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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit N= 215
109 sth Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81801
Phone (303) 945-8212
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit. r
PROPERTY
Owner's Name Jack Raffert Present Address Y.0. Bo:'5939 Bnotaass Phone 963 -9406
System Location 0890 Rings Row Avenue Lot 37, Glenwood Springs
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN •
J000 Septic Tank Capacity (gallon) Other
Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3
Required Absorption Area • See Attached
Special Setback Requirements: /
Date �! �3 Inspector 22✓1 /, 714 4 4e
•
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer r 3
,4„,.✓+'y 9-y"
Septic Tank Capacity /f c)
Septic Tank Manufacturer or Trade Name { 9
: , �o
Septic Tank Access within 8" of surface 1 "
1
Absorption Area 2 / r fr &
{ Absorption Area Type and /or Manufacturer or Trade Name eta' -1 n 0r"
•
Adequate compliance with County and State regulations/requirements L--
Other
st
Date) n 2 7' 7 Inspector 't 0.44Lt Ii .Q_
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 fully complied with County zoning and building requirements. Con- ..
or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a
and cause for both legal action and revocation of the permit.
._ =- or installs an Individual sewage disposal system In a manner which Involves a knowing and material
- -m contained In the application of permit commits a Class I, Petty Offense ($500.00 fine — 8
- "py Department: Pink Copy `
Application
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION Approval by
County Official:
OWNER 'ACK
ADDRESS ' 0 .f or 51'3 Uta One Co 8 /6/3 PNONE % / —
CONTRACTOR_ 0 Lo bones
ADDRESS, _ PHONE943 - R0/P5
PERMIT REQUEST FOR: (VC) 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 GAitFitt,b
Near what City of Town C 26on>>/itt Lot Size�.L` /klif?t°S
Legal Description •T0 / 'J. fou) XIUISion> _ ; 2i k
WASTES TYPE: (x ) Dwelling ( ) Transient Use
( ) Commercial or Institutional ( ) Non- domestic Wastes
( ) Other - Describe n
BUILDING OR SERVICE TYPE: S i,X .Ly KESIAP CP
Number of bedrooms .3 ! Number of persons
( ) Garbage grinder ()C) Automatic washer ( ) Dishwasher
ConvMUUry
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 name or supplier: its ow�u &hiu,Sron PIISJ0u2(f 1313
GROUND CONDITIONS: i1
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:
(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:
(X) Absorption Trench, Be or Pit ( ) Evapotranspiration
( ) Underground Dispersal ( ) Sand Filter
( ) Above Ground Dispersal ( ) Wastewater Pond
( ) Other - Describe:
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF TIIE STATE? P/0
1
•
•
Pang. 9 _. __
n l•
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._
Nance, 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.
Date 8 MO -
'igned \�
PLEASE DRAW AND ACCURATE MAP TO YOUR PROPERTY
•
0 Pro /o220 kirroN/oR -
kern*, NntoW Ru e L077;57 7 _\
Flw7 f32 P N s
( *kaolin
67 e
Pace 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
contni tments
�No5n UJ /se@m; OrQerccieSTS
•
•
Page 4
TYPE OF SYSTEM TO BE CONSTRUCTED
` ''" 0 (1A" to 2A Clean Gravel Required Unless Otherwise Approved)
TOP TOP
0Op o
00 , . o Gravel
4" perforated
.ength deter- _ _ boo 000 opo &0
nined from ••� pipe o 00 $° °O o0 Apo
ierc test • ^ ° 0' o$o
esults _� • „ At 4" solid pipe from tank coovoo b ° O o ° o 4" solid pipe ex-
^ n w ^ 1i - - * 0000 `��'�'�'� tending into
^ n n ti ` 0000
\\ . .4— drywell 1'
°p ° ° o .. ..;.. 4" hay or
r. I 1 M1 e o° 0 :* Y
T pe i q p q q q p e O � 00 0 I p ? •4fr • %4 :04 straw over rock •
;�± I �•0 CJ 400 4 p O oC o o t tr o c ," 0 • • • . • . • ..•Oi •
I
• Q O o p ot to dO 0 o t * >.
