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GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT Permit' I V: 2456 .‘, ,
109 8th Street Suite 303 Assessor's Parcel No.
Glenwood Springs, Colorado 81601
Phone (303) 945 -8212 t° ft
This does not constitute
INDIVIDUAL SEWAGE DISPOSAL PERMIT
e building or use permit. {
PROPERTY ih
Owner's Name Barbara Ormsby Present Address 7 Sugarbush Lane, Ancover,p ps. � �
System Location 0392 Springridge Drive, Springride, Lot 18, Glenwood Springs
Legal Description of Assessor's Parcel No. �\
SYSTEM DESIGN J '"
Lai
/ 55n Septic Tank Capacity (gallon) Other 0 a,
Percolation Rate (minutes /inch) Number of Bedrooms (or other) 4 'f4
j 1"
Required Absorption Area - See Attached C'
Special Setback Requirements: yy
fi
Date — Inspector d t
FINAL SYSTEM INSPECTION AND APPROVAL (as installed) (
Call for Inspection (24 hours notice). Before Covering Installation s i
System Installer_ - .4.c.•e_cl,, t - l )'
k u
Septic Tank Capacity /,- 1 ( 0
n 3 '
r
Septic Tank Manufacturer or Trade Name ,c-a -t
$ t 4 '
Septic Tank Access within 8" of surface y E . C
y ' +,
Absorption Area
,, 4
Absorption Area Type and /or Manufacturer or Trade Name 1 - ` a ..
Adequate compliance with County and State regulations/requirements I7 f S
Other 4 ,-)i) J Pc S . ,,1 " P¢ it-i_ t / t p r s `'
/ �� _ � x
Date SC' g=C' tag -` Inspector _
++�1 RETAIN WITH RECEIPT RECORDS`AT CONSTR. CTION SITE '�
*CONDITIONS: Rrrd bn Al c,50 , 6 a ':
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. t
2. This permit is valid only for connection to structures which have fully complied with County zoning and building requirements. Con- 7, ' ,
nection to or use with any dwelling or structures not approved by the Building and Zoning office shall automatically be a violation or a N:, It
requirement of the permit and cause for both legal action and revocation of the permit. • p
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 1, Petty Offense ($500.00 fine — 1
• months in jail or both).
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Applicant: Green Copy Department: Pink Copy
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1111]1YIDUALSP4WAGEMISWSALSYST M_APP'JCATION d
OWNER t•_, . t S .
ADDRESS
( 't S L r — - ° ' ._ p1 1ONa
CONTRACTOR . • e ' S S W PIIONE
ADDRESS + •
PERMIT It riQUES'f 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 hole.
(See page 4). COUNTY Near whin City ar' 1'IONSyC >'' rown P.R -Cl 13 � Lot 51
Near what . v vN
Legal Description a 0 Al `
Dwelling O Transient Use
aYAS "1TS "CYa_[.:
Commercial or Industrial ( ) Non - domestic Wastes
O Other - Describe
BUILDING OR SFRVICfs '1'YPP.: -- Number of persons ■
N of bedrooms: $ AuUPtomatic Washer Dishwasher
(Garbage Grinder SWELL O SP ZING () STREAM OR CREEK
SQUIiCP..A23I21.Y1'�QF.,'+IATC: L.SP_WC: Y'
Give depth of all wells within 1811 feet of system:
1f supplied by community water, give name of supplier: 21 d'
iaROUNR _CON
Depth to bedrock: T
Depth to first Ground Winer Table: '
Percent Ground Slope:
DIS'TANCETO NEAltl'sS'I'COMMUNI'T'Y saw E SYSTEM:
Was an effort made to connect to commmmity system?
TY PE OP INDIVIDUAL. SEWAGE DISPOSAL. SYSTEM PROPOSED:
Aeration Plant ( ) Vault
(�O Vau lt Privy ( Recycling,
O Vauh Privy ( Composting `Toilet ( otable use P
( ) Pit Privy ( ) Incineration Toilet ( ) Recycling, other use
( ) Chemical Toilet ( ) Other - Describe:
FINAL. DISPOSAL BY: P.va olrans iration
p Absorption 'french, Bed or Pit ( P P
( Sand Filter
( Underground Dispersal (') Wastewater Pond ) Above Ground Dispersal
( ) Other - Describe:
WILL EFFLIJEN"I' BE DISCIIARGED DMflefLY INTO WATERS OP THE STATE? 1 I
,\� l : 1'o be completed by Registered Professional Engineer)
,iS � ____ C.S'f_IiL inch i S f Minutes per inch in Hole No. 3
Minutes per inch in hole No. I Minutes per inch in Hole No.
Minuses per Inch in bole Nn. 2
Jibs./ Nance, address and telephone of RPR who made soil absorption tests: e-- a O
Nance, address and telephone of RPR responsible for design of the system
Applicant acknowledges That the completeness of the appliction is conditional upon such further mandatory
and y the i al t by the reports local be health depart department required
pu rposes the evaluation of the application; and the
issuance tan pplicant or Y
rule elf fife lationsl conditions
ad0 ted under Article 10, T Ile25, C.R S deemed `1973, as amended. The undersigned hereby
eby
cures and raga a 1
by the
certifies that all t uae will b e represented to be true and l correct l to the best of my knowledge and belief and
by
are designed to bra relied on by the local department of health in evluating the same fro purposes of issuing
in
the permit applied for herein. 1 further understand that n any Falted ba o ii or
a ent an result legal
denial of the application or revocation of any permit
action for perjury as provided by law.
Date
J
Signed — bae.��
I'LL'ASILDRAW AN ACCU1tATII_MA _ FQYQl.. ILPROPEICEY.
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