HomeMy WebLinkAboutSubsurface Investigation and OWTS Design 04.22.2025129 Cains Lane
Carbondale, CO 81623
970.309.5259
carla.ostberg@gmail.com
April 22, 2025 Project No. C1953
Roddy Stieger
stiegerw@gmail.com
Subsurface Investigation and Onsite Wastewater Treatment System Design
3-Bedroom Residence + 2 Future Bedrooms
414 Pinion Drive
Garfield County, Colorado
Roddy,
CBO Inc. performed a subsurface investigation and completed an onsite wastewater treatment system
(OWTS) design for the subject residence. The 2.019-acre property is located outside of Glenwood
Springs, in an area where OWTSs necessary.
Legal Description: Section: 5 Township: 7 Range: 88 Subdivision: LOS AMIGOS RANCH SUB-
DIV#2FLG2 Lot: 11
Parcel ID: 2393-053-05-010
SITE CONDITIONS The property is currently developed with a 3-bedroom residence. Limited information was provided by
Garfield County Individual Sewage Disposal System (ISDS) Permit 2242. The systems appears to have
been sized to accommodate 3 bedrooms and a note on the permit dated February 8, 1995 was
difficult/impossible to read. The system was inspected by B&R Septic on December 26, 2024. The
OWTS consists of a 1250-gallon, two-compartment poly septic tank followed by a distribution box and
three trenches. During pumping of the septic tank, backflow was noted, which is an indication of
saturation of the soil treatment area (STA). Ponding of effluent was also noted in the inspection ports.
Altitude Septic was also called to evaluate the OWTS. They concluded that the STA was saturated and
should be replaced.
An addition to the residence is contemplated and bedroom count may be increased to a total of 5
bedrooms in the future.
The residence will be served by a community water system. The water line was not noted on the site
plan; however, a curb stop is located on the survey to the west of the driveway. We assume the water
line runs up the driveway into the house. The water line must be at least 10-feet from the proposed
septic tank and at least 25-feet from the proposed STA.
The proposed soil treatment area (STA) location has an approximate ten percent slope to the southwest.
The proposed area is vegetated with sage, native grasses, and sparse pinion trees.
There should be no traffic or staging of material over the future STA site to avoid compaction of soils
prior to construction of the STA.
Page 2
SUBSURFACE
The subsurface was investigated on April 3, 2025 by digging two soil profile test pit excavations (Test Pits). A
visual and tactile soil analysis was completed by Carla Ostberg at the time of excavation.1
The materials encountered in Test Pit #1 consisted of dark brown clay loam topsoil to 2.0-feet, underlain by
tan to whitish calcareous clay matrix with scattered basalt boulders to a maximum depth explored of 5.0-
feet where difficult digging was encountered. No bedrock or groundwater was encountered.
The materials encountered in Test Pit #2 consisted of dark brown clay loam topsoil to 2.0-feet, underlain by
tan to whitish calcareous clay matrix with scattered basalt boulders to a maximum depth explored of 4.0-
feet where difficult digging was encountered. No bedrock or groundwater was encountered.
Large basalt boulders are common in the Missouri Heights area and with a small machine (303.5 CAT),
digging out the boulders results in extremely large pits and excessive disturbance to the native soils.
A sample of the soil was taken from Test Pit #1 at 3-feet below grade. Soil structure grade was
moderate. The soil formed a ball and a ribbon less than 1-inch in length before breaking. Soil structure
shape was blocky and consistence was friable. Soil texture was more gritty than smooth.
Calcareous clay matrix is consistent with Soil Type 2 with moderate structure grade. A long-term
acceptance rate (LTAR) of 0.6 gallons per square foot will be used to design the STA.
