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GARFIELD COUNTY BUILQ_ING AND SANITATION DEPARTMENT
109 8th-Street Suite 303
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NC' •• 3445 PermH -
An•-r'• Parcel No. . .
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Phone (303) 945-8212 ----------~ i:
INDIVIDUAL SEWAGE DISPOSAL PERMIT
This does not constitute
e building or use permit.
" PROPERTY
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l ~ Legal Description of Assessor's Parcel No. ;}., { iJ-. 1~ f I f -00 ' jC(Cj
.~ ~ SYSTEM DESIGN
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/Q){) Crfl Septic Tank C&peclty (gallon) Other
_/_fq{~--Percolation Rate (minutes/inch) Number ol Bedrooms (or otl'fl 3 P · R
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Required Absorption Area • See Attached '
Special Setback Requirements:
oa1e _________ 1nspec1or __ -!-/_. _?_. _b_fi_.;;)_( _;r_c._t+ __ ])_,_t/_~-~~<:~~/~n~r __
' . -' • FINAL SYSTEM INSPECTION AND APPROVAL (as Installed) •• J f Call for Inspection (24 hours notice) Before Covering Installation
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Se~lcTankCapacify._.l~'\l,,.....D~D_,_ ______________ ~------------~
Septic Tank Manufacturer or Trade Name 1-tJ-"-'O'-'-'f'-"IA,..)e.,_(__..(_..n.__f-T/-'l"""'-S_,_j.1.Li-=c."')'------------~---
~le Tank Accees within B" ot surtace ..U~~=-------------------------
Absor~lon Area 3o ~ . j,"'~ II ~ ID -'J
Absorption Area Type and/or Manufacturer or Trade Name ~-'=-·-='---~"'-<'\->!Lr<I..,,.•"''"""" -'""----'-H_._--'I._\>,.,_ ______ _ -~t"-0
Adequate compliance with Counfy and State regulatlonl/requlrement~s--1.I 'I-) ... .e .... ~""----------------. I
Other------~---------~---------------------~
Date t./-?,..(,,, -oi Inspector __,_.~~~J~~~~~------
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
\ t •CONDITIONS: ' ' . ~
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1. All installation must comply with all requirements o!the Colorado State Board ol Health Individual Sewage Dlspossl 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 cauea for both legal action and revocation of the permit.
3. Any person who constructs, alters, or Installs an Individual seW&ge dlspceal system In a manner which involves a knowing and material
variation trom the terms or specifications contained in the application of permit commits a Class I, !'atty Offense ($500.00 fine - 6
months in jail or both). 1
While-APPLICANT Yellow -DEPARTMENT
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INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION -•
:::.!1~;t~ Co.
CONTRACTOR~0_.....cu~Al~E22"""~<'-------------------------
ADDRESS _______________ _
PERMIT REQUEST FOR {Vf 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 ofTown._S=.....L1 ... '=u.7;_,_.._C ..... a ...... __________ _..S..,ize....,..of._.L..,o""t ..... ri'"'"d...._..tf.._,C=RESo==...=---
Legal Description or Address .. 5.f, 14 /l),f, )4 c-5£cTJOAJ!I Twp 55 £&;... C/J W @r-tRfn,
WASTES TYPE: ( ) DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( )OTHER-DESCRIBE ______________ _
BUILDING OR SERVICE TYPE:__._G_..dg...,..Af:z:1,..1..'rl:L.......,/ .... s~11o-o _______________ _
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NumberofBedrooms_.._._ __________ _ Number of Persons _ ___,,0..£_ __ _
( ) Dishwasher ( ) Garbage Grinder ( ) Automatic Washer
SOURCE AND TYPE OF WATER SUPPLY: ( 1-('WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: 0 ~ S TQM/ -I IA) t=--1--L
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:__../N"-'¥1=4'-L'-'j _______ _
Was an effort made to connect to the Community System? __ --:;...:,~~'-----------
A site ulan 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 Coone: 50 feet
Septic System to Property Lines: 10 feet
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITHOUT
A SITE PLAN.
