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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY Ian/C (1^1�n
Owner's Name S 0.' Present Address l�loev n�
System Location s C\--0— 1esf` AdM 01ObLRP
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
Septic Tank Capacity (gallon)
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
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
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Permit
Assessor's Parcel No.
4051
This does not constitute
a building or use permit.
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Other
Other
Date
Inspector
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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 (8500.00 fine — 6
months in jail or both).
n-J�C._ i1� INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER
ADDRESS ' • /a ' �_ �I '" HONE 3/9 — Z)
CONTRACTORp,
f j� (I�J L • U i
2 nZ /
ADDRESS )�( 41 ` ('(Q VQ/�( .' PHONE fp3 — 007
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 PROPOSED FACILITY: / /
Near what City of Town : KbOM • '� Size of Lot_ 6, b 7 /--
Legal Description or Addresra AC.� ' C EI`{ KE s 060C-6070
WASTES TYPE: WELLING ( ) TRANSIENT USE (&oofkMu-DV�
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
Number of Bedrooms Number of Persons
BUILDING OR SERVICE TYPE:
Z
{Garbage Grinder utomatic Washer Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: r l
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 0 t-1 Civ Ii PN
Was an effort made to connect to the Community System? MAD -
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 o2 8 0
Percent Ground Slope Scjia ,
2
Mar 04 05 12:16p Seth holler
MR -04-2E105 11:14 FROM:BRREBJRN BUILDERS 9709630074
/ •
fr
970-920-9559
P• 2
TO:970 920 9559 P.001,003
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
(FIN DISPOSAL BY:
ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
(3- OTHER -DESCRIBE JiLiCi ( 1 !L r } T(l l2
WELL P-PFLtJ ENT RP DISCHARORO nut FCTI-Y !Nit CI WAIF RS 01- 'r HE STATE?
MO
PERCOLATION TEST RESULTS; (To be completed by Reglsrered Professional Engineer, lithe Engineer does uic
Percolation Test)
Minutes R per inch in hole No. 1 Minutes i 7 per inch in hole No. 3
Minutes per inch in hole No. 2 Minutes Trr
P per inch in hole No. _
Name, address and telephone of RPE who made soil abso�aon tests: ft P 6 co QC_h
lemWCXY -
Name, address and telephone of RPE responsible for design of the system: 5 AMC-'.
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 Iocal 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 Iocal 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.
Si
Date
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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County Road (Note the Road Number and Name)
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HEPWORTH- PAW LAK GEOTECHNICAL
October 21, 2005
Braebum Builders, LLC
Attention: Doug Boyles
Carbondale, Colorado 81623
4('
Job No. 405 118
Subject: As -Built Evaluation of Individual Sewage Disposal System, Existing
Residence, Tract 5, Henke Property, Garfield County, Colorado.
Dear Mr. Boyles:
Hepworth-Pawlak Geotechnical, Inc. has observed the installation of the Individual
Sewage Disposal System (ISDS) for the four bedroom residence on the project site. The
ISDS components observed include: septic tank, effluent pipe, cleanouts, manifold pipes,
Infiltrator Equalizer 36 chambers, inspection ports, distribution box and the locations of
all components. Based on our observations made during our site visit on October 13,
2005 it is our opinion that the ISDS was constructed in accordance with the ISDS design
plan, dated March 31, 2005, Job No. 405 118.
Sincerely,
HEPWOR - PAWLAK GEOTECHNICAL, INC.
Andy
Reviewed by:
Ronald J. Uhle, P.E., C.C.E.
Associate
cc: Garfield County Building and Planning Department
Glenwood Springs 970-945-7988 • Parker 303-4-41-7119 • Colorado Springy. 719-63i-5562