HomeMy WebLinkAboutApplication- PermitGarfield County
Building & Planning Department
108 8th Street Suite 401
Glenwood Springs, CO 81601 -
Phone: (970)945-8212 Fax: (970)384-3470
Project Address
CR 109
CARBONDALE, CO 81623 -
Owner Information
Parcel No.
Permit /vo. SEPT -11-09-1365
Permit Type: Septic Permit
Work Classification: New
Penni! Status: Active
Issue Date: 11/17/2009
Expires: 11/17/2010
Subdivision
239333200399
Address
Andrew Beuter
6195 CR 109
Carbondale CO 81623
Section Township Range
33
Phone
7
Cell
88
970-309-1645
Contractor(s)
Phone
Primary Contractor
Proposed Construction / Details
FEES DUE
Fee
Percolation Test
Septic Fee - New
Total:
Amount
$100.00
$73.00
$173.00
Valuation:
Total Sq Feet:
FEES PAID
$ 0.00
0
Inv Total Paytype Amt Paid Amt Due
Inv # SEPT -11-09-19882
$ 173.00 Check # 1609
$173.00
$ 0.00
Required Inspections:
For Inspections call : 1(970)384-5003
Inspection
IVR
See Permit Record
Building Department
Copy
Tuesday, November 17, 2009 2
GARFIELD 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.garfield-counrv.com
1
Parcel No: (this information is available at the assessors office 970-945-9134) 3.r
k—j, ti r—r\ prkdorot
2
Job Address: (if an ad ess has nottbbeeen assigned please rovide Cr, Hwy orStreetName & City) or and legal description
Ir�
ii id
ootElluu
3
Lot Siz t Subd.I Exemption:1D,7
tat No:C.� �� eB sit 1 t.A-469.. LVd-e'i4
4
Owner: (property owner)
C (4
Mailing Address
Gi4 S- 1? kicPl
Ph:
3c9 -1145
Ph;
Alt Ph:
1ta3-LH,2 -
Alt Ph:
Cgpir• �`7��
1�
M 'lin$ Addrs
6
Engineer:
Mailing Address
Ph:
Alt Ph:
7
PERMIT REQUEST FOR: New Installation ( ) Alteration ( ) Repair
8
WASTE TYPE: elling
)Other -
( )Transient Use ( )Commercial or industrial ( )Non- Domestic wastes
Describe
9
BUILDING OR SERVICE TYPE: 3 (f e %"&4 -
Number of bedrooms :i1i3 Garbage Grinder(1Ves ( )No
10
SOURCE & TYPE OF WATER SUPPLY: dAWELL ( )SPRING ( )STREAM OR CREEK ( )CISTERN
If supplied by COMMUNITY WATER, give name of supplier.
11
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS:
Depth to 1d Ground Water Table Percent Ground Slope
13
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
Septic Tank ( )Aeration Plant ( )Vault ( )Vault Privy ( )Composting Toilet
Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet
( )Other- Describe
14
FINAL DISPOSAL BY:
absorption trench, Bed or Pit ( )Underground
( )Wastewater pond ( )Other-
Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
Describe
15
Will effluent be discharged directly into waters of the state? ( )YES ( )NO
16
PERCOLATION TEST RESULT: (to be
Minutes
Minutes
Name, address & telephone of RPE who
Name, address & telephone of RPE responsible
completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
per inch in hole No.1 Minutes per inch in hole
No.3
No._
per inch in hole No.2 Minutes per inch in hole
made soil
absorption test:
for design of the system:
17
Applicant acknowledges that the completeness
the local health department to be made
issuance of the permit is subject to such
reports submitted herewith and required
and are d- - gned to be relied on by the
underst. • hat any falsificatio o, mis
andI -.al .c))ion•orperjury Os,ra ideq
- " —iar• -
OWN RS SIGNA URE
of
and furnished
terms and
to be submitted
local department
pr entatio
aw.
the application is conditional upon such further mandatory
by the applicant or by the local health department
conditions as deemed necessary to insure compliance
by the applicant are or will be represented to
of health in evaluating the same for purposes
may result in the denial of the application or revocation
and additional test and
for purposed of the evaluation
with rules and regulations
be true and correct to the best
of issuing the permit applied for
of any permit granted based
11 t/Ci
reports as may be required by
of the application; and the
made, information and
of my knowledge and belief
herein. I further
upon said application
—
DAT
Permit Fee:
Septic Permit #:
STAFF USE ONLY
"Vv
Building,8t Planning Dep :
Perk Fee: Total fees:
f 11r
APPROVAL
Issue Date:
Building Permit 4:
DATE