HomeMy WebLinkAbout02609 ,�- ,l
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit 2 6 r ' 9
•+ 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
4 a building or use permit.
PROPERTY
Owner's Name John M. Guilin Present Address 0284 Auburn Ridge, Glenwoodphone 928
System Location �y77 County Road327, Silt
Legal DApription of Assessors Parcel No., it
6de 'ctc < 4 t6n4H t7'GO
SYSTEM DESIGN 44 9. z /l7F /LYPr4T °R $ a s 1E4
µOat 8/O - •r. n6LA.s o I < EA-
1000 • Septic Tank Cpjcity (gallon) Other
/ ' / Mlie c ) (or other) 3 C lvO474KBAyE D/spa i6
/ A) d 'Per olation Rate minutes/inch Number of Bedrooms or other �
Required Absorption Area - See.A I S ; i
A" L
4 y
Special Setback
T
Date f ( Inspector '" / - 241 12
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer,) /4
Septic Tank Capacity / 2 S O ,J
Septic Tank Manufacturer or Trade Name __1/454 _/. 9 / ( //rJ r c
Septic Tank Access within 8" of surface. Y-e -L •
Absorption Area 22, J. / t/ r f (/T K 4 7(4
Absorption Area Type and /or Manufacturer or Trade Name
Adequate compliance with County and State regulations /requirements fj
Other
-' Date O p
- c- f‘ Inspector
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 ($500.00 fine — 8
months in Jail or both). r
White - APPLICANT Yellow - DEPARTMENT
•
1
INDIVIT)TJAT, SEWAGE DISPOSAT. SYSTEM APPI.ICATION
OWNER i /0�n j�», � &Lt. n
ADDRESS r) A- t)too rn121)T.Ln ( PHONE 9 z P 0 1 4/
CONTRACTOR ,9t c-'>' J 9'
ADDRESS n 2- Fq A-u Innr„e,) .A1 Pry PHONE 9? 7 -n I &(
PERMIT REQUEST FOR (I0EW 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). ,/�.
J °CATION OF PROPOSED FACILITY COUNTY kfid $ r: ,. 1 a
Near what City or Town S S c ' {' Lot
Legal Description
WASTES TYPE: (v)'1Swelling () Transient Use
( ) Commercial or Industrial ( ) Non - domestic Wastes
( ) Other - Describe
BUILDING OR SERVICE TYPE:
Number of bedrooms: 3 Number of persons 3
( ) Garbage Grinder ( ) Automatic Washer G....)- Dishwasher
SOURCE ANT) TYPE OF WATER SUPPT,Y: (■'WELL () SPRING () STREAM OR CREEK
Give depth of all wells within 180 feet of system:
If supplied by communtiy water, give name of supplier:
OROT INT) CONDITIONS:
Depth to bedrock:
Depth to first Ground Water Table:
Percent Ground Slope:
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: 5 ; r T /3 m ; LA-5
Was an effort made to connect to community system?
TYPE OF y21DIVIDUAL 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 D,ISPOSAL BY:
04 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?
S1LIT EXIT L •
• 70 WEST
TIJRN 1ST RIGHTT MAP N
SOUTH
COLORADO RIVER
TURN LENT N' _ E
RIGHT JTIJIIN RIGT
AT T ROAD
TO COLLRRAN
S
ABOUT 9 MILE TO PROPTERY
MAP DRAWN IN STRAIGHT LINES
BUT ROAD IS NOT STRAIGHT
331
327
AT Y STAY an
TURN RIGIIT
DIRT DAILY
ROAD ROUSE TURN
IL LEFT
_ 1
HOUSE
CEDAR LANE
I
11 G RAY
THE RANCH{
AT SILT //
. ¥
L.ATION TEST RF,S1 1iXS: (To be completed by Registered Professional Engineer) I
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 appliction 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 inusre compliance with
rules and regulations adopted under Article 10, Title 25, C.R.S. 1973, as amended. The undersigned hereby
certifies that all statements make, 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 bre relied on by the local department of health in evluating the same fro 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 r, granted based upon said application and in legal
action for perjury as provided by law. 0 (��
Sign-' — I / Date I/ ` LI 95
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COUDTY ROAD 327
HOUSE
HOUSE
` ���7201.83
THE RANCH NT SILT
22.72 ACRES
LANE
1342.57 SITE PLAN
PHRASE ONE
OLD 1441.67
WELL\ WELL TO
IIOUSE
Il ' BE INSTALLED
PERMIT #178977
W
E mum GULCH
200'
FROM
HOUSE
T
30'
L FROM Dm71 ROCKY MOUNTAIN BUILDERS
0284 AUBURN RIDGE LANE
GLENWOOD C.O.
176.40
SET BACK FROM PROPERTY
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