GROUND CONDmONS:
Depth to first Ground Water Table __ ....:l)~N~K.;::,J.J=:o:QW.=::Af....,__ ____________ _
Percent Ground Slope I % -J..JtJ
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED: -' ~ SEPTICTANK ' ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POT ABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET ( ) OTHER-DESCRIBE
FINAL DISPOSAL BY:
0' ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?_....;..l\J-"-'()....._ __ _
PERCQLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes. ___ __.per inch in hole No. 1 Minutes -----l"per inch in hole NO. 3
Minutes per inch in hole No. 2 Minutes per inch in hole NO. _
Name, address and telephone ofRPE who made soil absorption tests: _____________ _
Name, address and telephone ofRPE 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
tillsification 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.
Dme _ _,_l!~C-:~J_-_._3~u~,1_-_l.=)~C_J __ _
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
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Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house,
septic tank & system, detached garages, and driveway.
If a change oflocation is necessary, you must submit II corrected drawing, before a
Certificate of Occupation will be issued.
County R<jad (Note the Road Number and Name)
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Your Neighbor's
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HEPWORTH -PAWLAK GEOTECHNICAL
November 5, 2003
Dan and Charla Makufke
P.O. Box 621
New Castle, Colorado 81647
Hepworth-Pawlak Geotechn1cal. lnc
5020 County Road 154
Glenwood Spnng~, Colorad,) 81601
Phoneo 970-945-7986
Fax. 970-945-8454
email: hpgeo@hpgeotech con1
Job No. 103 690
Subject: Percolation Testing, Proposed Residence and Garage, 20 Acre Parcel,
County Road 226, Garfield County, Colorado
Dear Mr. and Mrs. Makufke:
As requested by you, Hepworth -Pawlak Geotechnical, Inc., performed percolation
testing at the subject site. The work was done in accordance with our agreement for
Professional Services to you, dated October 24, 2003.
A Profile Pit and three percolation test holes were excavated on October 23, 2003 at the
locations shown on Fig. 1. The subsoils exposed in the Profile Pit consisted of about
\h feet of topsoil overlying sandy clay to 3 feet and weathered claystone to the bottom
pit depth of 8 feet. No free water was observed in the pit and the soils and claystone
were slightly moist to moist. Percolation test holes were hand dug in the bottom of
shallow backhoe pits into the weathered claystone and soaked with water on October
23, 2003.
Percolation testing was conducted on October 24, 2003, by a representative of
Hepworth -Pawlak Geotechnical, Inc. The percolation test results are summarized on
Table I. Based on the subsurface conditions encountered and the percolation test
results, the tested area should be suitable for a conventional infiltration septic disposal
system.
If you have any questions or need further assistance, please call our office.
Sincerely,
HEPWORTH -PAWLAK GEOTECHNICAL, INC.
Parker 303-841-7119 • Colorado Springs 719-633-5562 • Silverthorne 970-468-1989
103 690
p 1
p 3 15'
• 20'
75·
PROFILE
PIT
p 2
HEPWORTH-PAWLAK
GEOTECHNICAL, INC.
ACCESS ROAD
EXISTING
DRIVEWAY
NOT TO SCALE
LOCATION OF PERCOLATION TEST HOLES Figure 1
HEPWORTH-PAWLAK GEOTECHNICAL, INC.
TABLE 2
PERCOLATION TEST RES UL TS JOB NO. 103 690
HOLE NO. HOLE DEPTH LENGTH OF WATER DEPTH WATER DEPTH DROP IN AVERAGE
!INCHES) INTERVAL AT START OF AT END OF WATER PERCOLATION
!MINI INTERVAL INTERVAL LEVEL RATE
!INCHES) (INCHES I !INCHES) !MIN.llNCHI
P-1 49 15 10 9 114 314
9 1/4 B 1/2 314
B 1/2 7 1/2 1
7 1/2 6 3/4 314
6 314 6 314
6 5 1/4 3/4 20
p 2 50 15 9 7 1/4 1 314
7 114 5 112 1 3/4
water added 9 1/4 7 3/4 1 1 /2
7 3/4 6 1 /2 1 114
6 1/2 5 1/2 1
17
5 112 4 3/4 314
P-3 49 15 10 6 3/4 3 1/4
6 3/4 5 1/4 1 1 /2
water added 8 1/4 6 3/4 1 1/2
6 3/4 5 1/2 1 1/4
5 1/2 4 314 3/4
20
4 3/4 4 3/4
Note: Percolation test holes were hand dug in the bottom of backhoe pits and soaked on
October 23, 2003. Percolation tests were conducted on October 24, 2003. The average
percolation rate were based on the last two readings of each test. The tests were dug
into the weathered claystone.