We have researched soils in the area through USGS Web Soil Survey. The report is enclosed. The area of
the proposed STA is identified by map unit symbol 106. The map unit name is Tridell-Brownso stony sandy
loams, 12 to 50% slopes. Typical soil profile from 0 to 11-inches stony sandy loam, from 11 to 30-inches
very gravelly sandy loam, from 30 to 42-inches very gravelley loamy sand, and from 42 to 60-inches
gravelley sandy loam.
There is no mention of any limiting layer such as groundwater or bedrock.
Existing clean out near foundation
1 Carla Ostberg holds a Certificate of Attendance and Examination from the CPOW Visual and Tactile
Evaluation of Soils Training.
Page 3
Test Pit #1
Calcareous clay matrix below topsoil Sieved sampl
Page 4
Test Pit #2 Refusal at 4-feet in Test Pit #2
Sieved sample
Page 5
Ribbon less than 1”
DESIGN SPECIFICATIONS The existing septic tank will be abandoned by pumping the tank and removing it or crushing the top,
bottom, and sides and filling in the void with onsite materials. The existing STA will be abandoned in
place.
Design Calculations:
Average Design Flow = 75 GPD x 2 people/bedroom x 3 Bedrooms + 150 GPD (4th and 5th Bedrooms) = 600
GPD
LTAR = 0.6 GPD/SF
600 GPD / 0.6 GPD/SF = 1000 SF x 1.2 (gravity bed) x 0.7 = min. 840 SF
The OWTS design is based on 5-bedrooms. An average daily wastewater flow of 600 GPD will be used.
For the purposes of this OWTS design, Benchmark Elevation has been established as 100’ (existing
sewer line exiting the residence). CBO Inc. should be notified of any discrepancies or problems with
grade elevations of proposed components during installation of the OWTS.
OWTS Component Minimum Elevation
Primary Tank Inlet Invert Approximate horizontal distance 49’ / min. 2% fall /
min. 12.25” fall
Distribution Box Approximate horizontal distance 14’ / min. 1% fall /
min. 1.75” fall
Infiltrative Surface Approximate horizontal distance 23’ / min. 1% fall
to STA / min. 2.875” fall
*Elevations are based upon standard OWTS installation practices. Component elevations may change during
installation due to site conditions. Minimum grade refers to piping between components.
A new 4-inch SDR-35 sewer line should tie into the existing sewer line with a wye fitting. The new portion
of sewer line must have a minimum 2% grade to the septic tank.
The system installation must include a 1050-gallon, two-compartment Infiltrator® poly septic tank with an
Orenco® Biotube effluent filter on the outlet tee. Any state-approved concrete or poly septic tank may be
substituted. Risers must bring the manhole lids to grade for access. If more than one riser is added to
the septic tank, an extension handle must be installed on the effluent filter.
Page 6
Effluent will gravity flow to a distribution box, and then to two gravelless chamber beds. The distribution
box must be accessible from grade and must have flow equalizers, or similar product, installed on each
outlet pipe in the distribution box to assure equal flow to each bed.
A 4-inch diameter SDR-35 level manifold must be installed to connect each row of the chamber beds.
The chamber beds will each consist of 3 rows of 12 ‘Quick 4’ Infiltrator® chambers for a total of 72
chambers and 864 square feet of infiltrative area. Inspection ports must be installed at each corner of the
bed. Ports may be cut to grade and placed in sprinkler boxes for access.
COMPONENT SPECIFICATIONS
The component manufacturers are typical of applications used by contractors and engineers in this area.
CBO Inc. must approve alternative components prior to installation of the OWTS. Requests must
be submitted, in writing, to our office for approval prior to installation. Component technical data
sheets are available upon request.
COMPONENT MANUFACTURER MODEL NO. COMMENTS
Septic Tank Infiltrator® IM-1530-2CP 1500-gallon, two-
compartment poly septic
tank
Effluent Filter Orenco® 4” diameter full size filter
Tank Risers and Lids Orenco® Double-walled PVC Risers and Lids (24” diameter)
Distribution Box Polylok Distribution box, risers, lid, flow
equalizers (2) Chambers Infiltrator® ‘Quick 4’ Plus Standard Chamber 72 ‘Quick 4’ chambers
Construction must be according to the jurisdiction’s adopted On-Site Wastewater Treatment System
Regulations, the OWTS Permit, and this design.
