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4
GARFIELD COUNTY BUILDING AND SANRATION DEPARTMENT
108 Eighth Street, Suite 201
Glenwood Springs, Coloradof 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Owner's Name
System Location
Present Address S'5"
Permit
4065
Assessor's Pareel No.
This does not constitute
a building or use permit.
Phone LI ---7q 79
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
/4 sr)
Septic Tank Capacity (gallon) _Other
1 L n,^�
V Percolation Rete (minutes/inch) Numlrbeer of Bedrooms ( (or other) T OetA - _ %'
Required Absorption Area - See Attached (3 r C ��77
d5-
fin Pt Q(,, Lk 3 if)
fig ir^ b4
Special Setback Requirements:
Date /a 3 ) Oro Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
I
System Installer (n/ n « r
Septic Tank Capacity / K C/i )
kikim I
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface ( Q.-I2P.
10-
Absorption
3Absorption Area ise 14,1' ` Li halt
Absorption Area Type and/or Manufacturer or Trade Name
if(d ,..„4(7
Adequate compliance with County and State regulations/requirements 7-�
Other
Clete
DC®NDITIONS:
Inspector jl 442r
ifiA L
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
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 aviolation or a
requirement of the permit and cause for both legal action and revocation of the permit.
a ‘Any person who constructs, alters, or Installs an individual sewage disposal system Inc manner which Involves a knowing and material
mutation from the terms or specifications contained In the application of permit commits a Class I, Petty Offense (5500.00 fine —8
e In Jail or both).
i
\lc un.:e. sea ,rsKrr v.,,. nes. n.. .!
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION - y 1 [aS
OWNER 7-575% NS5Cvt) Q�`���‘��
ADDRESS < R D FIT' pnAck 4dIS6 n CU PHONE(fC-(,2/Sr--7 7q
CONTRACTOR c3L r\ Qtr
ADDRESS PHONE
PERMIT REQUEST FOR
G
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 FACILIXY: t S n
Near what City of Town ` 1 Size of Lot 1 Ec s
Legal Description or Address
WASTES TYPE:
TBD
e` ISoa, C°
(yQ DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER–DESCRIBE
BUILDING OR SERVICE TYPE: S I i 'U- ' (! i I`9
Number of Bedrooms 4 I Number of Persons `-2 – q
(t Garbage Grinder (\A Automatic Washer (4 Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
A site ' Ian is re ' uired to be submitted that indicates the followin ' MINIMUM distances:
Leach Field to Well:
Septic Tank to Well:
Leach r ieiu to Irrigation Ditches, Stream or Water Course:
100 feet
50 feet
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 OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(`O 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
UNDERGROUND DISPERSAL
ABOVE GROUND DISPERSAL
OTHER -DESCRIBE
( ) EVAPOTRANSPIRATION
( ) SAND FILTER
( ) WASTEWATER POND
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? t1l b
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test) [y
Minutes IP 0 per inch in hole No. 1 Minutes / O per inc in hole No. 3
Minutes
per inch in hole No. 2 Minutes e o.
Name, address and telephone of RPE who made soil absorption tests:
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 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
-Arm Date 4- /C -r)
PLEASE DRAW AN CCURATE MAP TO YOUR PROPERTY!!
3
PLOT PLAN
In SW 1/4 of the NE 1/4 and the SE 1/4 of the NE 1/4 of Section 31,
in T 6 S, R94 W of the 6th P.M. in Garfield County, Colorado.
D.J. Road (maintained by Lot
owners in Lemon Resolution 77-76)
Scale
1"= 50"
519'
175'
Frame dwetting with
full basement
To west bndy.
Septic tank &
infiltration field
-
On grade patio &
retaining walls
Existing
power pole
Well
e
Garage
slab
94'
149' Underground
power service
To south bndy.
