HomeMy WebLinkAboutApplicationGarfield County
nt
ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
tr Repairtr AlterationEl New lnstallation
WASTË TYPE
tr Comm./lndustrial Non-Domestictrtr Dwelling Ef Transient Use
E Other Describe
INVOTVED PARTIES
Property OWnef: BUCHMAN, ED&MICHELLE Phone: ( )
Mailing Address:PO BOX669, CARBONDALE, CO,81623
Email Address:
Contractor:Teral¡nk (Builder) / Dirt Devil (Êxcavation Company)Phone:
Mailing Address:PO Box 1242, Càlbondale, CO 81623
Email Address:andy@teralinkstructurss.com
Engineer:ALL SERVICE sept¡c, LLC Phone:
Mailing AddfeSS: 33 Four\¡vlìael Drive Road,
Email AddfeSS: ærla.ostberg@gmail.com
PROJECT NAME AND LOCATION
Job Address:574 Crystal Road, Carbondâle
AsSeSSOI'S ParCel Number: 2463441-os413 SUb.Rock Creek Subdivision Lot 12-13 Block
Building or Service Type: sinsle ram¡ly residenæ #Bedrooms: 3 Garbage Disposal(Y/N)-
D¡stence to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:yes/ RVR (not feasible)
Type of QWTS El SepticTank E Aeration Plant û Vault E Vault Privy ñ CompostingToilet
El Recycling, Potable Use E Recycling [1 eit erivy E Incineration Toilet
E Chemical Toilet E other
Ground Conditions Depth to lst Ground watef table gresterlhan6 ñ Percent Ground Slope ù5%
FinalDisposalby El Absorption trench, Bed or Pit E Underground Dispersal El Above Ground Dispersal
E Evapotransp¡rat¡on E Wastewater Pond El Sand Filter
E other
Water Source & Type E well E Spring tl Stream or Creek E cistern
E Community Water System Namg Rock Cresk Subdiv¡s¡on
Effluent Will Effluent be discharged directly ¡nto watcrs of the stete? El Yc¡ E lto
I CERTIFICATION
Applicant acknowledges that thc completeness of the application is conditiona! Vpgn such further
nìa'ndatory and additional test and reports as may be required by the local health department to be
nrade ¿rid'furnislred by tlie 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 app[iqd 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 which is correct and accurate to the best of my knowledge.
Print and Date
OFF¡CIAI UsE ONIY
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Special Conditions:
Total Fees:lL'j to FeesPaid: ln rlrlPermit Fee:
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Balance Due:
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Seotic Permit:(rpr'íztT lssue Date: i ,
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Signed Approval Date