3' 1. 6' 1 3' *Size determined from perc test results
SIDE VIEW Backfill SIDE VIEW
lackfi l l kxxx�x hay Backfill
2'+ — �cn 4"
r straw 4" solid pipe to tan'
° g ° ,�•:
eS'. " grave over k�l!'�* ,
Cone . . 4" hay or straw
S 4" pipe fi — `V? 1 o p , gravel 4,', . : ' . ' , , s
Gravel
Q 0Opo a%opoo•• P y, �
00? es es CD ca ao o e9J, 6" Gravel 2 r �
0 0 0 0.1> °,$ ' 1? I L `Y Concrete rings or
0 0 0 p ° C e 0 0.0 under pipe ;',�� cinder blocks
.n4cP�eoo ° ,f'rP„o ° ° .' 1110 1' of gravel in
a bottom
n Seepage Bed LA Drywell n •
fl Other \OILI CTCYL6y 41,
•� f 4 e 3:77,
' r* &J 3• y 3
27, Q3 s / t,- 02 3 • , /'/
` 3 Flo
2\ir — 6
10 2 f i; 9; n 6 e
or
(1/ 2 �3 ini //ti
i3
L
2
0 0 .,
y ,,,,,,,, -
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, ,_____
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v • • 892 INrIuItATOR CON IACI'Olt —_
IrlJ A
per Dispersal A (0.5) (06 �) M0.6)
Mite 11111) ['ethanol Area Trench Picce's I1cd Pieces Trench or lIcd s
) :I Fr —
RAM ROOMS —EP Fn 5 1 247 ? 132 123 7 1413 13 1413 9
> r 1 41 11 169 9 16'? 10
2 141 223 141 25
3 423 141 21 i 1 1 ..,_i4 14 254 15
4 563 I E311 202 15 3313 10 330 20
6 1 270 — 90 135 7 162 9 162 10
2 154 309 103 154 1.1 1135 10 1135 11
2 15 2'
<.1
3 463 154 231 1'<? 270 113 17
4 617 206 30'? 16 370 20 370 22 --
7 1 292 97 146 13 175 9 175 10
2 167 `_ 333 111 167 9 200 11 200 12
-
3 ,uu 167 250 ].3 :dd 16 300 18
4 667 222 333 113 4 00 2I 400 24
13 r 312 TcIIIC I56 0 ID 0 — 1117 — 1 _ —
2 179 356 119 170 10 2.14 11 214 13
'535 1711 267 14 321 17 321 19
3 ',?3 428 26
4 713 238 356 19 47:.13 . _
9 1 331 110 165 9 190 1 I 190 12
2 1139 3713 126 113'7 10 227 12 227 14
3 567 1E39 2114 15 340 10 340 20
4 756 252 3713 20 454 24 454 27
1 - -_
— 141 1 16 — fir 9 209 11 209 13
2 200 390 133 199 11 23'? 13 a 23c
7 14
16 359 19 359 21
4 7797 266 3913
3 :597 26 6 390 21 4713 26 4713 29
11 — : ' , — T 2 2 — I — 70 :219 — 12 219 13
2 209 4113 139 209 11. e.5 l 13 251 23
3 627 209 :313 17 376 20 376
2'2 501. 27 :501 30
4 836 279 4111 . 12 5 14
--
302 12 7 191 I0 229 1
12 1 262 14 250 15
2 219 436 1.4.5 210 1 =.
3
655 211-3 327 17 393 21 393 31 4 137:a 291 436 23 : "i24_ :a] ye.4 ..
13 39 13 23
39E3 133 19''i' 11 239 14
1 j
2 227 454 151 227 12 213 15 273 16
3 6111. 22'7 341 111 409 22 409 24
0 .3 .),. _.a e. 0 .a J J . —_..
14 1 413 1311 246
11 2111 13 240 15
1 ' 113 15 2133 17
236 471 1:;'7 231, 13 `'' , 23 424 25
707 2:36 354 19 424
3 F. 30 566 3� - --
4 943 =:1. 471 2 r.�i X66 —
256 15
15 1 427 1.42 213 11 256 14
2 244 4013 163 244 13 293 16 293 113
3 732 244' 366 • 20 439 23 4:39 26
4 976 325 4011 26 5136 31 5136 35
441 147 221 12 265 14 265 16
16 1 252 ?:02 16 :302 113
2 2152 504 1 faf3 <..�•. I �`
3 756 25.2 37E1 20 454 24 454 27
4 100E3 :336 5011 27 605 32 605 36 „-
1 7 1 455 152 227 12 273 15 273 16
2 259 520 I73 260 14 312 17 312 19
3 779 :260 391 21 4611 25 4613 37
1.0.39 346 52() 2E1 623 33 623 .—
4 156 234 12 281
10 1 46B l..il :� 15 2E11 17 2v � .>
2 267 535 170 267 14 321 17 321 19
3 002 267 401 21. 4111 26 4131 29
4 1069 356 ;i : {;3 29 641 34 641 313