MD
Mer
OIL PERCOLATION TEST R ESI JI.TS: (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. _
'ame, address and telephone of RPE who made soil absorption tests:
'ame, 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 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. 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.
Date 1/9/1; (b , 7 7 Signed Pn u �` c_5r71 /
p1 ,EASE DRAW AN ACCI IRATE MAP TO YO1 JR PROPERTY
•