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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945·8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
Permit N~ 3910
Assessor's Parcel No.
This does not constitute
a building or use permit.
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Owner's Name pC I S l\t'.v1 ~ Present Address 0 '-f f3 c_ ~ / b] f; • S "f J bo j Phone lf 5-~ f4 f
System Location __ ~{)~d-"'------5-=S'---'C,,___,_Q"'--.;2_'-=-'-[-=-0----'-K-=•---'' H_,_~_,__-----'--Co='_,,_f_:_:/ b::.<.<SCc..:::Ll:__ ____ ~
Legal Description of Assessor's Parcel No. --~J_~/_· ~~'/_-_/_.S __ / _-_O_o_--=O--=O'-'~"----=--------------
SYSTEM DESIGN
______ Septic Tank Capacity (gallon) ______ ,Qt her
______ Percolation Rate (minutes/inch) Number of Bedrooms (or other) ____ _
Required Absorption Area -See Attached
Special Setback Requirements: rr--_ \'-
Date ________ Inspector ----~---'-~-...:_:_:-"~___,,0r-¥-Yu'if"'1__,q__ ___ _
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer G fiht>k1D
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 _____________________ _
R TAIN 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 to 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·
nect1on 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 ($500.00 fine -6
months 1n jail or both).
White -APPLICANT Yellow -DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER \~~ \L.,~
ADDRESS cO '-t "i? p -e._ "-( (. ) (c,,-W >
CONTRACTOR G-...;lc{i~ ~
ADDRESS ~j~
PERMIT REQUEST FOR ..Q4_Jl/EW INST ALLA TI ON
PHONE 4 g 5 -52\ l..f "l
( ) ALTERATION ( ) REPAIR
Attach separate sheets or report showing entire area with respect to surrounding areas, topography of area, habitable
building, location of potable water wells, soil percolation test holes, soil profiles in test holes (See page 4).
LOCATION OF PROPOSED FACILITY:
Near what City ofTown~ __ .:....R~=-~-·:::..._ ________ ,Size of Lot "J;, l ~,
Legal Description or Address_-=O_'-_-=S'---'S'---"(?"--_~ __ l..... __ l_Cl __ __._G_._~:....,-"'---------
WASTES TYPE: .t><(DWELLING ( ) TRANSIENT USE
( ) COMMERCIAL OR INDUSTRIAL ( ) NON-DOMESTIC WASTES
( ) OTHER-DESCRIBE _______________ _
' " /)_ -I A BUILDING OR SERVICE TYPE: /.:>.: • ( "-< ..:(C'"' • " . a • ' ..., -g • >"-<-!
Number of Bedrooms -~<f>~--*-=--'-'$'--____ N.umber of Persons __ q __ _
~ Garbage Grinder ~utomatic Washer
SOURCE AND TYPE OF WATER SUPPLY: <>{_WELL
If supplied by Community Water, give name of supplier:
~ishwasher
( ) SPRING ( ) STREAM OR CREEK
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: _ __,___:...~--~-------
Was an effort made to connect to the Community System?--~~~---------
A site plan is required to be submitted that indicates the followini: 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 ___ __.::v:::..._ _________________ _
Percent Ground Slope _____ ~-=~"--~~-----------------
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(-,<;i SEPTIC TANK ( ) AERATION PLANT
( ) VAULT PRIVY ( ) COMPOSTING TOILET
( ) PIT PRIVY ( ) INCINERATION TOILET
( ) CHEMICAL TOILET( ) OTHER-DESCRIBE
FINAL DISPOSAL BY:
(>4, ABSORPTION TRENCH, BED OR PIT
( ) UNDERGROUND DISPERSAL
( ) VAULT
( ) RECYCLING, POTABLE USE
( ) RECYCLING, OTHER USE
( ) EVAPOTRANSPIRATION
( ) SAND FILTER
( ) ABOVEGROUNDDISPERSAL ( ) WASTEWATERPOND
( ) OTHER-DESCRIBE ~: ••, • iJ ~ ~
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?~
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
Minutes ____ _,.er inch in hole No. 1 Minutes ______ ,per inch in hole No. 3
Minutes ____ _,.er inch in hole No. 2 Minutes er inch in hole No.
Name, address and telephone ofRPE who made soil absorption tests:-------------
Name, address and telephone ofRPE responsible for design of the system: ~ ~
'l -._ '::'.::> e., o I~ <7-'b ! D "'2..--G;..... W S 9 '-l ~ -"S '"1.-. S ..,_
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 l ~->-----lL,~ Date l -~ -o Lj
PLEASE DRAW AN ACCURATE MAP TO YOUR PROPERTY!!
•
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Designate North Arrow
Your Neighbor's
Name & Address
Your Plot -Shape to Fit
(No Scale)
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Locate well, all streams, irrigation ditchs, and any water courses. Draw in your house,
septic tank & system, detached garages, and driveway.
If a change of location is necessary, you must submit a corrected drawing, before a
Certificate of Occupation will be issued.
'
. \.
Your Neighbor's
Name & Address
County Road (Note the Road Number and Name) f~ ..:f2..t_ P ~ (Z,. A -~ R, ~ \. C
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ATTACH REl.«>VAElt.E CAP OR
THREADED CLE.\NOUT •SSEMllL Y
INSTALL lolol.RKER 1r CAP IS TO
BE BURIED
~R~:~)TI[ {-f~'(
6' TYP. .· ~ · '·. 1 •,, • . -
w···"· " ::> ··o: TANK ANCl-O'l.t.C£ 1 0 C.Y • ~COt!CMTE BLIXK ON BOTHl ., '
SIDES OF TANK :
. c·· . . J 73 .. ••• • .
