HomeMy WebLinkAboutApplicationGarfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrsl
PERMIT APPLICATION
Community Development Department
RECEIVED 1oB 8th Street, Suite 401
Glenwood SPrings, CO 81601AUü232t1& p7olsus-szLz
GARFIELD6gUI.¡1@
COMMUNITY DEVELOPMENT
TYPË OF CO.ÊTSTRUCNON
tr New lnstallation tr Alteration tr Repair
WÀSTSTYPE
tr Dwelling E Transient Use tr Comm./lndustrial tl Non-Domestic
E Other Describe
II*VOIVES PARÏIES
Phone: g, ) 913-5405PropertyOWnef: Nona N¡land
Mailing Add ¡ggg1 2331 County Road 100, Cârbondale, CO 81623
Email Address:nonaniland@me.com
COntfaCtOf : Holmes Excavat¡on
Mailing AddfeSS: PO Box 1269, Carbondale, CO81623
phone: (e7o 1379-2245
Email Address:
Email Address:
Engineen All Seru¡ce seplic Phone: (eio )309-5259
Mailing Address:33 FourWheel Drive Road, Carbondale, CO I1623
Was an effort made to connect to the Community Sewer System:
Crr b. Coffman Ranch n parcel
Distance to Nearest Community Sewer System:112 mile
no
Job Address:233'1 County Road 100, carbondale, CO 81623
Building or Service Type:Residenlial
.P.RO""JECTNAME AND TOCAT|ON
Assessor's ParCel NUmber: 2se33M0o271
#Bedroomsr 4 Garbage Disposal(Y/Nln
Lot z Block
Compost¡ng To¡lettlEl Aeration Plant E vault El vault PrivyE septicTank
E Pit Rrivy E lncinerat¡on Toilet[1 Recycling, Potâble Use E Recycling
E chemical Toilet E other
Type of OWTS
Percent Ground Slope 1t20/"Ground Conditions Depth to lst Ground water table 2'+
E Underground Dispersal E Above Ground DispersalE Absorption trench, Bed or Pit
E Sand FilterE Evapotrðnspiration E Wastewater Pond
E other
Final Disposalby
E stream or creek E CisternE Well E Spring
E Community Water System Name
Water Source & Type
Effluent Will Effluent be discharged directly into waters of the State? El Yes El ¡lo
' crRnrrcenon¡
Aoolicant acknowledges that the completeness of the application is conditional upon such further
;i#àä;ï;;d ;äãiti;;;ítäii.nà reþorts a.s Tay be required by the local health department to be
"iãäËåño'rüir-r¡ãj
uv tne ãpplicant br.by the toéal he.alih department for pu.rposed.of the evaluation
;iìh¿äpór¡ðri¡ıñ;ánitÏãiiiüánàã otthé permit is subject to such terms and conditions as deemed
necessary to insure .oról¡r* *¡* ruiàt ánd regu.lations made,.information and reports submitted
f.rãiı"r-¡if.r'rnd requireJ lå Ui irUritted by the apþl.icant are or will be rep.resented t.o be true and
tãii"åftoìf'Ë ¡ãLi of mv tnowL"ag" and belief ånd are designed to be relied on by the.local
ããorrtìrìãnt ór néaltn ¡n'eváiuatinf the sarn" for purposes oi issuing the. permit a.pplie.d for herein. I
i;ih;;';;d;;itãnäîr'àt ãny rilsitiıation or misrepresentation may result.in the denial of the
aöpt¡cat¡on or revocatio*n äi.ñv permit granted based upon said application and legal action for perjury
as provided by law.
I hereby acknowledge that I have read and understand the Not¡ce and Certification above as well as
have provided the required i nformation which is co and accurate to the best of my knowledge.
8t2212018
Property Owner Print an d Sign Date
I ü!ù 3g5l$ ++ıOFFICIAT USE ONIY I
AD1J obove gøroge addition is specíficolty not allowed without fìrst obtalnlng ø land use
chonge permit per Buitding Permit #BLRE-03-78-5144 Conditions oÍ Perm¡t'
Speclal Condltlons:
Paid q5FeessI Fees:@Perk Fee:Permit Fee oo
Bala ooDue:lssue Date:Septic PermBuilding Permit
øl-24/øtø
BUILDING/ PLANNING DIVISION
Signed Approval
I
Date