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r-..,aw.ns.mn a.^efis o9 ,...-w.nn.,.- ,;..,,.. - „r -.. • GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N.. 2 1 4 5 109 8th Street Suite 303 Assessor's Parcel No. Glenwood Springs, Colorado 81801 Phone (303) 9454212 This does not constitute INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. 1 PROPERTY 1 Owner's Name Greg Selvage I Present Address G /10 5 .. Grand Jet. Phone_ 434' $310 C l System Location 3716 Asesgmbe e. Nev Castle 1 ` Legal Description of Assessor's Parcel No. SYSTEM DESIGN z oo C Septic Tank Capacity (gallon) Other / 1/ ' MYY IA*. 3 "'at a 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) t Call for Inspection (24 hours notice) Before Covering Installation System Installer (! tI4 ,..i.e/ 1 ,p°WY�- UA Septic Tank Capapfty f 0 0 0 _ , r Septic Tank Manufacturer or Trade Name a�- QQ / ,Q >'"�'' '' Septic Tank Access within 8” of surface Absorption Area _ " .s_' A, _a—Lc. r r f ... . sLi_' ! 4' ' Absorption Area Type and /or Manufacturer or Trade Name 7/4 f Adequate compliance with County and State regulations/requirements 1 Other Date /0 '/2 �( `� I nspector i=<.ri - 49 ..s .. _.4 , 4 RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE i a •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. 't 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 1 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 1, Petty Offense ($500.00 fine — 8 months In Jail or both). App Department: Pink Copy Applicant: Green Y Depart -- v- - --- -- Application INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by County Official: OWNER a - ^ p - ADDRESS G-3. RL rd 4 v-cs Co D PHONE4 69 /b (5° CONTRACTOR'' IM /1 /1 I/LS ADDRESS 2 2 2 3 Qd w y Gr4 Scat" c p /o PHONEal S 1r if PERMIT REQUEST FOR: (IX 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.) r e LOCATION OF PROPOSED FACILITY: County rA J r Near what City of Town i e / Lot Size 1 0 2 -t ,Q-C r e S Legal Description /.,A+ 7 peat\ Ailey Acres WASTES TYPE: (iilDwelling ( ) Transient Use ( ) Commercial or Institutional ( ) Non- domestic Wastes ( ) Other - Describe BUILDING OR SERVICE TYPE: Number of bedrooms . Number of persons ("t Garbage grinder ( utomatic washer (4 Dishwasher SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek Give depth of all wells within 180 feet of system: Co If supplied by community water, give name or supplier: C M u n. \ ry GROUND 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 INDIV DUAL SEWAGE DISPOSAL SYSTEM PROPOSED: (AT 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: (I.—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 TFIE STATE? lip • • Dann 9 prric larr. y ea 2,/ iti �" 2r el /1. ��� SOIL PERCOLATION TEST RESULTS: (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 permltis 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 under- stand 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 per- jury as provided by law. /1 Date 6141 LA / ,lcf 7 3 SignedtvI PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY 2_0 ri it' �2� r s14 T'r2 jotille2Pnoons 4/60eV it /e- = f v 0 FIT 2 IF (P F[t7n4"G rflCPC = ,(23 Air -- 23 p< ! F COPTOCr0'I - S`o7 3v et /aaa ri97 7 /9r` Page 3 PLOT PLAN AND DESIGN FEATURES: 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 comnitments. • Page 4 TYPE OF SYSTEM TO BE CONSTRUCTED (15" to 25" Clean Gravel Requfiinless Otherwise Approved) TOP TOP .ength deter- .t _ _ , _, 4" perforated t 4,9 , o n 0 0°0oo0 ° p 0 °0 Gravel dined from MC 0 0 i 0 0 °0 0 0 0 )erc test 4 , ; ® ` ' solid pipe 0 00 °p o O ° p0 o $ 00 •esults from tank o0Qp0 ° ° °o 4" solid pipe ex- * a o `� 6 �` tending into n 41 0 p 0 9 ^ �^ 0 , on 0000. drywall 1' n �• n ` � ` O A 4 a o 0114140 n ' ♦ 414 u 0o ca l '^ ° w 0 0„,,;",••4 °,,°•.. •' � straw over pCJC7 K7 q4 4 A es ,p4 V 0 00 ♦11:.$ ;'+ F CJ oO OO 0 p 0 00 Q C taO 0 o 0 � �1�1"���� I� e ' 3' 1. 6' 1 3' *Size determined from perc test results - SIDE VIEW Backfill SIDE VIEW tackfill �y v\\NN „ Backfill /Xk�(^ X >0 x or straw 4" solid pipe to tan' — % O B 0 2 "4 P gravel over go Cone 4" hay or straw ati@ yi gio � O v r o 1 p o 0 0 , 0 o cnc4° gravel ,/ , .- Gravel e o o ea pp n r �mr ?c ca c oo el) 6" Gravel •ft$ ;. b oo o ©0 a ex c) c g * ` ' r f !i Concrete rings or CIO. ° o ° w � g.P i oo under pipe ' , J cinder blocks ,r O 1 pci 1' of gravel in ail bottom n Seepage Bed : '. S agi Drywel l n El Other ,• /OH .:y. TRY 1.r y� 0 August 11, 1993 q'M Mr. Jim Mullis Jim Mullis Construction 2223 Broadway Ma, Grand Junction, CO 21503 RE: Percolation Test for Peach Valley Subdivision Lot 7 HCE Job No. 93004.11 Dear Mr. Mullis: On August 4, 1993, High Country Engineering, Inc. personnel conducted a percolation test on your lot in the Peach Valley Subdivision near Silt, Colorado. The soil profile consisted of approximately one foot of topsoil, then grey silt to the bottom of the profile hole. No bedrock or groundwater was noted. Based on the results of our percolation testing for three holes, and on the understanding that the holes were properly pre - soaked, we recommend a design percolation rate of 20 minutes per inch. If you have any questions or need additional information, please call Sincerely, 4s HIGH COUNTRY ENGINEERING, INC. Tim thy P. Beck, P.E. Prin ipal Engineer TPB:rjh 923 Cooper Avenue •` Glenwood Springs, CO 81601 Telephone: 303.945.8676 • FAX: 303-945-2555