Prepared by
JERRY BAUER
P.L.S. P9009
1854 CO, ROAD 293
RIFLE, CO 81050
910-625-1a-12
Prepared for
Tony 4 Cathleen Janssen
P.O. Box 090
Parachute, CO 81050
910-285-1819
January 3 2003
File Janssen/plotplan
FROM : JRhiJSSEN TRRNSPORTRT1 ON
FW< NO. :9702857879
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May. 25 2005 01:56PM P1
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MAY 2 :, , �t
GARricLu
BUILDING & J/'4rr
PLANNING
FROM t JANSSEN TRRNSPORTRT ION
FAX NO. :9702857879
HEPWORTH-PAWLAK GEOTECHNICAL, INC.
August 24, 1998
May. 25 2005 01:56PM P2
5020 Reed 154
Glenwood Syringe, CO 81501
fa 970 9454154
Phone 970 945-7989
Tony and Kathy Janssen
2321 Sunland Street Job No. 198 573
Louisville, Colorado 80027
Subject: Percolation Testing, 309 Road, East of Rulison 1-70 Exit, Garfield
Cwtnty, Colorado
Dear Mr. and Mrs. Janssen:
M requested by Becky Warner-Pecters, Hepworth-Pawlak Geotechnical, Inc.
performed percolation testing at the subject site. The work was done in accordance
with our agr'eemem for professional services to you dated August 20, 1998.
Percolation test holes were dug and presoaked by Mr. Janssen on August 21, 1998. We
visited the site on August 22, 1998. A profile pit had been excavated in the proposed
septic disposal area and the soils exposed in the pit consisted on about 2 feet of topsoil
overlying basalt cobbles and boulders up to 2 feet in size in a sandy clay matrix to the
maximum depth dug of 4 feet. We understand backhoe refusal on basalt boulders was
encountered at 4 feet. The profile pit and percolation test hole locations are shown on
Fig. 1. No free water was observed in the pit and the subsoils were moist.
Percolation testing was performed on August 22, 1998. The percolation test results are
presented on Table 1. The percolation rates varied from 30 to 60 minutes per inch with
an average of 45 minutes per inch.
If you have any questions or we may be of further service, please call our office.
Sincerely,
HEPWORH - PAWLAK GEOTECHNICAL, ANC.
Ci"
Louis E. Eller
Rev. by:
LEE/kmk
attachment
cc: Bray & Cont
y Warner-Peeters
r RUM.: IRNSSEN TRANSPORT RT I ON
FRX NO. :9702857879
May. 25 2005 01:57PM P3
Kai •: fgt./ESN TP NSPORTRTION
FAS( N0. :9702857879
May. 25 2005 01:57PN P4
HEPWORTH-PAWLAK GEOTECHNICAL, INC.
TABLE I
PERCOLATION TEST RESULTS
JOB NO. 188 673
HOLE KO.
HOLE oem
(INCHES)
LENGTH OF
INTERVAL
(MIN)
WATER
05PTH AT
START OF
INTERVAL
(NCLE6)
WATER DEPTH
AT ENO OF
INTERVAL
001 4011
mop*
WATER
LEVEL
(INCHES'
AVERAGE
PERCOLATION
RATE
(MIN./WOO
P-1
40
15
14
13'6
r
%
r
13 %
12 %
16
12 %
12 %
%
12 14
11 %
%
11 %
11 %
%
30
11/
10%
%
10%
10%
%
P•2
47
15
12
11 %
%
10
11 %
11
%
11
10 %
%
10 A
10 %
14
10 %
10
%
10
9 4
14
974
9 %
%
P•3
5a
15
12 %
11 14
%
45
11 %
11 14
%
11%
10%
'.6
10 74
10 %
'A
10'A
10
14
10
914
%
974
0 )4
%
Note: Pistols ion tests were performed an Augus 22, 1990. The everage percolation rue wee based on the Wet three
ruddy of dye test. The tut holes were rocky end the ranee of percdatlan rites Is probebly due to the presence of
beset cobbles end boulders.