HomeMy WebLinkAboutApplicationCGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county,corn
J
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
Property Owner: Casey Sheehan Phone: ( ) 303-775-1671
Mailing Address: 113 Crystal River Road Carbondale CO
Email Address: sheahancasey@gmail.com
• New Installation
Mailing Address: 1338 Grand Ave #294 Glenwood Springs, CO 81601
Email Address: Rey@pillc.co
El
Alteration
a
Repair
WASTE TYPE
PROJECT NAME AND LOCATION
Job Address: 113 Crystal River Road Carbondale CO
Assessor's Parcel Number: 2393-334-09-002 Sub_ Rock Creek Add Lot 2 Block
Building or Service Type: Residential #Bedrooms: 4 Garbage Disposal(Y/N) Y
Distance to Nearest Community Sewer System: None
Was an effort made to connect to the Community Sewer System: Yes
• Dwelling
•
Transient Use
0 Aeration Plant
• Comm./Industrial
Composting Toilet
• Non -Domestic
• Other Describe
0 Pit Privy '
0 Incineration Toilet
0 Chemical Toilet
0 Other
Ground Conditions
Depth to tst Ground water table
Percent Ground Slope 16%
Final Disposal by III Absorption trench, Bed or Pit
j 0 Underground Dispersal
INVOLVED PARTIES
Property Owner: Casey Sheehan Phone: ( ) 303-775-1671
Mailing Address: 113 Crystal River Road Carbondale CO
Email Address: sheahancasey@gmail.com
Contractor: Phoeinz Industries LLC Phone: ( ) 970-6184 on
Mailing Address: 1338 Grand Ave #294 Glenwood Springs, CO 81601
Email Address: Rey@pillc.co
Engineer: All Septic Service Phone: ( ) 970-309-5259
Mailing Address: 33 Four Wheel Drive Carbondale CO 8162.3
Email Address: carla.ostberg@gmail.com
PROJECT NAME AND LOCATION
Job Address: 113 Crystal River Road Carbondale CO
Assessor's Parcel Number: 2393-334-09-002 Sub_ Rock Creek Add Lot 2 Block
Building or Service Type: Residential #Bedrooms: 4 Garbage Disposal(Y/N) Y
Distance to Nearest Community Sewer System: None
Was an effort made to connect to the Community Sewer System: Yes
Type of OWTS
® Septic Tank
0 Aeration Plant
I 0 Vault I 0 Vault Privy
Composting Toilet
❑ Recycling, Potable Use
0 Recycling
0 Pit Privy '
0 Incineration Toilet
0 Chemical Toilet
0 Other
Ground Conditions
Depth to tst Ground water table
Percent Ground Slope 16%
Final Disposal by III Absorption trench, Bed or Pit
j 0 Underground Dispersal
0 Above Ground Dispersal
❑ Evapotranspiration
0 Wastewater Pond
0 Sand Filter
❑ Other
Water Source & Type
O Well
0 Spring 0 Stream or Creek
1-
r
0 Cistern
0 Community Water System Name T.
Effluent
Will Effluent be discharged directly into miters 4f the State
Yes
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.
Property Owner Print and Sign
05-30-2018
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Feer
r Perk Fee: _ &
Total Fees: , :
Fees Paid:
Building Permit
Septic Permit:
s`/
Issue Date: i3) r
Due:
i`Balance
vc
BUILDING/ PLANNING DIVISION:
'
64
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Sign
al
Date
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