4° PVC WYE>. el-
1"-llSI-! GRADE
~ «'.
4"t PY<: RISER
4"t 45' BEi<!
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• $ ~ ~IPl"ll;~DRAIN l:i·__::_·· ·. •, ' • ,• 1 •' • ,.:..;_]
BACK TO DOSING TAlllK SEPTIC/DOSING TANK ANCHORAGE DETAJL
4"tSEWERL~
~ CLEAN OUT ! !r~
PIPE LATERAL LAYOUT
(N.TS)
2" SOL ID PVC
FROM DOS I NG TANK
,+A
1--~~~~~~~~~~~~~91'±~~~~~~~~+-~~~~--J
_/TOE OF SA~ BED
i - . -.·. U-: . r--.. . ,.. '"-'". i . »·~-i ·. J
'· ..... ·.~.,:~~f;~~." . ...-2";SCHE~ll::· .M, ·~ •. 1:·(.~ I--~-.'."'-"':'I."':·-.. -y·.~-~'.'."-~~-< ··~--. ,
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'-. "/·""'"'""·").' . . . : : .-. . l" ~'.~ ••.(1~P). '•'· • .... I . • . -.• ... ' , ., . 1'-.• •• • . . . .
PLOWED SURFACE
MOUND PLAN VIEW
(NT.SJ
OISTRISUTION
LATERAL
L+A
FILTER FABRIC
OVER GRAVEL
BEO OF 1-1/2" SCREENED ROCK,
12" (MIN,)
@ ty11frclmw J l.llN
'~
24" SAl<I rill. SEE
NOTES FOR MIN!-
BASE AREA 4 O' l.llN A&Ovt J
GRCIUNOwATER
MOUND SECTION DETAIL
--1s ·
(WIN.)
REMOVABLE C/\P
SOL I D CAP FOR
SIJl>PORT • BOTTQ,I
OF" BED
4 -1/2"' HOLES
4" 'SOI.ID PIPE
PLACE ADJACENT TO
Dl~TRISUTION PIPE
OR THROl.!GM TOI' OF
INflLTRATOR UNIT
4" • PERFORATED
PIPE M!APPED WIT!-!
FILTER FABRIC
(WITHl"I SAN'.)S)
--~~-
COMBIN~~IR VENT &
INSPECTION PORT DETAIL
(NTS.J
n~'"-';>;;:./';\//',<'i. -::., ..... " /"'\(/ 'r~ lj." 0,,<_~~(0 :-: l ;>S,;>0-
SURFACE
L GROUNDWATER
OBSERVED SOIL PROFILE
CLEAN OUT DETAILASSEtoBLY ~ I l! ~
{N,T.S) (N.TS)
4• x ··-1
Tilt.t.TED ELEC JCT. BOX 2" AIR V(NT
"'" =S~~~ACE
2" (HOU LINE TO
FIELD, SLDl'EO AT
1/8" PER FT MIN.
SHALL DRAIN BACK
TO UNI( MTER
EACH Pl.MF' CYCLE
" "" ~-I '
QUICK
DISCONNECT
Oii IJNION
COIL ANO TIE AN .. A001TIONAL 10' or WIRE Hill PIM" -WEIGMT· REMOVAL
"I ·. "OfF"
SUBMERSIBLE
w,t.STEwATER PlMP
I j !l_.I L---11+.t-~~~~ s· OH
"""' SWITCH!S TO BE 1,!ERCllRY Flao.T TYPE
flO,O.T SWITCM DIMENSIONS ARE BASED QN A COl'ElAHD 1000 GAL TANK
(CISTERN) AT 4 OOS[S PER DAY
J. OOS!NC: TANK SKI.LL BE OF WATERTIGHT CONSTRUCTION
4 ALARW SO<All BE BOTH ALt>IBLE ANO VISIBLE. LOCATED WITHIN
Tl-IE lfOUSE ANO ON A CIRCUIT SEPARATE FROM THE Pl.U'
Pl.AF SHALL 9[ CAPABLE OF AT LEAST 30 GPM • 15 FT OF 1-!EAO.
(ELEVATION DIFFERENcr ANO Plf>E LENGTl-!S SI-IA.LL B£ FIELD MEASURED
BY COtHRACTOR ANO REFERRED TO ENGl!.IEER FOR VERlriCA,TION OF l'l,u>
PARAMETERS )
DOSING TANK ARRANGEMENT
(N.T.S.)
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BOUNDARIES
UNLIMITED INC.
Consulting Engineers
July 12, 2004
Garfield County Building & Planning
108 gth Street, Ste. 201
Glenwood Springs, CO 81601
Re: ISDS for Kriz Property: One Mile Pond near Rifle, CO
BUI Project: Kriz
To Whom It May Concern:
On July 7, 2004, Boundaries Unlimited Inc. personnel observed the construction of the ISDS
for the Kriz Property located on Lots 1 & 2 of Section 15 at One Mile Pond near Rifle,
Colorado. One 2000-gallon septic tank, a 1000-gallon dosing tank and a 3 l 'x91' absorption
mound had been installed. No backfilling had taken place. The contractor was advised to
install the pump system in accordance to the design specifications. Otherwise, the system
appeared to be 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,
D~-
Deric J. Walter, P.E.
Project Manager
Cc: KenKriz
Dave Gibbens
923 Cooper Avenue I Suite 102 I Glenwood Springs I Colorado 81601 I Ph 970.945.5252 ! Fax 970.384.2833