HomeMy WebLinkAboutApplicationGarfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPTICATION
,juT{ 0 I ?tl1'¡
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 8L601
(970194s-8212
www.garfield-countv.com
TYPE OF CONSTRUCTION
tr New lnstallation tr Alteration tr Repair
WASTE ÏYPE
tr Dwellins E Transient Use tr Com m./lndustria I n Non-Domestic
E other Describe
INVOTVED PARTIES
Property OWnef: Richard Neiley and lvaria lvlaniscalchi
Mailing AddfeSS: 6800 H¡ghway 82, Suit 1
Phone: ((e7o)e48-eps3
Email Address: ryneilev@sopris.net
Phone: ((e7o) e48-4)l77COntf aCtOf : Owner(Rick Neiley); l\¡ountain Works(Gavin Grifiìths)
Email AddfeSS: griff¡thssavin@hotmail.com
Mailing AddfgSS: lvlountain Works PO Box 3260, Basalt, CO 81621
Carla Ostberg, i\,,lPH, REHS, NAWT Certified lnspector, Certifìcation# 11044ïc PhOne: ((970) 704-ry84Engineer:
Emai I AddfeSS: carl.aostberg@gmail.com
Mailing AddfeSS: CBO lnc.33 FourWheel Drive Road, Carbondale, COB1623
PROJECT NAME AND LOCATION
Was an effort made to connect to the Community Sewer System:
Job Address:4412-4418CounlyRoad 154, Glenwood Springs, CO 81601
nla
Distance to Nearest Community Sewer Syste m. 5 miles
seryice nol available / not in RF San Dist
Building or Service Type:residentiâl #Bedrooms: 4 Garbage Disposal(Y/N) Y
ASSeSSOT'S Parcel Numbe¡' 218536313001 SUb.Lot Block
E vault Privy Composting ToiletEI Septic Tank El Aerat¡on Plant E Vault
E Recycling E eit erivy E lncineration ToiletE Recycling, Potable Use
E other
Type of OWTS
E Chemical Toilet
Percent Ground SlopeGround Conditions Depth tO ltt GrOUnd water table 50feet
E Absorption trench, Bed or Pit E Underground Dispersal E Above Ground Dispersal
EI Wastewater Pond E Sand FilterE Evapotranspiration
E other
Final Disposal by
tr well fl Spring E Stream or Creek E cistern
fJ Community Water System Name
Water Source & Type
Effluent Will Effluent be discharged directly into waters of the State? E Yes E l¡o
Applicant acknowledges that the completeness of the application is conditiona! upon such further
mandatory and additional test and reports as may be required by the local health department to be
made and fr¡rnished by the applicant or by the local health clepartment for purposecl of the evahration
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
deþartment 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 denialof the
application or revocation of any permit granted based upon said application and legal action for perjury
as provided by law.
I
h
acknowledge that I have read and understand the Notice and Certification above as well as
the required information which is correct and accurate to the best of my knowledge.
alslt+
Pro Owner Print and Sign o^1" I
FD {K.P¡M t7Ç, V lqlt+
Taur fi7¡rnt**n+ UwfSpecial Conditions:
Total Fees 4{Fees Paid:vçPermit Fee w Perk Fee:
Permit:Seotic
-I Dí_lssue Date:l-, t2,17-
Balance Due:
ú
Building Permit
S[,pf- \1TW
BUITDING/ PLANNING DIVISION:
t
éf,4
Date