PERMIT APPLICATION INSTRUCTIONS
An OWTS Permit Application must be submitted to Garfield County Environmental Health Department.
https://www.garfield-county.com/environmental-health/filesgcco/sites/16/OWTS-Application-Complete-
Packet-Dec.-2019.pdf. If the OWTS Permit Application will be submitted with a Building Permit
Application, it should be submitted directly to Garfield County Building Department.
All questions regarding permit submission can be directed to Garfield County Environmental Health
Department, 970-945-6614 x8150.
INSTALLATION CONTRACTOR
CBO Inc. expects that the installer be experienced and qualified to perform the scope of work outlined in this
design. The installer must review this design thoroughly and coordinate with our office in advance of
installation. Any additional conditions in this design or county permit must be completed and documented
prior to final approval of the OWTS installation. Communication between the installer and this office is
expected throughout the installation.
Page 7
INSTALLATION OBSERVATIONS CBO Inc. must view the OWTS during construction. The OWTS observation should be performed before
backfill, after placement of OWTS components. Septic tanks, distribution devices, pumps, dosing
siphons, and other plumbing, as applicable, must also be observed. CBO Inc. should be notified 48 hours
in advance to observe the installation.
In an effort to improve the accuracy of the record drawing, we request that the installer provide a
sketch of the installation, including path of the sewer lines, water line installation (if applicable),
septic tank location, STA location, and measurements from building corners or another fixed
objects on the property. This sketch is most easily provided on Sheet W2.0 of the OWTS Design
Packet. Photographs of the installation and final cover are also requested to supplement our installation
documentation.
REVEGETATION REQUIREMENTS
An adequate layer of good quality topsoil capable of supporting revegetation shall be placed over the entire
disturbed area of the OWTS installation. A mixture of native grass seed that has good soil stabilizing
characteristics (but without taproots), provides a maximum transpiration rate, and competes well with
successional species. No trees or shrubs, or any vegetation requiring regular irrigation shall be placed over
the STA. Until vegetation is reestablished, erosion and sediment control measures shall be implemented
and maintained on site. The owner of the OWTS shall be responsible for maintaining proper vegetation
cover.
OPERATION INFORMATION AND MAINTENANCE
The property owner shall be responsible for the operation and maintenance of each OWTS servicing the
property. The property owner is responsible for maintaining service contracts for manufactured units,
alternating STAs, and any other components needing maintenance.
Geo-fabrics or plastics should not be used over the STA. No heavy equipment, machinery, or materials
should be placed on the backfilled STA. Machines with tracks (not wheels) should be used during
construction of the STA for better weight distribution. Livestock should not graze on the STA. Plumbing
fixtures should be checked to ensure that no additional water is being discharged to OWTS. For example, a
running toilet or leaky faucet can discharge hundreds of gallons of water a day and harm a STA.
If an effluent filter or screen has been installed in the OWTS, we recommend this filter or screen be cleaned
annually, or as needed. If the OWTS consists of a pressurized pump system, we recommend the laterals be
flushed annually, or as needed.
The homeowner should pump the septic tank every two years, or as needed gauged by measurement of
solids in the tank. Garbage disposal use should be minimized, and non-biodegradable materials should not
be placed into the OWTS. Grease should not be placed in household drains. Loading from a water softener
should not be discharged into the OWTS. No hazardous wastes should be directed into the OWTS.
Mechanical room drains should not discharge into the OWTS. The OWTS is engineered for domestic waste
only.
ADDITIONAL CONSTRUCTION NOTES If design includes a pump, weep holes must be installed to allow pump lines to drain to minimize risk of
freezing. The pump shall have an audible and visual alarm notification in the event of excessively high-
water conditions and shall be connected to a control breaker separate from the high-water alarm breaker
and from any other control system circuits. The pump system shall have a switch so the pump can be
manually operated.
