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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N- 3999
109 8th Street Suite 303
Glenwood Springs, Colorado 81601
Phone (303) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY m
Owner's Name L4 1C.1-� / Qat
/leg �CC% Lu
System Location `'YA RIi 'r LAI ..�..at 1-10q S /L.
Legal Description of Assessor's Parcel No
SYSTEM DESIGN
Assessor's Parcel No.
This does not constitute
a building or use permit.
Phone/ g4 22..%4
o2c8(— os(- oo - %YI
Septic Tank Capacity (gallon) Other
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)
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
Date 97g0/0 y Inspector 4�tsa& Ra s- JJ RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE Z7'f i.5-
*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 jail or both).
White - APPLICANT Yellow - DEPARTMENT
OWNER `` --
ADDRESS /6, R/no L
CONTRACTOR PHONE yt7 u/
ADDRESS PHONE
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
PERMIT REQUEST FOR (4 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 !UAP,FACILITY: Gt /
Near what City of Town [ f , i
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
(x) 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 DISPPERSAL ( ) WASTEWATER POND
(k) OTHER -DESCRIBE no„._ oVLA I
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE? nee)
PERCOLATION TEST RESULTS: (To be completed by Registered Professional Engineer, if the Engineer does the
Percolation Test)
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 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 d- 'al of the application or revocation of any permit granted based
upon said application and in legal ctio erj i s provided by law.
Signed
Date ?- % ` 0 L/
PLEASE DRAW AN ACCURA {' MAP TO YOUR PROPERTY!!
r
IYI GLENWOOD SPRINGS, CO
1517 Blake Avenue
Suite 101
Glenwood Springs, CO 81601
970.945.8676 phone
970.945.2555 fax
❑ ENGLEWOOD, CO
14 Inverness Drive East
Suite F-120
Englewood, CO 80112
303.925.0544 phone
303.925.0547 fax
t/.� i� �1 An EmployetOwned Company (�
TO ar -Ci P 1 no DATE -1 - c20 nq
g',‘AA �c {aF'licnnI SUBJECT 1SbS MUs;C.k
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(nItktt,,Oo' Spr.nis Co JOB NO. 0(-1/015.°c'
ATTN
FAX NO. SHEET OF
We are sending the following:
1
1
Lt tf c r'
T5D5 Dry Je�l
C n ; -J-.I Aik e
loca++-on ek040's
Follow up) Vino)
If material received is not listed above, kindly notify us at once.
Transmitted by:
❑ First Class Mail
❑ UPS Next Day Air
0 Federal Express
❑ U.S. Express Mail
❑ UPS Standard Service
❑ Courier
❑Pickup
❑FAX
HCE Hand Deliver
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By:
P,,ir KLtaL
RECEIVED
SE
P 2 1 2004
GARFIELD COUNTY
BUILDING & PLANNING
September 20, 2004
Garfield County Building & Planning
109 Eighth Street, Third Floor
Glenwood Springs, CO 81601
Re: ISDS for Musich Residence
HCE Job No. 2041015.00
To Whom It May Concern:
On September 9, 2004, and September 13, 2004, High Country Engineering personnel
observed the construction of the ISDS for the Musich Residence, in Garfield County,
Colorado. One 1000 -gallon septic tank and one 466 s.f of absorption wet well had been
installed. No backfilling had taken place. The installation of the system was in conformance
with the intent of the design. If you have any questions, or need additional information,
please contact us.
Sincerely,
HIGH COUNTRY ENGINEERING,
Roger Neal, P.E.
Pri cipal
Cc: Pat Musich
n.•
1517 Blake Avenue, Suite 101
14 Inverness Drive East Suite D-136
High Country Engineering, Inc.
1517 Blake Avenue, Suite 101.
Glenwood Springs, CO 81601
(970) 945-8676
Field Report — Date: /11/44
Conditions: P Gupuct
Temp: 68'
Project Name: l ✓s /C H 1-30S 204 1075,40
Project Number: Z04 lo1.5.ero Pen-rt4 S99P
Contractor:
Subcontractor:
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Report Prepared By:
Attachments:
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High Country Engineering, Inc.
1517 Blake Avenue, Suite 101
Glenwood Springs, CO 81601
(970) 945-8676
Field Report
r1/44,Date: 1//3 /04
Conditions: GcouoY
Temp: 7,2'
Project Name: /%usrcM rsns
Project Number:
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Contractor: CK4<✓ATjNCv
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Report Prepared By:
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