HomeMy WebLinkAboutApplicationGarfield CounPublic Healthty
195 W. 141h Street EC2014 Blake Avenue
Rifle, CO 81650 Glenwood Springs, CO 81601
(970) 625-5200 (970) 945-6614
OWTS PERMIT APPLICATION
TYPE OF SYSTEM CONSTRUCTION
ElNew Installation 10 Alteration T9 Repair
BUILDING USAGE TYPE
® Dwelling ❑ Transient Use ❑ Comm./Industrial �❑ Non -Domestic
❑ Other Describe
INVOLVED PARTIES J
Property Owner: Vicco II, LLC Phone: ( 303) 570-1157
Mailing Address: 607 Westbank Rd, Glenwood Springs, CO 81601
Email Address: vicco1@comcast.net
Contractor: Altitude Septic Phone: (970 ) 471-0913
Mailing Address: PO Box 1534, Eagle, CO 81631
Email Address: altitudeseptic@gmail.com
Engineer: Phone:( 1
Mailing Address:
Email Address:
PROJECT LOCATION AND DESCRIPTION
Job Address: 45755 Hwy 6, Glewood 5 rin s, CO 81601
Assessor's Parcel Number: 212336200007 Sub. Lot Block
Building or Service Type: Residence #Bedrooms: 3 Garbage Disposal(Y/N) Y
Distance to Nearest Community Sewer System:
Was an effort made to connect to the Community Sewer System:
Potable Water Source
& Type
❑ Well ❑ Spring
❑ Stream or Creek
❑ Cistern
12 Community Water System Name Canyon Creek Water
Garfield County Public Health Department — working to.promote health and prevent disease
CERTIFICATION
Applicant acknowledges that the completeness of the application is conditional upon such further
mandatory and additional tests 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 purpose 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.
�I� 2
Property Owner Print and Sign
2/24/2021
Date
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
$75.00
Total Fees:
$75.00
Fees Paid:
$75.00
Building Permit
N/A
QWTS Permit:
SEPT-6709
Issue Date:
7Z,-z &(� z,
Balance Due:
$0.00
Garfield County Public Health Department: 44 p
Signed Approval Date
Page 5 of 3
L pdaled 17cc 2013
Lq~. Garfield Coun__T] ty
Public Health
Garfield County Public Health
2014 Blake Ave.
Glenwood Springs, CO 81601
Phone: (970) 945-6614 ext. 8150
Permit Number SEPT-6709
OWTS PERMIT
KEEP AVAILABLE AT PROJECT SITE
Permit Type X New X Repair X Remodel/addition X Taink only
Issue Date 03/04/2021 Expiration Date 03/04/2022
For inspections, call: 970-945-6614 ext. 8150 and call the Design Engineer, if applicable.
Project Address: 45755 HwV 6, Glenwood Springs, CO 81601 Parcel No.: 2123-362-00-007
Owner Name: Vicco II, LLC
Owner Phone: (30) 570-1157
Contractor: Altitude Septic Contractor Phone: (970) 471-0913
Number of Bedrooms 3 Minimum Tank Capacity 1,000-gal_Minimum Absorption_
Permit Conditions:
This OWTS Permit is approved on the condition of compliance with the application and description
of work specifying tank as submitted by Altitude Septic dated February 21, 2021. Changes must be
approved by Garfield County Public Health and the designer prior to construction.
A failing septic tank at the property will be replaced with a 1,060-gallon infiltrator Poly septic tank.
The installed tank shall be on the Colorado Department of Public Health and Environment (CDPHE)
approved septic tank list for OWTS installations.
Contact Garfield County Public Health at feast 48 hours prior to requesting final inspection of the
installed system prior to backfill.
Agreement
All installations must comply with all requirements of the Garfield County OWTS regulations
including but not limited to the conditions specified above.
In consideration of the issuance of the permit, the applicant hereby agrees to comply with all
laws and regulations related to the zoning, location, construction and erection of the proposed
OWTS and associated structures for which this permit is granted. The applicant further agrees
that if the above said regulations are not fully complied with in the zoning, location, erection
and construction of the above described OWTS and structure, the permit may then be revoked
by notice from the Health Department and immediately become null and void.
The issuance of a permit and specifications of terms and conditions therein will not constitute
assumption of liability, nor create presumption that the local public health agency or its
employees may be liable for the failure or malfunctioning of any system. Permit issuance will
not constitute a certification that the system, the equipment used in the system, or any
component used for system operation will ensure continuous compliance with the provision of
the OWTS Act, the regulations adopted thereunder, or any terms and conditions of a permit.
Permit Approval
Plans and specifications for the proposed OWTS have been reviewed and are considered
satisfactory, Permission is hereby given to the property owner(s) to perform the work indicated
in accordance with the Garfield County OWTS Regulation. This Permit will expire 1 year from
the date of issuance unless construction on the system has commenced. An "as -built" drawing
must be submitted and inspection of the system must be completed by GCPH before final
approval of the system will be issued.
03/04/2021
Issued By: Garfield County Environmental Health
Date
Department