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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
Owner's Name
-c
System Location
Permit
4073
Assessor's Parcel No.
crs3--05-.:e7
This does not constitute
a building or use permit
SopI4vlIFeentAddress C.C' . / A76.S.C�lbPone)%(-.-)V/-LLf)?
LC( G5 t111ov, Di. C. c . 6 Sf(ccf
Legal Description of Assessor's Parcel No Lit ( LvS tr
SYSTEM DESIGN
QLl((rl SLJ (.
Septic Tank Capacity (gallon) Other
Percolation Rale (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 I �]
Date I q / Z" .7/0(r Inspector (i/Ci I fC r) % lC r [�Tl`` 10CjY 1 CS
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE l)/') I Art rci I ✓(C.
*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 ($500.00 fine — 6
months in lad or both).
•
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER ‘•-Thoso., fi /"les 4y
ADDRESS 0
CONTRACTOR
/3.2
�rIQ C
r
PHONE/97o) o9.6y/V
ADDRESS PHONE
PERMIT REQUEST FOR 'NEW INSTALLATION ( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City of Town 6 rein 'dad spr� ;cif s
Legal Description or Address Oe/!.S tr.ex.tp. ue
WASTES TYPE: (StWELLING
( ) COMMERCIAL OR INDUSTRIAL
Size of Lot 2.3 dtCteS
LGf ( 7
6le— weo Sprl^SS Sf inA;9cs
( ) TRANSIENT USE Ft.( '6`c) -
( ) NON-DOMESTIC WASTES
( ) OTHER—DESCRIBE
BUILDING OR SERVICE TYPE: RCS i die ti 4;c -
Number of Bedrooms Z Number of Persons 2
Garbage Grinder ($'Automatic Washer (dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) WELL
( ) SPRING ( ) STREAM OR CREEK
3E4,13 drllr5io✓15
If supplied by Community Water, give name of supplier: A 4,1 Cs:-: - J �+ c
Waite(' Sc -f Srei��
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: L/KSfi/A's
Was an effort made to connect to the Community System? ye 5
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
2
TYPE QF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(Sc SEPTIC TANK ( ) AERATION PLANT ( ) VAULT
( ) VAULT PRIVY ( ) COMPOSTING TOILET ( ) RECYCLING, POTABLE USE
( ) PIT PRIVY ( ) INCINERATION TOILET ( ) RECYCLING, OTHER USE
( ) CHEMICAL TOILET( ) OTHER -DESCRIBE
FINAL DISPOSAL BY:
ABSORPTION TRENCH, BED OR PIT ( ) EVAPOTRANSPIRATION
( ) UNDERGROUND DISPERSAL ( ) SAND FILTER
( ) ABOVE GROUND DISPERSAL ( ) WASTEWATER POND
( ) OTHER -DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? n o
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test) 3 �� Cl Clycbt
Minutes per inch in hole No. 1 Minutes per inch in hole No. 3
Minutes per inch in hole No. 2 Minutes per inch in hole No. _
Name, address and telephone of RPE who made soil absorption tests: HP Geo Te 0-1
Kdolt) Cv--(cj&t G s gteoi
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 famished 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 / / " Date, S / %-Q-3
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
3
HEPWORTH-PAWLAK GEOTECHNICAL, INC.
TABLE II
PERCOLATION TEST RESULTS
JOB NO. 195 127
HOLE NO.
HOLE DEPTH
INCHES).
LENGTH OF
INTERVAL
MINI
WATER DEPTH
AT START OF
INTERVAL
(INCHES)
WATER DEPTH
AT END OF
INTERVAL
(INCHES'
°OOP Nil
WATER
LEVEL
INCHES'
AVERAGE
PERCOLATION
RATE
(MINIINCH)
P•1
50
15
7 114
4 314
2 112
7
811311
0
4 1/2
3 112
R11il1
6
6 114
1 3/4
Re(6I
Relitl
MON
6 114
3 314
2 112
8
6
2
8
5 3/4
2 114
0
6
2
6
33/4
2114
P-2
46
15
Relill
81161
7
6
1
6
5
1
7
6114
3/4
6 114
5 3/4
1/2
1
61/4
3(4
6 1/4
5 3/4
- 1/2
5 314
5
3/4
5
4 114
314
Y4
P•3
48 112
15
NOM
ISM
8 1/2
5 1/2
1
5 1/2
4 3/4
3/4
6 1/2
6
1/2
6
5 112
112
6 112
8
1/2
6
5 112
112
5 1/2
5
112
5
4112
112
30
Note: Holes were hand dug 1n bottom at backhnn nI1e nn Lal•••• ••• °
BOUNDARIES
UNLIMITED INC.
Civil & Consulting Engineers
September 29, 2006
Garfield County Building & Planning
108 811" Street, Ste. 201
Glenwood Springs, CO 81601
Re: ISDS for 0465 Pinion Drive (Elk Springs Sub.), Garfield County, Colorado
BUI Project: 06002.05 (Grosse)
To Whom It May Concern:
On September 27, 2006, Boundaries Unlimited Inc. personnel observed the construction
of the ISDS for 0465 Pinion Drive (Elk Springs Sub.) in Garfield County, Colorado. A
new 1250 -gallon septic tank with an effluent filter and 66 Quick 4 Infiltrator units had
been installed in a bed configuration. No backfilling had taken place. The system had
been installed 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 UNIp tfificqt'
o��•;o'ON h,,,F9f,l
•a 37110 Di
r 9••• tll1cr, /cc-
Doric
Project ManagerP '41 5S/p,NA1_ F.\\�\",�'
Cc: Jason Grosse
823 Blake Avenue Suite 102 Glenwood Springs Colorado 81601 Ph: 970.945.5252 Fax: 970.384.2833
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LOT 17 LOS AMIGOS. GARFIELD COUNTY CO
GROSSE INDIVIDUAL SEWAGE DISPOSAL SYSTEM
SEPTIC SYSTEM DETAILS
QUICK4 STANDARD INFILTRATOR BED DETAIL
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(970) 209-6418
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INFILTRATOR BED PLAN DETAIL
opgdaries
Unlimited Inc.
can,mnnge CAA Engineers
823 Blake AYenue 5 e 102
Glenwood Springs. CO 81601
tel 970945 5252 1,. 970 39.4 2533
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LOT 17 LOS AMIGOS. GARFIELD COUNTY, CO
GROSSE INDIVIDUAL SEWAGE DISPOSAL SYSTEM
SEPTIC SYSTEM PLAN AND COMPUTATIONS
JASON GROSSE
(970)7096419
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Unlimited nG.
Cena.or.neso.uEne ears
523 Blue Avenue ole 102
01 eso 15 CO 601
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709065251 la. 970360 833
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