Page 8
Excavation equipment must not drive in the excavation of the STA due to the potential to compact soil.
Extensions should be placed on all septic tank components to allow access to them from existing grade.
Backfill over the STA must be uniform and granular with no material greater than minus 3-inch.
LIMITS: The design is based on information submitted. If soil conditions encountered are different from conditions
described in report, CBO Inc. should be notified. All OWTS construction must be according to the county
regulations. Requirements not specified in this report must follow applicable county regulations. The
contractor should have documented and demonstrated knowledge of the requirements and regulations of
the county in which they are working. Licensing of Systems Contractors may be required by county
regulation.
Please call with questions.
Sincerely,
CBO Inc.
Carla Ostberg, MPH, REHS
414 Pinion Drive Legend
414 Pinion Dr
200 ft
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Septic Tank
Lids
Sewer
Clean-out
5/8" Rebar &
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Fire
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Stone Column
Telephone Pedestal
Electric Manhole
Sign
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Water Valve
Underground Gas Line MarkerUnderground Gas
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4" PVC Risers
4" PVC
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90.54'Septic Tank Lids
Pinon Point
40.00' Access &
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40.00' Access &
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PROPERTY DESCRIPTION
LOT 11
LOS AMIGOS RANCH SUBDIVISION NO. 2
FILING NO. 2
ACCORDING TO THE PLAT RECORDED NOVEMBER 10, 1992 AS RECEPTION NO. 441028, AMENDED
PLAT RECORDED MAY 13, 1994 AS RECEPTION NO. 463087 AND REVISED PLAT RECORDED
DECEMBER 14, 1994 AS RECEPTION NO. 472116.
COUNTY OF GARFIELD
STATE OF COLORADO
SURVEYOR'S CERTIFICATE:
I SCOTT R. BLACKARD HEREBY CERTIFY THAT THIS IMPROVEMENT LOCATION CERTIFICATE WAS
PREPARED FOR *SEE BELOW* THAT IT IS NOT A LAND SURVEY PLAT OR IMPROVEMENT SURVEY
PLAT, AND THAT IT IS NOT TO BE RELIED UPON FOR THE ESTABLISHMENT OF FENCE, BUILDING,
OR OTHER FUTURE IMPROVEMENT LINES. I FURTHER CERTIFY THAT THE IMPROVEMENTS ON THE
ABOVE DESCRIBED PARCEL ON THIS DATE, DECEMBER 26, 2024, EXCEPT UTILITY CONNECTIONS
ARE ENTIRELY WITHIN THE BOUNDARIES OF THE PARCEL, EXCEPT AS SHOWN, THAT THERE ARE
NO ENCROACHMENTS UPON THE DESCRIBED PREMISES BY IMPROVEMENTS ON ANY ADJOINING
PREMISES, EXCEPT AS INDICATED, AND THAT THERE IS NO APPARENT EVIDENCE OR SIGN OF ANY
EASEMENT CROSSING OR BURDENING ANY PART OF SAID PARCEL, EXCEPT AS NOTED.
*COMMONWEALTH TITLE COMPANY
*FILE NO. 2024-12-23
*EFFECTIVE DATE: DECEMBER 17, 2024
_____________________________________________________________________________________________
SCOTT R. BLACKARD L.S. 38342 DATE
EMAIL: sblackard11@gmail.com
IMPROVEMENT LOCATION CERTIFICATE
LOT 11, LOS AMIGOS RANCH SUBDIVISION NO. 2 FILING NO. 2
COUNTY OF GARFIELD, STATE OF COLORADO
414 PINON DRIVE, GLENWOOD SPRINGS, CO 81601
NOTES
1.) THE DATE OF THE FIELD SURVEY WAS DECEMBER 26, 2024.
