HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
F21' New Installation
•
Alteration
• Repair
WASTE TYPE
• Comm./Industrial
�
_
I Non -Domestic
Dwelling E Transient Use
I
• Other Describe
INVOLVED PARTIES
Property Owner: - Patrick Morrissy and Jean Campbell
Mailing Address:
Email Address:
10 Walnut Court, South Orange, NJ
07079
Phone: ( _ )
patrick.morrissy@grnail.com
Contractor: Phone: (
Mailing Address:
Email Address:
Engineer: ALL SERVICE septic LLC Phone: ( 970-30)9-5259
)
Mailing Address:
Email Address:
33 Four Wheel Drive Road
Carbondale, CO 81623
carla.ostberg@gmail.com
PROJECT NAME AND LOCATION
Job Address:
TBD Cedar Street
Assessor's Parcel Number:
2393-284-10-004
Sub. Cooperton Townsite
Building or Service Type: residential
Lot 21-27 Block 10
#Bedrooms: 4 Garbage Disposal Y
Distance to Nearest Community Sewer System: n/a
Was an effort made to connect to the Community Sewer System:
not available
Type of OWTS
Septic Tank I 0 Aeration Plant
0 Vault
0 Vault Privy 0 Composting Toilet
O Recycling, Potable Use
O Chemical Toilet
❑ Recycling
0 Other
0 Pit Privy 0 Incineration Toilet
Ground Conditions
Depth to 1" Ground water table 'T
Percent Ground Slope 0-5o/°
Final Disposal by
O Absorption trench, Bed or Pit
'O Underground Dispersal
0 Above Ground Dispersal
O Evapotranspiration
O Wastewater Pond
47 Sand Filter
❑ Other
Water Source & Type 0 Well 0 Spring
0 Stream or Creek
a Community Water System Name Carbondale
0 Cistern
Effluent
Will Effluent be discharged directly into waters of the State? 0 Yes Ki No
CERTIFICATION
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 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.
Olivia Emery for Patrick Morrissy and A -
Jean Ray Campbell
Property Owner Print and Sign
1.24.17
Date
OFFICIAL USE ONLY
Special Conditions:
Pgmit Fe ad
�
Perk Fee:
CI
Tot I Fees: ��
ia3.
Fees Paid:
lra3 .
Building Permit
ZLIZE
SeptictiPermit:
/ '
Issue Date f' I _ i
Bai�nceM uez
f
BLDG DIV: 11/�
�i• 2�If'p/ �1�
APPROVAL
DATE
y'zUd '.? .I�00
Va Ian