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Home My WebLink AboutApplicationIleGarfield County I 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 I— Property Owner: Chevron U.S A. Inc. Phone: 970 .) 683-4073 Mailing Address: 8311 County Road 215, Parachute, CO 81635 Email Address: rickcross@chevron.com ❑ New Installation • Alteration • Repair WASTE TYPE Email Address: PROJECT NAME AND LOCATION Job Address: 8311 County Road 215, Parachute, CO, 81635 (GPS Coordinates: 39,54097, -108.119138) • Dwelling • Transient Use Building or Service Type: Office Trailer #Bedrooms: 0 Garbage Disposal(Y/N) Y ■ Comm./Industrial I • Non -Domestic Type of OWTS I 0 Septic Tank I 0 Aeration Plant Iia Vault 0 Vault Privy Composting Toilet El Other Describe Manufactured Office Trailer 0 Recycling 0 Pit Privy 0 Incineration Toilet ❑ Chemical Toilet 0 Other INVOLVED PARTIES I— Property Owner: Chevron U.S A. Inc. Phone: 970 .) 683-4073 Mailing Address: 8311 County Road 215, Parachute, CO 81635 Email Address: rickcross@chevron.com Contractor: Sprinkler Professionals, (David Small) Phone: (970 ) 210-1795 Mailing Address: 160 County Road 301, Parachute, CO 81635 Email Address: david@spilandscape.com Engineer: Phone: ( Mailing Address: Email Address: PROJECT NAME AND LOCATION Job Address: 8311 County Road 215, Parachute, CO, 81635 (GPS Coordinates: 39,54097, -108.119138) Assessor's Parcel Number: 217118200008 Sub. SE/4 NE/4, Sec 8, TES, R96W Lot Block Building or Service Type: Office Trailer #Bedrooms: 0 Garbage Disposal(Y/N) Y Distance to Nearest Community Sewer System; 8 miles, Parachute, CO Was an effort made to connect to the Community Sewer System: No Type of OWTS I 0 Septic Tank I 0 Aeration Plant Iia Vault 0 Vault Privy Composting Toilet ❑ Recycling, Potable Use 0 Recycling 0 Pit Privy 0 Incineration Toilet ❑ Chemical Toilet 0 Other Ground Conditions Depth to 15t Ground water table 3° feel Well Percent Ground Slope t1 Final Disposal by 0 Absorption trench, Bed or Pit 0 Underground Dispersal I 0 Above Ground Dispersal ❑ Evapotranspiration 0 Wastewater Pond 0 Sand Filter I] Other Pump and haul by Redi Services, LLC 970-625-0233 Water Source & Type III Well 0 Spring 0 Stream or Creek 0 Cistern ❑ Community Water System Name Effluent Will Effluent be discharged directly into waters of the State? 0 Yes Et No Well Permit 275085 (Nov 2007) indicates water encountered at 30 feet. 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. Digitally signed by crossrd, Rick Cross crossrd, Rick Cross eDmN=iCc hkeCoossn@PcKhl,ecvn=c.rcoosmsrd, cn=Rick Cross, Date: 2019 09 03 17:23:06 -06'00' Property Owner Print and Sign Rick Cross Chevon Piceance Ranch Manager 9/3/2019 Date OFFICIAL USE ONLY A Special Conditions: toe?rrf f'Fee: Building Permit RLIAF i Perk Fee: Septic Permit: SSP -F. 5g4 BUILDING/ PLANNING DIVISION: Total Fees: •Vi.). -3 te: Fees Paid: 1 o13 -- Balance Due: Sign -rral 0' Date