2.) THIS PROPERTY IS SUBJECT TO APPARENT EASEMENTS FOR ACCESS, EXISTING UTILITIES AND
DITCHES.
3.) THIS PROPERTY IS SUBJECT TO EASEMENTS, RIGHTS OF WAY AND/ OR REQUIREMENTS AS
NOTED OR SHOWN IN THE RECORDS OF THE GARFIELD COUNTY CLERK AND RECORDER.
4.) THIS DOES NOT REPRESENT A TITLE SEARCH BY THIS FIRM OR SURVEYOR.
US SURVEY FOOT USED
IMPROVEMENT LOCATION CERTIFICATE
LOT 11, LOS AMIGOS RANCH SUBDIVISION NO. 2 FILING NO. 2
COUNTY OF GARFIELD, STATE OF COLORADO
414 PINON DRIVE, GLENWOOD SPRINGS, CO 81601
Soil Map—Aspen-Gypsum Area, Colorado, Parts of Eagle, Garfield, and Pitkin Counties
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
5/1/2025
Page 1 of 3
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306260 306280 306300 306320 306340 306360 306380 306400 306420 306440
306260 306280 306300 306320 306340 306360 306380 306400 306420 306440
39° 28' 20'' N
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39° 28' 16'' N
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Map projection: Web Mercator Corner coordinates: WGS84 Edge tics: UTM Zone 13N WGS84
0 40 80 160 240
Feet
0 10 20 40 60
Meters
Map Scale: 1:907 if printed on A landscape (11" x 8.5") sheet.
Soil Map may not be valid at this scale.
Aspen-Gypsum Area, Colorado, Parts of Eagle,
Garfield, and Pitkin Counties
106—Tridell-Brownsto stony sandy loams, 12 to 50 percent
slopes, extremely stony
Map Unit Setting
National map unit symbol: jq4f
Elevation: 6,400 to 7,700 feet
Mean annual precipitation: 12 to 14 inches
Mean annual air temperature: 42 to 44 degrees F
Frost-free period: 85 to 105 days
Farmland classification: Not prime farmland
Map Unit Composition
Tridell and similar soils:45 percent
Brownsto and similar soils:35 percent
Minor components:20 percent
Estimates are based on observations, descriptions, and transects of
the mapunit.
Description of Tridell
Setting
Landform:Terraces, mountains
Landform position (three-dimensional):Lower third of
mountainflank, tread
Down-slope shape:Linear
Across-slope shape:Linear
Parent material:Alluvium derived from sandstone and/or colluvium
derived from sandstone and/or alluvium derived from basalt
and/or colluvium derived from basalt
Typical profile
H1 - 0 to 2 inches: stony sandy loam
H2 - 2 to 14 inches: very cobbly fine sandy loam
H3 - 14 to 25 inches: cobbly sandy loam
H4 - 25 to 37 inches: very stony fine sandy loam
H5 - 37 to 60 inches: very stony loamy sand
Properties and qualities
Slope:12 to 50 percent
Depth to restrictive feature:More than 80 inches
Drainage class:Well drained
Runoff class: Medium
Capacity of the most limiting layer to transmit water
(Ksat):Moderately high to high (0.60 to 6.00 in/hr)
Depth to water table:More than 80 inches
Frequency of flooding:None
Frequency of ponding:None
Calcium carbonate, maximum content:25 percent
Map Unit Description: Tridell-Brownsto stony sandy loams, 12 to 50 percent slopes, extremely
stony---Aspen-Gypsum Area, Colorado, Parts of Eagle, Garfield, and Pitkin Counties
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
5/1/2025
Page 1 of 3
Maximum salinity:Nonsaline to very slightly saline (0.0 to 2.0
mmhos/cm)
Available water supply, 0 to 60 inches: Low (about 4.0 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 7s
Hydrologic Soil Group: A
Ecological site: R048AY287CO - Stony Foothills
Other vegetative classification: Pinyon-Juniper (null_10)
Hydric soil rating: No
Description of Brownsto
Setting
Landform:Terraces
Landform position (three-dimensional):Tread
Down-slope shape:Linear
Across-slope shape:Linear
Parent material:Alluvium derived from basalt and/or coarse
