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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N , 2 0 0 4 e . A
} '' 109 4th Street Suite 303 Assessor's Parcel No.
lenwood Springs, Colorado 81601
tI6�W Phone (303) 945-8212
This does not constitute t
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. { i
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PROPERTY a {
Owner's Name Matthew Van Portfliet Present Address 0120 Saver Lasp CerbondalO 963 -2937 {
System Location
2074 County Road 109 Teller Springs, Glenwood Springs
Legal Description of Assessor's Parcel No. 4 }
SYSTEM DESIGN 5
7'. <) 4c 2 'f Septic Tank Capacity (gallon) Other 4
L v c
I.;, '� Percolation Rate (minutes/inch) Number of Bedrooms (or other) I
/inc4 e) cot 6 90 la t7e // .2 X riie. C - ✓ / (1K
Required Absorption Area - See Attached TM l . � Z "' r r Al / // Pr L<pt 24 Z ry a. o T [ ago p c
p '. G.' I l I rr 2 f f 4; f p. ;-
Special Setback Requirements: G U o, t' P c 1, O V it I b
Date 7— /1- old Inspector ( 14-- 1 p
� �t .ua tty t i
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) g q„N.-a °l) 6
Call for Inspection (24 hours notice) Before Covering Installation 400.4, p . )
System Installer ) " `-" It pr,-,4-
n1' q • tv ? - ? A D
Septic Tank Capacity 1 M
0 0 0 r,4 _ C 1
Septic Tank Manufacturer or Trade Name Q / W
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Septic Tank Access within 8" of surface I
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4
Absorption Area 4 1 / nil` 4.��V T'^�V "tab. 3
Absorption Area Type and/or Manufacturer or Trade Name /) i
�/ A
Adequate compliance with County and State regulations/requirements L/ F
Other c'
Date b —' 2 t j 1-- Inspector :• r%ni IL 4 — " d
RETAIN 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 10 C.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to structures which have Cully 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 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 )ail or both). it
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Applicant: Green Copy Department: Pink Copy
r Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
�� County Official:
OWNER ��.¢,7d� l/.f,v jeerci<•T
ADDRESS L C i • Rd . tog
..Qir 1 o Tct� E s� eitsefi s PHONE Ic 3-„x9,37
CONTRACTOR,'q ree
ADDRESS PRONE
PERMIT REQUEST FOR: 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 FACILITY: County 6k&i :e n_A
Near what City of Town 0-4. Lot Size 7. 0 c! G neat, s
Legal Description L . rim s re, At, y
WASTES TYPE: ()C ) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe _
BUILDING OR SERVICE TYPE: __
Number of bedrooms Number of persons Lk
( ) Garbage grinder ( -) Automatic washer ( ) Dishwasher
SOURCE AND TYPE OF WATER SUPPLY: ( ) well ( ) spring ( ) stream or creek
Give depth of all wells within 180 feet of system:
If supplied by community water, give naive or supplier: • «2 sPe
GROUND CONDITIONS:
Depth to bedrock: 3/4
Depth to first Ground Water Table:
Percent ground slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 3 m , L s
Was an effort made to connect to community system? Kit'
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
('1) 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:
(V) 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? g 6
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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 Mo.
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 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.
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Date 6 -57 - Signed / it / /� /i�E - -4
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
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the first 10 feet in paved areas. Granular wall backfill should be capped with about
2 feet of the on -site fine - grained soils to reduce surface water infiltration.
4) Roof downspouts and drains should discharge well beyond the limits of all backfill.
PERCOLATION TESTING
Results of the percolation testing of the coarse gravel soils at the site indicate
average infiltration rates ranging from about 5 minutes per inch to 20 minutes per inch. A
profile pit near the percolation tests did not encounter bedrock or groundwater to a depth
of 7 feet. We believe the coarse gravel soils extend a considerable depth below the site.
Based on these considerations, it appears feasible for a conventional leach field
disposal system based in the coarse gravels to dispose of septic water. We have not
evaluated the possible effect of the septic water on the springs that underlie the site. Due
to the variations of the percolation rates, we recommend the system be oversized and based
on a percolation rate of 30 minutes per inch.
LIMITATIONS
This report has been prepared in accordance with generally accepted soil and
foundation engineering practices in this area for use by the client for design purposes. The
conclusions and recommendations submitted in this report are based upon the data obtained
from the exploratory pits excavated at the locations indicated on Fig. 1 and the proposed
type of construction. The nature and extent of subsurface variations across the site may not
F ROM CHEN t ORTHERki zNC Slll3sou_
Tu0 Jn r.( o. 4 4os cy
Clicn ONort kern. I nc.
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Job No. 4 405 92 July 10, 1992
TABLE I
PERCOLATION TEST RESULTS
WATER WATER
LENGTH DEPTH AT DEPTH AT DROP IN AVERAGE
HOLE OF START OF END OF WATER PERCOLATION
HOLE DEPTH INTERVAL INTERVAL INTERVAL LEVEL RATE
NO. (In.) (Min.) (Inches) (Inches) (Inches) (Min. /Inch)
P -1 10 5 10 81/2 11/2 3.3
5 8 1/2 8 1/4 1/4 20
5 8 1/4 8 1/4 20
5 8 71/4 3/4 6.7
5 7 1/4 7 1/4 20
10 7 6 3/4 1/4 40
5 6 3/4 6 1/2 1/4 20
5 6 1/2 6 1/4 1/4 20
10 61/4 51/2 3/4 13.3
10 5 1/2 5 1/4 1/4 40
P -2 9 5 7 6 1 5
5 6 51/4 3/4 6.7
5 51/4 41/4 1 5
5 41/4 31/2 3/4 1 ,6.7
10 3 1/2 2 1/2 1 10
refilled 5 81/2 71/4 11/4 8
5 7 1/4 6 3/4 1/2 10
10 6 3/4 5 1/2 1 1/4 8
10 5 1/2 5 1/2 20
P -3 12 5 10 1/2 10 1/4 1/4 20
5 10 1/4 9 3/4 1/2 10
5 9 3/4 9 1/2 1/4 20
5 9 1/2 9 1/2 10
10 9 8 1/2 1/2 20
5 81/2 81/4 1/4 20
5 81/4 8 1/4 20
10 8 71/4 3/4 13.3
10 7 1/4 6 3/4 1/2 20
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