HomeMy WebLinkAboutSeptic System Designa NicRols lssoclates, Inc. 1
751 Horizon Court. Suite 102, Grand Junction, CO 81506
.970·245-7101 ~ 970·245·3251
email • nai@acsol.net
Date: rs'?" f" Total # of pages Including coveraheet: E
To: To'\M 1;l.i..v..9e Recipient FAX: cf70-7'1'--S -~';;?<f5
From: I e v v J' fl/ c.. k <: \.s
Nichols i«:ssoclates , Inc.
Memo:
sender FAX: t::f 7 o -:R ct-s;--3 ~ f;; /
Check
Cash
Assessor's Parcel No.
CHARGES
Percolation Test $100.00
(Includes final Inspection)
Permit Processing Fee $50.00 1 ..J v
Permit N:
J .-Owner's Name ' l .\ ~' ('1 e Ir:.: I\''\ .J
Address at System Location Ld 3
Amount P;;id /S 'L crt.
Date Pai:! ·7/.J.7/~/
3205
( 1t J..Si:..· c:-; I I~ (I..'
~tt; S..J-
Money Order Cashier _CJ_~_.\._· _ ... _,.~-)'"'-~--~----------
ALL CHECKS ARE TO BE MADE PAYABLE TO GARFIELD COUNTY TREASURER
While. APrltCANT Yellow. DEPARTMENT '(' 1 .,:.l.-C)~ s .£ _;, • ~ ' ·--· t• !:">-&\
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·---INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION --OWNER~~__.L_,;;OJ?z~~,j~~~r?~er~..&:>~·~~~------------~------------~~
ADDRESS __._P..;;;;;..o_.....;...a__;:CJ=-X..=------'-X"-r~ j"--'· 7'---..;;;....5__.-' 6-'-1 ........ 6=-o--=6.~:li-=~s 2 PHONE _S_79---'-: _____ !J-_;;?_;:_L-:f__;;8'::____
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CONTRACTOR __ _..,~~P--.------------------------
ADDRESS _~----------------PHONE _________ _
PEIDvflT REQUEST FOR M NEW INST ALLA TI ON ( ) AL TERA TION ( ) REPAJR
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 ____ ----'S._..:/_./ _________ ----"'-S=ize"'-"'-'of'"""L...,.o_._t _/9_ ....... ~<-·r"J_~_tJ __ ~_F_-_
Legal Description or Address C ~ ./"1.!;;t t/?oc.-d .:JS-0
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WASTES TYPE . SXf DWELLING ( ) TR.t\NSIENT USE
( ) COM!vlERCIAL OR Il'l"DUSTRJAL ( ) NON-DO.rvfESTIC WASTES
( ) OTHER-DESCRIBE _~~~~----------------------
BUil..DING OR SERVICE TYPE ·------------------------
Number of Bedrooms 3 ----=-------------Number of Persons _._..J....__ __ _
0 Garbage Grinder 00 Automatic Washer }\') Dishwasher
( ) SPRING ( ) STREA...~ OR CREEK SOlJRCE A ... ND TYPE OF WATER SUPPLY: -)>{WELL
If supplied by Commurury Water, give name of supplier: ________________ _
DISTA...NCE TO NEAREST COMMUNITY SE\iVER SYSTEM: ____ ;2 __ r-_""1-_~_~_r _____ _
Was an effort made to connect to the Community System? _____ /l._c.> _________ _
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 to Property Lines: 10 feet
YOUR JJ'UlIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDITIONS:
,fi v I D~ili~fu~Gro~dW~rT~~---~~~~·~~'~'-c~Y~ ___ o ____________ ~
'I Percent Ground Slope ________ _..:;"'?=-~.-.......::P' ________________ _
t/t/S--fQ/ 2
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Jf' INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
.,;{ SEPTIC TANK ( ) AERATION PLANf ( ) VAULT
{ ) VAULT PRIVY ( ) COr...n>OSTING TOILET ( ) RECYCLING. POT ABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTIIER USE
( ) CHEMICAL TOILET ( ) OTIIER -DESCRIBE
FINAL DISPOSAL BY:
( ) ABSORPTION TRENCH, BED OR PIT ( ) EV APO~~SPIR..l\TION
c>6 UNDERGROUN'"D DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUN-0 DISPERSAL ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? /70
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. 3
Minutes per inch in hole No. 2 l\ifinutes 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: _____________ _
A pplicant 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 depanment for purposed of the evaluation of the application~ and the issuance of the permit is
~ubject 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---.....~c.......r-.tP.~--'J~~---,7 rV....._ ___ _ r~, Date __ 6-_2._'fs_-9 _____ y __ _
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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·~:10c;!ll 999 03: 13 978245'.;:251
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0688 COUNTY ROAD 250 ----
460 Feet _______ ......... ____ . --·-·---................... ------
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3 BR House
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'I i"'-..' T !--6~--~; ·,, 'Septic Tank 1,000Gal minimum
: '-concrete distribution box
Repair area
Pt-t.. -
472 Feet
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419 Feet
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ISOS SILT, CO
~ Prepared for: Tom Junge. P .O. Box 827, Sitt, CO 81652
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:rop;,oo iiy: Nich~ A$$0daces~T~.~ 1s1 Horizon A6-:;Grand Jundion, cf~ _1~ .•. _ .
Phone 970-245-7101 FAX 24S.32!i1 emai nalGru.net
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.. ;?J9/09/19''B 03:13 '371?2452251 PAGE 04
ISDS DESIGN FOR 0688 CR250 ROAD, S'LT, COLORADO
NOTES:
1. Construction must be done according to current Garfield County individual Sewage
Disposal System Regulations. Ar:y changes rnu~t be approved by the engineer and Garfield
County Health Department.
2. The lnstallaticn will be inspected by the engineer and Gar11eld County Health
Oel)&rtment before backfilling.
3. A 1.000 gallon minimum capacity septic tank is required. The tank mu~t meet the
septlo design criteria specified by the Garfield County Health Department. The tank shall
be Installed on a solid base and shall be level. Tank access and Inspection port shall be no
more than S" below finished grada
4. Use 4~ diameter ASTM D 3034 plastic pipe from the building to the septic tank. A
clasnout shall be Installed outside the bulldfng. Pipe from !he septic tank to the
distribution box and infiltrators shall be 4' diameter ASTM 0 3034 .
5. As-built drawings shall be made after construction One copy ol the as·built drawing
shall be delivered to the Garfl!ld County Health Department
6. The system must be Installed by a licensed septic tank Installer.
7. Plot plan must adhere to all hcri~ontal distance requirements as de&ignated by
ttie Garfield County Health Department.
-25' minimum distance to foundation
4 • diameter ASTM D 3034 plastic pipe
' ''-' , Bencn pipe \.!• area to same
-""'-"'\f'\ elevatlon as
''., "fJ\' ;Jrflltrator I~~
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1000 oaf. &~tic tank / t 1 I -.--··--·----
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