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HomeMy WebLinkAboutApplicationCommunity Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION TYPE OF CONSTRUCTION Property Owner: Michael and Angela Simpson Phone: ( 9743795589 Mailing Address: PO Box 1281 Glenwood Springs, CO 81602 Contractor: Larry Martin Construction Phone: ( ) 970.379,7188 M New Installation Engineer: Mountain Cross Engineering - Chris Hale Phone: ( ) 970.618.8814 • Alteration • Repair WASTE TYPE Building or Service Type: Single Family Residence #Bedrooms: 3 Garbage Grinder Distance to Nearest Community Sewer System: City of Glenwood Springs Was an effort made to connect to the Community Sewer System: Yes, it is not available Type of OWTS ® Septic Tank I ❑ Aeration Plant O Dwelling • Transient Use 0 Pit Privy I 0 Incineration Toilet • Comm./Industrial 0 Other • Non -Domestic Ground Conditions • Other Describe Final Disposal by II Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal ❑ Evapotranspiration 0 Wastewater Pond 0 Sand Filter ❑ Other 0 Well ❑ Spring 0 Stream or Creek 0 Cistern Water Source & Type 0 Community Water System Name City of Glenwood Springs INVOLVED PARTIES Property Owner: Michael and Angela Simpson Phone: ( 9743795589 Mailing Address: PO Box 1281 Glenwood Springs, CO 81602 Contractor: Larry Martin Construction Phone: ( ) 970.379,7188 Mailing Address: P.O. Box 0982 Glenwood Springs, CO 81602 Engineer: Mountain Cross Engineering - Chris Hale Phone: ( ) 970.618.8814 Mailing Address: 826.5 Grand Ave, Glenwood Springs, CO 81601 PROJECT NAME AND LOCATION Simpson Residence -1800 Midland Ave, Glenwood Springs Job Address: Assessor's Parcel Number: 218516200008 Sub. Lot Block Building or Service Type: Single Family Residence #Bedrooms: 3 Garbage Grinder Distance to Nearest Community Sewer System: City of Glenwood Springs Was an effort made to connect to the Community Sewer System: Yes, it is not available Type of OWTS ® Septic Tank I ❑ Aeration Plant ❑ Vault J 0 Vault Privy 0 Composting Toilet j ❑ Recycling, Potable Use 0 Recycling 0 Pit Privy I 0 Incineration Toilet ❑ Chemical Toilet 0 Other Ground Conditions Depth to is` Ground water table I Percent Ground Slope Final Disposal by II Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal ❑ Evapotranspiration 0 Wastewater Pond 0 Sand Filter ❑ Other 0 Well ❑ Spring 0 Stream or Creek 0 Cistern Water Source & Type 0 Community Water System Name City of Glenwood Springs Effluent Will Effluent be discharged directly into waters of the State? 0 Yes NI No CERTIFICATION Applicant acknowledges that the completeness of the application is conditional upon such further mandatory and additional test 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. 1 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 legal action for perjury as provided by law. I hereby acknowledge that I have read a d understand the Notice and Certification above as well as have provided the required informati �'elhis rroc ect and accurate to the best of my knowledge. Michael Simpson Property Owner Print and Sign 2.9.17 Date OFFICIAL USE ONLY Special Conditions: Permit Fee: 1.? :'= Perk Fee: Total Fees: 1 ' Fees Paid: / )°' Building Permit --� Septic Permit: ,se 4Sg3 Issue Dale: 211311 I- � Balance Due: i. , i BLDG DIV: •{�'-�� ���_•--Q„ 2-M-2017 APPROAL.• DATE `?D F 6 7 7,3 i23-/- 2 -to- 1 7