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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2874
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212
This does not constitute •
INDIVIDUAL SEWAGE DISPOSAL PERMIT a building or use permit.
PROPERTY
Owner's Name Tom Willcoxen Present Address 3800 034 /Age Rd, G. S. Phone_ 844 9 49
System Location • 1 P e•ta•r 1•.1 1- • ._ -.
Legal Description of Assessor's Parcel No.
SYSTEM DESIGN
j O � I 0 l/ Septic Tank Capacity (gallon) Other
//M w4
u. /1/9 Percolation Rate (minutes /inch) Number of Bedrooms (or other) 3
Required Absorption Ara" - See Attached
Special Setback Requirements:
Y / F
Date /0-6- 9 ! Inspector 7 , �•'� �'" a d > c , ' -0 0 • 5
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer � / 0 r `
0 9
Septic Tank Capacity 1 0 0 C N-� n r
Septic Tank Manufacturer or Trade Name C d /' `-- ( -4 !& / -
Septic Tank Access within 8" of surface Y C $
Absorption Area 3 ` 2_ e r t .t
Absorption Area Type and /or Manufacturer or Trade Name j �( �- i L 1 it A 7 0
Adequate compliance with County and State regulations/requirements y C S
Other
Date 1 1 " • 1 3 elt Inspector A y
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-
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 (8500.00 fine — 8
months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
INDIVIDUAL SEWAGE DISPOSAL SYSTEM APPLICATION
OWNER f/ n _/
ADDRESS (Lt AI4 l.d � PHONE Sys- 9339
CONTRACTOR G�, /.� iatt v • ^ �� q ,/
ADDRESS 842 10 MAIM - C PHONE 6V 0 171
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: mil/ /
Near what City of Town - /Yl /�f. 11 <WDOci' J�• Size oELot
Legal Description or Address? 6e . Z95' d
WASTES TYPE ( DWELLING ( ) TRANSIENT USE
, ( ) COMMERCIAL OR INDUSTRIAL ( ) NON - DOMESTIC WASTES
( ) OTHER - DESCRIBE
BUILDING OR SERVICE TYPE:COtlST 0't pt — ✓ - OCA! iron ay /e - 3
Number of Bedrooms .3 Number of Persons y
(K Garbage Grinder ( 14? Automatic Washer (') Dishwasher
$OI JRCE AND TYPE OF WATER SUPPLY (k) WELL ( ) SPRING ( ) STREAM OR CREEK
If supplied by Community Water, give name of supplier:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: -
Was an effort made to connect to the Community System ?4(4
• • I, i r•s ir• )• 'mi •• h. 'tsi t • h• NIu M'' ,n • •
Leach Field to Well: 100 feet
Septic Tank to Well: X 50 feet
Leach Field to Irrigation Ditches, Stream or Water Course: A 50 feet
Septic System to Property Lines: 4' 10 feet
YOUR INDIVIDUAL. SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED
WITHOUT A SITE PLAN,
GROTIND CONDITIONS:
Depth to first Ground Water Table
Percent Ground Slope
2
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM PROPOSED:
( ) 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 DISPERSAL ( ) WASTEWATER POND
( ) OTHER - DESCRIBE
WILL EFFLUENT BE DISCHARGED DIRECTLY INTO WATERS OF THE STATE?
pFRCOLATION TEST REST TITS: (To be completed by Registered Professional Engineer, if the Engineer does
the Percolation Test) Seat A'4
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 =phone tele phone f f RPE who ma ig soil absorption tests: (. n- t�pt'SO'7V
a 3 y �t , ,4e - / � b fritraa d 94' s - 28oi
Name, address and telephone of RPE responsible for design of the system- c+'- 67,
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 ,�/t Date / // t 7
tell ( all t Gt •
PLEASE DRAW AN ACCURATE 1 TO YOUR PROPERTY!!
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. drain board should be compacted to at least 95 percent of standard Proctor
maximum dry density (ASTM D 698). The upper two feet of backfill against the wall
1 should be with on -site clays (see Figure 6). The provision of a foundation drain
should reduce hydrostatic pressure which could develop.
lir
PERCOLATION TESTING
C
I
#i We performed percolation tests at locations shown on Figure 1. Test results
I ranged from 20 to 30 minutes per inch. We recommend a design percolation rate
it of 40 minutes per inch. Test results on shown in Figure 7.
rv,
SURFACE DRAINAGE
i { .; he performance of foundations and concrete fiatwork is influenced by the
E w moisture conditions in the subsoils. Wetting of foundation soils can be reduced by
grading the ground surface to cause rapid run -off of water away from the building.
Wetting or drying of the open foundation excavation should be avoided. During
I spring snowmelt sheetwash can be expected to occur over ground surfaces at this
I
site. We suggest incorporating a drainage swale into the landscaping scheme uphill
of the building to channelize and direct surface run -off down, around and away from
' the building. In addition, the ground surface surrounding the building should be
sloped to drain away from the building in all directions. We recommend a slope of
_ at least 12 inches in the first 10 feet. Landscaping such as grasses that require a
significant amount of water should be avoided within 10 feet of the building.
Sprinkler heads should be at least 10 feet from the building and directed away from
the building. Roof downspouts and drains should discharge well beyond the limits
of all backfill. Splash blocks or downspout extensions should be provided at all
discharge locations.
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MR. TOM WILLCOXEN
CTL/T GS-2189 7
,
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