textured alluvium derived from calcareous sandstone
Typical profile
H1 - 0 to 11 inches: stony sandy loam
H2 - 11 to 30 inches: very gravelly sandy loam
H3 - 30 to 42 inches: very gravelly loamy sand
H4 - 42 to 60 inches: gravelly sandy loam
Properties and qualities
Slope:12 to 50 percent
Depth to restrictive feature:More than 80 inches
Drainage class:Well drained
Runoff class: Medium
Capacity of the most limiting layer to transmit water
(Ksat):Moderately high to high (0.60 to 6.00 in/hr)
Depth to water table:More than 80 inches
Frequency of flooding:None
Frequency of ponding:None
Calcium carbonate, maximum content:30 percent
Maximum salinity:Nonsaline to very slightly saline (0.0 to 2.0
mmhos/cm)
Available water supply, 0 to 60 inches: Low (about 4.2 inches)
Interpretive groups
Land capability classification (irrigated): None specified
Land capability classification (nonirrigated): 7e
Hydrologic Soil Group: A
Ecological site: R048AY287CO - Stony Foothills
Other vegetative classification: Stony Foothills (null_81)
Hydric soil rating: No
Map Unit Description: Tridell-Brownsto stony sandy loams, 12 to 50 percent slopes, extremely
stony---Aspen-Gypsum Area, Colorado, Parts of Eagle, Garfield, and Pitkin Counties
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
5/1/2025
Page 2 of 3
Minor Components
Other soils
Percent of map unit:20 percent
Hydric soil rating: No
Data Source Information
Soil Survey Area: Aspen-Gypsum Area, Colorado, Parts of Eagle, Garfield, and
Pitkin Counties
Survey Area Data: Version 15, Aug 29, 2024
Map Unit Description: Tridell-Brownsto stony sandy loams, 12 to 50 percent slopes, extremely
stony---Aspen-Gypsum Area, Colorado, Parts of Eagle, Garfield, and Pitkin Counties
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
5/1/2025
Page 3 of 3
MAP LEGEND MAP INFORMATION
Area of Interest (AOI)
Area of Interest (AOI)
Soils
Soil Map Unit Polygons
Soil Map Unit Lines
Soil Map Unit Points
Special Point Features
Blowout
Borrow Pit
Clay Spot
Closed Depression
Gravel Pit
Gravelly Spot
Landfill
Lava Flow
Marsh or swamp
Mine or Quarry
Miscellaneous Water
Perennial Water
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
Sodic Spot
Spoil Area
Stony Spot
Very Stony Spot
Wet Spot
Other
Special Line Features
Water Features
Streams and Canals
Transportation
Rails
Interstate Highways
US Routes
Major Roads
Local Roads
Background
Aerial Photography
The soil surveys that comprise your AOI were mapped at
1:24,000.
Warning: Soil Map may not be valid at this scale.
Enlargement of maps beyond the scale of mapping can cause
misunderstanding of the detail of mapping and accuracy of soil
line placement. The maps do not show the small areas of
contrasting soils that could have been shown at a more detailed
scale.
Please rely on the bar scale on each map sheet for map
measurements.
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL:
Coordinate System: Web Mercator (EPSG:3857)
Maps from the Web Soil Survey are based on the Web Mercator
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Albers equal-area conic projection, should be used if more
accurate calculations of distance or area are required.
This product is generated from the USDA-NRCS certified data as
of the version date(s) listed below.
Soil Survey Area: Aspen-Gypsum Area, Colorado, Parts of
Eagle, Garfield, and Pitkin Counties
Survey Area Data: Version 15, Aug 29, 2024
Soil map units are labeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photographed: Aug 25, 2021—Sep
5, 2021
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor
shifting of map unit boundaries may be evident.
