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Home My WebLink About02803 GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2803 109 8th Street Suite 303 A is 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 Matthew & Jett!. Rent w ent Address 1012 Ramaley Way, Rifle Phone 625 -2203 System Location 0130 County Road 332, Rifle Legal Description of Assessor's Parcel No. (LOCK– c. r,E(-JD (G2/42o%) > 7S 2 rT 2 SYSTEM DESIGN 1_ E C H C 1-(Pt M ✓S E &$ [3 D -- f 1--S 4. If 1 0 0 0 Septic Tank Capacity (gallon) Other T E HC 14 BS --7 18 s' u rAcf�f i - 11 Percolation Rate (minutes/inch) Number of Bedrooms (or other) 3 24 P( CCEJ Required Absorption Area - See Attached Special Setback Requirements: Date Inspector FINAL SYSTEM INSPECTION AND APPROVAL (as installed) Call for Inspection (24 hours notice) Before Covering Installation System Installer et •I1 %f EK Septic Tank Capacity 1 1. S 0 Septic Tank Manufacturer or Trade Name r b P E t•-- /a Septic Tank Access within 8" of surface E� Absorption Area 1 4 5 lI A:7 '- T rt EN C t4 es I C ,4 Absorption Area Type and /or Manufacturer or Trade Name 1 /1/41 F ft- 1 it A- r ovtl (:.. Adequate compliance with County and State regulations/requirements 4 6 & Other n �E Date ( -to `' 9) Inspector A A-N 0 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 (5500.00 fine —8 months in )ail or both). mite- APPLICANT Yellow • DEPARTMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION OWNER _Matthew _and .Je ti Ann Renner *LDDRESS 1012 Wamsley Way, Rifle PHONE 625 - 2203 CONTRACTOR Johnson Construction ADDRESS 1920 Hwy. 13 Rifle PHONE 625 -2251 PERMIT REQUEST FOR (a) 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 Ri f t e Size of Lot 8.32 acres Legal Description or Address 0130 County Road 332 Rifle, Co 81650 WASTES TYPE: kg) DWELLING ( ) TRANSIENT USE ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES ( ) OTHER - DESCRIBE BUILDING OR SERVICE TYPE: Single Family Dwelling 'Number of Bedrooms 3 Number of Persons 3 X) Garbage Grinder (x) Automatic Washer (x) Dishwasher SOI JRCE AND TYPE OF WATER SI JPPI .Y' (x) WELL ( ) SPRING ( ) STREAM OR CREEK If supplied by Community Water, give name of supplier: DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: approx. 500 ft. Was an effort made to connect to the Community System? Not economically feasable A site plan is required to be submitted that indicates the following MINIMi),M t1)ctances: 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 YOIJR INDIVIDUAL SEWAGE DISPOSAL, SYSTEM P .RMIT WILL NOT BE ISSUED WITHOUT A SITE PLAN, GROI JND CONDITIONS: No ground water encountered in teat pit Depth to first Ground Water Table Percent Ground Slope Land is flat in vicinity of proposed leach field 2 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: r -' is SEPTIC TANK ( ) AERATION PLANT ( ) VAULT 1 "( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE ( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE ( ) CHEMICAL TOILET ( ) OTHER - DESCRIBE FINAL DISPOSAL BY: ( 4 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? no pFRCOI ATION TEST REST II .TS (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 ( t ,AA kt-A ---- Date S `7.7.--- \, C t 7 al GZS - I Z Z PLEASE W AN ACCURATE MAP TO YOUR PROPERTY!! 3 PLOT PLAN A portion of the Mead Subdivision in Gar field County, Colorado. ad # 332 Paved Surface o f COUnty RO Existing ad . icated ry5 om ea water well $etbaok line�o \ cen / Septic • eptio Tank ro ( is 1s 1 N t 1 1 L. 2 1 1120 ft to rear property line from house.. 1 1 A Power, phone and gas lines Distance form septic tank to well /05' exist along the front of the lot. f rom Leach field to well 132' Connection will be made to these utilities Distance to serve the residence. Prepared by Scale Prepared for JERRY BAUER - 40 Matt, 4 Jeri Ann Renner P.L.S. 0 9009 1012 Wameley Way 1554 CO, ROAD 293 Rifle, CO 51650 RIFLE, CO E31650 A 910-625-2203 303- 625 -1812 I May 16, 1997 I File: Renner/stifle PLOT PLAN A portion of the Mead Subdivision in Gar *tad County, Colorado. # 332 tot ct surface of C paved tt.. 0,0 -/- — - — -- •—• Existing ad udicated setbaotn OP water well. \ „....ih . ,....,, Fr Septic Tank e r A ' o t 4 9 11.1 e, 4 rA 1 1 I IS" tr 11 — 1*O r Ei I Pr 51/ g 1 1:7. 000: 67 c Sa I sit 1 12 1 I f z 1 .2., 1 g 11291. to rear property tine from house.. te 1 1 .... 1 , • • Power, phone and gas lines 11 Distance form septic tank to well 105' • exist along the front of the tot. Connection will be made to these utilities Distance from teach field to welt 132' to serve the residence. • Prepared bt. I" Seal0' Prepared for = JERRY SAUER Matt 4 ,.Ierri Ann Renner P.L.6. 0 9009 1012 Wamelew, Way_ 1554 CO, ROAD 293 A Rifle, CO 81650 RIFLE, CO 81630 W0-623-2203 303-625-1012 _ _______ 1 May 16, 1997 1 File: Renner/srlfle