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I , ?-'is' A)~ GARRELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY ~
Permit N~ 3900
Assessor's Parcel No.
This does not constitute
a building or use permit.
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Owner's NameVfn/~\YlQi tl 11. r Present AddressDl"J \ \14.. ~ l?-0 C'..ao ~ Phone5\c.~ -I 1 <63
System Location loU A JJA.f"u "---S\ o.1
Legal Description of Assessor's Parcel No. a/c'3J-~J-0/-fY'>9
SYSTEM DESIGN
______ Septic Tank Capacity (gallon) ______ .Other
______ 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 _____________________ _
Other ___________________________________________ _
Date 1 -;q -0 £/ Inspector ~~ (fmt.;u:/,_/
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 spec1fications contained 1n the application of permit commits a Class I, Petty Offense ($500.00 fine -6
months in jail or both).
White -APPLICANT Yellow -DEPARTMENT
' '
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
PERMIT REQUEST FOR tj..> 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:
NearwhatCityofTown Sbt 1Cdofada SizeofLot 1D ~5>
Legal Description or Address 00 l (l rY6P1J r ,~1 bk 1 ffi 6Pwch \~ llo1i i>ah.Ob
WASTES TYPE: C'/J DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
()OTHER-DESCRIBE _______________ _
BUILDINGORSERVIcETE: F2'1cql11 ·&Y"Y\·,I~ c-hayrl.«
Number of Bedrooms 4-Number of Persons_5 ____ _
( ) Garbage Grinder <j) Automatic Washer ~ Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: <:/J WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier: ~i rrDn t,lkl.L
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: _ __._tJ_.)_,_ft~,'-------
Was an effort made to connect to the Community System? -~ .......... ~-----------
A site plan is required to be submitted that indicates the followine MINIMUM distances:
Leach Field to Well: ND will 0 n...fl~ 100 feet
Septic Tank to Well: 11 • • • • 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 __ _,,,Le.._-£-"'":s.a:J:::..__ ________________ _
Percent Ground Slope_-+......,.__ ______________________ _
TYPE OF INDIVIDUAL SEW AGE DISPOSAL SYSTEM PROPOSED:
<>ef SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PITPRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET( ) OTHER-DESCRIBE
FINAL DISPOSAL BY:
('fJ) ABSORPTION TRENCH, BED OR PIT ( ) EV APOTRANSPIRATION
eef UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER-DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? _ _,fJ'--D-
PERCOLATION TEST RES UL TS: (To be completed by Registered Professional Engineer, ifthe Engineer does the
Percolation Test)
Minutes 51 O per inch in hole No. 1 Minutes / og per inch in hole No. 3
Minutes 3;:;? per inch in hole No. 2 Minutes er inch in hole No.
Name, address and tel!oneofRPE who made soil absorption tests: bcfiC. lw Her 9R:J~c Hv:.e. ~;iJQ lJ\2 6l€n11~t· CD -~ llaDl
D.t10;> UJ,)imi-\ac) :r:71c. ~ ~t.t <tM.llf\.UF~ [lfi)")qt15-'5252
Name, address and telephone ofRPE responsible for design of the syst~: ~ o Q,[) abtJ1.c O
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~':;;--==wLlk-,-) (} Date . .=l:l~-:t'-"--2'-0_3-<=-----
PLEASE DRAW AN AcclJRM< MAP ~OPERTY!!
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PLAN VIEW ~
6"TOl'SOIL
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PROFILE VIEW
SEPTIC TANK DETAIL
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i.llACtt flt_v:NMll..E CM' OR
THREADED CLEANOUT "SSEMBL T
INSTALL -ER I( CAP IS JO
BE BURIED
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!NISH GRACIE
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4"• PVC RISER
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4"f S£W[R LINE,_ ~
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STANDARD INFILTRATOR TRENCH DETAIL
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ATTACH R'(t.l:IVABLE CAP OR
n~EA0£0 ClEN«lUT ASS£r.et. Y
INSTALL MARKCR ff C1>P IS TO
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4"• F'VC SOLIO
PIPE CUT TO FIT '/'
4"• COUPLtNC (UNION)-·'°"
USE 140LE SAW TO CUT OUT
PRE~D CIRCLE AT
TI-IE CENTER IS Tl£ UN I T
4'• PERFORATED PVC
PIPE EXTEND PIPE TO
REST ON 8DTTCM OF
&ED/TRENCH
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INSPECTION PORT DETAIL
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OBSERVED SOIL PROFILE
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REBAR AND CAP
LS #1 J501
POWER POLE
W/GUY WIRE
N 89'59'54" 676.22'
UTIL. PED.
DITCH
GRAVEL RD
DITCH
OVERHEAD ELECT.
DITCH
75' ACCESS AND
UTILITY EASEMENT
LOT 12
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~ AT POWER POLE GRAVEL ROAD
·1RR. VALVES 18"~ CMP 30' ACCESS AND
UTILITY EASEMENT
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REBAR AND
LS #13501
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-200'
REBAR AND CAP
LS #13501
LOT 14
PROPERTY IS SUBJECT TO RESERVATIONS, RESTRICTIONS, COVENANTS AND EASEMEI\
>RD OR IN PLACE.
PROPERTY DESCRIPTION
LOT 12, PEACH VALLEY ORCHARD
IG TO THE PLAT RECORDED DECEMBER 5, 1909 AS RECEPTION NO.
COUNTY OF GARFIELD, STATE OF COLORADO
IMPROVEMENT LOCATION CERTIFICATE
, _.,... .. .,..~ T'llAT" llllt"'"" ILJl"'"'ll"'"'ln\J~LJr-.. 1T lr'\r'\ATll""\ .. I l""rnTlllr'\ATI \AIAr nnrn
BOUNDARIES
UNLIMITED INC.
Consulting Engineers
February 23, 2004
Garfield County Building & Planning
108 S'h Street, Ste. 201
Glenwood Springs, CO 81601
..
Re: ISDS for Verveja Residence: Columbine Lane, Silt, CO
BUI Project: Verveja Residence
To Whom It May Concern:
On February 19, 2004, Boundaries Unlimited Inc. personnel observed the construction of the
ISDS for the Verveja Residence located off Columbine Lane, Silt, Colorado. One 1500-
gallon septic tank and 42 standard Infiltrator units had been installed in a trench configuration.
No backfilling had taken place. The owner was advised to install the inspection ports as
specified in BUI' s design. Other than that, the installation of the system was in conformance
with the intent of the design. If you have any questions, or need additional information,
please feel free to contact me at 945-5252.
Sincerely,
BOUNDARIES UNLIMITED INC.
Deric J. Walter, P.E.
Project Manager
Cc: Martin Verveja
923 Cooper Avenue I Suite 102 I Glenwood Springs I Colorado 81601 I Ph 970.945.5252 Fax 970.384.2833