Soil Map—Aspen-Gypsum Area, Colorado, Parts of Eagle, Garfield, and Pitkin Counties
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
5/1/2025
Page 2 of 3
Map Unit Legend
Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
106 Tridell-Brownsto stony sandy
loams, 12 to 50 percent
slopes, extremely stony
3.3 100.0%
Totals for Area of Interest 3.3 100.0%
Soil Map—Aspen-Gypsum Area, Colorado, Parts of Eagle, Garfield, and Pitkin Counties
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
5/1/2025
Page 3 of 3
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N . r .224 2
109 8th Street Suite 903 A is Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Trey Construction Inresent Address 085 Tanager Dr Glenwood Phone 945 -5199
System Location 0404 Pinon Drive, Los Amigos, Lot 11, Glenwood Springs
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
Septic Tank Capacity (gallon)Other
3
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
i
FINAL SYSTEM INSPECTION AND APPROVAL (as Installed)z / r ..
Call for Inspection (24 hours notice) Before Covering Installation d J
System Installer J 1 ! " -
r
I
Septic Tank Capacity l 1 f'
Septic Tank Manufacturer or Trade Name
irk ''
r
Septic Tank Access within 8" of surface
8
Absorption Area
i
Absorption Area Type and /or Manufacturer or Trade Name e
Adequate compliance with County and State regulations/requirements r
Other p
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
S
CONDITIONS:
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage Disposal Systems Chapter
425, 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-
nectiontoorusewithanydwellingorstructuresnotapprovedbytheBuildingandZoningofficeshallautomaticallybeaviolationora 4requirementofthepermitandcausetorbothlegalactionandrevocationofthepermit.1
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 (5500.00 fine —
months in (ail or both).
Applicant Qtpen y Department: Pink Copy
Application
JNDIVIDI JAI, SEWAGE DISPOSAI , SYSTEM APPT JCATION Approval By
County Official
OWNER E y Co N5-1- Ptrt,o ICJ J tf(
ADDRESS 65 F 1 i4 t`r AF,D i — ' — 6.5 PHONE 945 5/q9
CONTRACTOR 54ADDRESS PHONE -
PERMIT REQUEST FOR: Q< 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).
J.00ATION OF PROPOSED FACIH,ITY County 67d Q UN
Near what City or Town 611-E141A- SP6 S. a to .Lot Size 0-1 A C ('t? S
Legal Description O"-f 1 `i NON! Da 1-01 l 4111 iGnS rJc-H-
WASTES TYPE :4 Dwelling Transient Use
Commercial or Institutional Non - domestic Wastes
Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms 3 Number of persons APtt OY o
Q) Garbage grinder Automatic Washer 1 ) Dishwasher
SMIRCHIRCF, AND TYPE OF WATER SI 1PPI,Y:well spring,stream or creek
Give depth of all wells within 180 feet of system:1 -05 /JoYi&oS /C WC,V I/PtCe 5y.51 - Ce
If supplied by community water, give name of supplier: 7
GROI JND CONDITIONS;
Depth to bedrock:
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM
Was an effort made to connect to community system?
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:
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?
t
SOIT, PRRCOT.ATION TEST REST IT TS: To be completed by Registered Professional Engineer)
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;
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 purposes 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 adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby
certifies that all statements 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.
Date 1L-20/11 Signeai
If
PT ,RASE DRAW AN ACCT JRATE MAP TO YOTJR PROPS T
p1.OT PI AN AND DESIGN FEATI JRFS
Include by measured distance location of wells, springs, potable water supply lines, cisterns, buildings,
property lines, subsoil drains, lake, water course, stream, dry gulch and show location of proposed system by
direction and distance from dwelling or other fixed reference object, and additional submissions in support
of this application such as data, plans, specifications statements and commitments.