HomeMy WebLinkAboutApplicationGARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
www. tarfielcl-crwm x.n:ti1
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STAFF USE ONLY
Permit Fee:
`°7f
Perk Fee:
Parcel No: (this intonation is available at the assessors office 970.945-9134) 217 3 2 5 2 0 0 0 3 6
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Septic Permit #:
EPT— 9 --1 D --17 60
Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name E. City) or and legal description
16609sHwy 6 and 24 Parachte CO
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APPROVAL DATE
Lot Size: Lot No; Bloc No: Subd./ Exemptio :
44 Acres N/A N/A N/A
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Owner: (property owner)
TRI STATE TRUCKING, LLC
Mailing Address pc Box 789
VERNAL, UT 84078
Ph:
435-828-2456
Alt Ph:
970-625-1228
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Contractor. SAME AS OWNER
Mailing Address
Ph:
Alt Ph:
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Engineer: N/A
Mailing Address
Ph:
Alt Ph
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PERMIT REQUEST FOR: (X) New Installation ( ) Alteration ( ) Repair
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WASTE TYPE: ( )Dwelling ( )Transient Use ()Commercial or industrial ( )Non- Domestic wastes
( }Other -Describe
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BUILDING OR SERVICE TYPE: Sewage vaults associated with temporary construction trailer
Number of bedrooms
NS A
Garbage Grinder ( )Yes (X)No
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SOURCE & TYPE OF WATER SUPPLY: (_ )WELL ( )SPRING ( }STREAM OR CREEK (X)CISTERN
If supplied by COMMUNITY WATER, give name of supplier: water hauled to location by Stallion Oilfield Services
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DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
Town of Parachute - app. 6 miles to the Southwest
No - distance too great
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
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GROUND CONDITIONS:
Depth to PI Ground Water Table app. 80 feet Percent Ground Slope ` 1t)%
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TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
( )Seplic Tank ( }Aeration Plant ()Vault ( }Vault Privy ( )Composting Toilet
( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet
( )Other- Describe
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FINAL DISPOSAL BY:
( }Absorption trench, Bed or Pit ()UndergroundDispersal
( )Wastewater pond ( Other-Descn
)Above tO
on( )Above Geuni Pi persal f i l(l )Eovapootrtanspration (41 d finer
y permittedce �t
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Will effluent be discharged directly into waters of the state? ( )YES (4NO
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PERCOLATION TEST RESULT: (lo be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes N/A per inch in hole No,1 Minutes N/A per inch in hole
No.3
No._
Minutes N/A per inch in hole No.2 Minutes N/A per inch in hole
Name, address & telephone of RPE who made soil
Name, address & telephone of RPE responsible
absorption test: N/A
for design of the system: N/A
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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. I further
understand that any falsification or misrepre tation may result in the denial of the application or revocation of any permit granted based upon said application
and legal action for perjury as provid I . ,(� q7:2 -__L-0 Ail.,....:... -L- l0
OWNERS SIGNATURE DATE
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STAFF USE ONLY
Permit Fee:
`°7f
Perk Fee:
Total'`feees:
3•
Building Permit #:
119-9
Septic Permit #:
EPT— 9 --1 D --17 60
Issue Date:
io -1-3-9NO 10
Building & Planning Dept:
APPROVAL DATE