HomeMy WebLinkAboutApplicationGARFIELD COTINTY SEPTIC PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Encono Pad P28, PAT 308
Submitted *Uffi f"^porory
Employee Housing
Phone: 970-945-8212 I Fax:970-384-3470 I Inspection \b wrWur
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I Parcel No: (this information is available at the assessors office 970-945-9134) t9t7-274-OO-O\2
2 Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
Section 28, T4S, R96W / directions provided with Site Plan
3 Lot No:n/a Subd./ Exemotion:n/aBlock No:
00Lot Size:
Ph:
91 0-285-2600
AIt Ph:Mailing Address
2717 CR215, Parachute, CO
4 Owner: (property owner)
Encana Oil & Gas (USA) lnc
AIt Ph:
97 0-2A5-2825
Ph:
97 0-285-2600
Contractor:
F:neana Oi 1 & Gas (USA) Tnc
Mailing Address
271,1 CF.2I5, Parachute, Co
5
Ph:
435-78L-2501
AIt Ph:Engineer:
TriState Land Surveying, Inc
Mailing Address
180 N.Vernal Ave, Vernal, UT
6
7 PERMIT REQUEST FOR:(x) New lnstallation ( ) Alteration ( )Repair
8 ( )Dwelling( )Other -
( )Non- Domestic wastes( )Commercial or industrialWASTE TYPE:( x)Transient Use
9 BUILDING OR SE
Garbage Grinder ( )Yes ( )No
t Non-residential
Number of bedrooms
l0
lf supplied by COMMUNITY WATER, give name of
SOURCE & TYPE OF WATER SUPPLY
ll
Was an effort made to connect to the Community System?
DISTANCE TO NEAREST COMMUNITY SEWER
YOU R INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
t2
Depth to lstGround Water Table- Percent Ground Slope-GROUND CONDITIONS:
l3 TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:()SepticTank ()AerationPlant (x)Vault
( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy( )Other-
( )Vault Privy
( )lncineration Toilet
( )Composting Toilet( )ChemicalToilet
l4 FINAL DISPOSAL BY:
( )Absorption trench, Bed or Pit
( )Wastewater pond
( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
8c )Other- Describe water hauled mrrnic.i naIitw
l5 state? ( )YES (x)NOWill effluent be discharged utwaters IE1lorrecuy rnro
t6 PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes-perinchinholeNo.1Minutes-perinchinholeNo.3
Name, address & telephone of RPE responsible for design of the system:
Name, address & telephone of RPE who made soil absorption
per inch in hole No.2 Minutes- per inch in hole No.-
Applicant acknowledges that the completeness of the application is conditional upon
the local health department to be made and furnished by the applicant or by the local
issuance of the permit is subject to such terms and conditions as deemed necessary
such further mandatory and additional test and reports as may be required by
health department for purposed of the evaluation of the application; and the
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 conect to the best of my knowledge and belief
and are designed to be relied on by the local deparlment 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 lhe denial of the application or revocation of any permit granted based upon said application
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SIGNATURE Eckman /tt es DATE e/20/20IL
Building Permit #:
BLro -9- tl - )L,q
Perk Fee:
Enf-D
Total fees:
a3
Permit Fec:
-+3
Issue Date:q-,o-Aot I5Epl-Q -tt-)).33
Septic Permit #:
APPROVAL
Bu
3
& Planning