HomeMy WebLinkAboutApplicationEC Garfield Co
195 W. 14'h Street Puhlic Health 2014 Blake Avenue
Rifle, CO 81650 Glenwood Springs, CO 81601
(970)625-5200 (970)945-6614
QWTS PERMIT APPLICATION
TYPF OF
_
New In
BUILDING
Transient Use
❑ Other Describe
Property
Email Address:
Mailing Address:
Email Address:
Mailing Addres
Email Address:
Job Address:
Assessor's Parcel
Building or Service
n
Distance to Nearest Community Sewer System: AJ IT
Was an effort made to connect to the Community Sewer System:._ JN
Potable Water Source well ❑ Spring ❑ Stream orCreek
& Type ❑Community water System Name
❑ Cistern
Non -Domestic
Disposal(Y/N)
Garfield County Public Health Department— working to promote health and prevent disease
CERTIFICATION
Applicant acknowledges that the completeness of the application 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 purpose 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. I
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 and understand the Notice and Certification above as
well as have provided the required information which is correct and accurate to the best of
my knowledge.
Propert wner Print anSign Date
OFFICIAL USE ONLY
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Special Conditions:
Permit fee:
412.3-00
Total Fees:
412.3-60
Fees Paid:
* 12-3.°=
Building Permit
owTS Permit: Issue Date:
Balance Due:
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131.8 E- (MM
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Garfield County Public Health Department:
Signed Approval
Date
Garfield County
Public Health
Garfield County Public Health
2014 Blake Ave.
Glenwood Springs, CO 81601
Phone: (970) 945-6614 ext. 8150
OWTS PERMIT
KEEP AVAILABLE AT PROJECT SITE
Permit Number SEPT -6890
Permit Type X New X Repair X Remodel/addition X Tank only
Issue Date 06/08/2021 Expiration Date 06/08/2022
For inspections, call: 970-945-6614 ext. 8150 and call the Design Engineer, if applicable
Project Address: 16714 Hwy 82, Carbondale, CO 81623 Parcel No.: 239132202003
Owner Name: Jeremy Cerise Owner Phone: (970) 379-7908
Designed By: Odisea Consulting Engineers, Inc. Designer Phone: (970) 527-9540
Number of Bedrooms: Two 3 -BR SF Residences Minimum Tank Capacity: 1,000 -gallon each residence
Minimum Absorption: 3,086 ft' rock bed, 2,160 ft' chamber bed
Permit Conditions:
This OWTS Permit is approved on the condition of compliance with the report and design as
submitted via email after comments by GCPH by Odisea Consulting Engineers, Inc. dated May 28,
2021. Changes to the design and permit must be approved by Garfield County Public Health and the
designer prior to construction.
The new OWTS will serve two new 3 -bedroom residences, located on Lots 2 and 3 of the Cerise
Minor Subdivision. The system will consist of a new, two-compartment 1,000 -gallon septic tank set
level with access to grade and an effluent filter in the outlet tee of the tank for each residence.
Effluent will gravity feed to a distribution box set level with access to grade to distribute effluent to
either 3,096 ftz (rock bed) or 2,208 ft' (chamber bed) of STA. The new STA will consist of two
chamber beds, each with four rows of 23 Infiltrator Quick 4 chambers (184 chambers total) or three
rock beds. Inspection ports are to be installed at each corner of each bed. Maintain all setbacks and
elevations as designed.
Contact the designer and Garfield County Public Health at least 48 hours prior to requesting final
inspection of the installed system prior to backfill.
Agreement
All installations must comply with all requirements of the Garfield County OWTS regulations
including but not limited to the conditions specified above.
In consideration of the issuance of the permit, the applicant hereby agrees to comply with all
laws and regulations related to the zoning, location, construction, and erection of the proposed
OWTS and associated structures for which this permit is granted. The applicant further agrees
that if the above said regulations are not fully complied with in the zoning, location, erection,
and construction of the above described OWTS and structure, the permit may then be revoked
by notice from the Health Department and immediately become null and void.
The issuance of a permit and specifications of terms and conditions therein will not constitute
assumption of liability, nor create presumption that the local public health agency or its
employees may be liable for the failure or malfunctioning of any system. Permit issuance will
not constitute a certification that the system, the equipment used in the system, or any
component used for system operation will ensure continuous compliance with the provision of
the OWTS Act, the regulations adopted thereunder, or any terms and conditions of a permit.
Permit Approval
Plans and specifications for the proposed OWTS have been reviewed and are considered
satisfactory. Permission is hereby given to the property owner(s) to perform the work indicated
in accordance with the Garfield County OWTS Regulation. This Permit will expire 1 year from
the date of issuance unless construction on the system has commenced. An "as -built" drawing
must be submitted and inspection of the system must be completed by GCPH before final
approval of the system will be issued.
dtir � L
06/08/2021
Issued By: Garfield County Environmental Health
Department
Date