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- GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Perml N_ 3 8 3 9
109 8t1i Street Suh8403 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
t Owner's NameeL. 7e1- -I �-L— Present Add s1te5 K nJay 0004(2. Phone
System Location
} Legal Description of Assessor's Parcel No
SYSTEM DESIGN
This does not constitute
a building or use permit.
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Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
Number of Bedrooms (or other)
4
3 4 /r, iliera wee
L
9/ 3 h L e r Jp C ,a,,., 44.S AM pc sTizc.hf
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
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System Installer
Septic Tank Capacity
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Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of .surface
en -
Absorption
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
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Adequate compliance with County and State regulations/requirements
Other
Date f--(70 3 Inspector x+'17 it t.rtiP�l�
RETAIN WITH RECEIPT RECORB AT CONSTRUCTION SITE
J 4) L 7)f.
*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 1, Petty Offense ($500.00 fine — 6
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER Rd eb T /11-5‘
p.$‘ }�
ADDRESS / lD tJ / �' A VATO A414W CAS Ae. CO PHONE 98-1-2 i
CONTRACTOR G,. D b eiv's Co Nr i
S -uc lB/ e N,
ADDRESS 5991 Co Rd 2P1 NewCmile/ Co1 PHONE ,'f-2127
PERMIT REQUEST FOR AQ NEW INSTALLATION ( ) ALTERATION 60 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 FACIILITY:,r
Near what City of Town N W C -A s 1 `L e Size of Lot 33 A eR e S
Legal Description or Address 47? eiock,2 OF Ne o F TA e ELI! Cr ee/r DPveJo o,Nni/7L
WASTES TYPE:
oc>Q DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE: /1 D us e
Number of Bedrooms 3
Number of Persons .2..
(4 Garbage Grinder 60 Automatic Washer Cie Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: Tow N or New 0A -site,
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: .2 mi Le S
Was an effort made to connect to the Community System? NO
A site plan is required to be 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 (septic tank & disposal field) 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 .L eveL
1
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
SEPTIC TANK
VAULT PRIVY
PIT PRIVY
CHEMICAL TOILET( )
( ) AERATION PLANT ( ) VAULT
( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
OTHER -DESCRIBE
FINAL DISPOSAL BY:
( ) ABSORPTION TRENCH, BED OR PIT (3 EVAPOTRANSPIRATION
UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? /V d
PERCOLATION TEST RESULTS: (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. 2
Minutes per inch in hole No. 3
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 ptamit 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
PLEA
Date L/('S
ACCURATE MAP TO YOUR PROPERTY!!
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BOUNDARIES
UNLIMITED INC.
Consulting Engineers
September 9, 2003
Garfield County Building & Planning
108 t Street, Ste. 201
Glenwood Springs, CO 81601
Re: ISDS for Dobbs Residence: 165 Navajo Street, New Castle, CO
BUI Project: Dobbs Residence
To Whom It May Concern:
On September 8, 2003, Boundaries Unlimited Inc. personnel observed the construction of the
ISDS for the Dobbs Residence located at 165 Navajo Street, New Castle, Colorado. One
1000 -gallon septic tank and 30 standard Infiltrator units had been installed in a 5x6
configuration. No backfilling bad taken place. The owner was advised to install 5 more units
for a total of 35units as specified in BUI's design. Other than that, the installation of the
system was in conformance with the intent of the design. I have enclosed an as -built drawing
for your files. If you have any questions, or need additional information, please feel free to
contact me at 945-5252.
Sincerely,
BOUNDARIES UNLIMI
Deric J. Walter, P.E.
Project Manager
Cc: Robert Dobbs
RECEIVED
SEP 0 9 2003