HomeMy WebLinkAboutApplication- PermitGARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 401 4637
Glenwood Springs, Colorado 81601 Permit
Phone (970) 945-8212 Assessor's Parcel No.
\C -e -0 va\ 86- b9
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY
i
Owner's Name -E'� --ANDCo Present Address6i- tJ ( 111 Phone —7 L3. 1(D3
1
System Location TAQ G. V" cg. 21,5
Legal Description of Assessor's Parcel No. 171` )1- 0 '
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SYSTEM DESIGN
109
This does not constitute
a building or use permit.
Septic Tank Capacity (gallon) Other
Percolation Rate (minutes/inch) Number of Bedrooms (or other)
Required Absorption Area - See Attached
Special Setback Requirements:
Date Inspector
FINAL SYSTEM INSPECTION AND APPROVAL (as installed)
Call for Inspection (24 hours notice) Before Covering Installation
System Installer
Septic Tank Capacity
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
Other
Date Inspector
RETAIN WITH RECEIPT RECORDS AT CONSTRUCTION SITE
CONDITIONS:
1. All installation must comply with all requirements of the Colorado State Board of Health Individual Sewage
Disposal Systems Chapter 25, Article 10 C.R.S. 1973, Revised 1984.
2. This permit is valid only for connection to structures which have fully complied with County zoning and
building requirements. Connection to or use with any dwelling or structures not approved by the Building and
Zoning office shall automatically be a violation or a requirement of the permit and cause for both legal action
and revocation of the permit.
3. Any person who constructs, alters, or installs an individual sewage disposal system in a manner which
involves a knowing and material variation from the terms or specifications contained in the application of
permit commits a Class 1, Petty Offense ($500.00 fine - 6 months in jail or both).
White - APPLICANT Yellow - DEPARTMENT
GARFIELD COUNTY SEPTIC PERMIT APPLICATION
1088"'Street, Suite401, Glenwood Springs, CO 81601
Phone: 970-945-82121 Fax: 970-384-34701 Inspection Line: 970-384-5003
www .gaifeld-county-corn
1
Perk Fec:
Parcel No:(this information is available at the assessors office 970-945-9134)
2171-311-00-006
2
It iA:
ff
Job Address: (if an address has not been assigned, please provide Cr,hlwy or Street Name & City) or legal description
GV 2-31 Pad site Off of County Road 215 See attached Access Description
3
i3ttildina Be Piannin
Lot Size: Lot No: Block No: Subd/Exemption:
See Attached Survey Plat package and Assessors Detail
4
Owner: (property owner) —Mailing
Puckett LandCompany
Address
5460 South Qubec St Ste 250
Greenwood Viliaae. CO. 80111
Ph:
303-763-1003
Alt Ph: A
5
Contractor:
Williams Production
i l T Co
Mailing Address
PO Box 370, Parachute, CO
81635
Ph:
970-286-9377 ext 2288
Alt Ph;
6
_R
Engineer:
N/A
Mailing Address
Ph:
_
Alt Ph:
7
Reaest For: (X 1 New Installation ( } Alteration (}Repair
8
.permit
Waste Type: (X ) Dwelling ( ) Tranient Use ( ) Commercial or industrial ( ) Non- Domestic Wastes
( ) Other- Describe
9
Building Or Service Type:
Number of Bedrooms: 2 Garbage Grinder ( ) Yes (X No
10
Source & Type of Water Supply: ( ) Well ( ) Spring ( ) Stream Or Creek ( ) Cistern
if supplied by COMMUNITY WATER, give name of supplier: Down Valley Septic and Waste
11
Distance to Nearest Community Sewer
Was there an effort to connect to the
System:
-,-„NIA
community System? N/A
_ ,
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUSED WITH OUT A SITE PLAN
12
Ground Conditions:
Depth to lst Ground Water Table. N/A Percent Ground Slope NIA
13
Type of Individual Sewage System (ISM) Proposed:
( ) Septic Tank ( )Aeration Plant ( ) Vault ( ) Vault Privy ( )Composting Toilet F
( ) Recycling, Potable Use ( )Recycling, Other use ( ) Pit Privy ( ) Incineration Toilet ( } Chemical Toilet
(X) Other- Describe: Hauled to Down Valley Waste for their disposal
14
Final Disposal By:
( ) Absortion trench, Bed or Pit ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Evapotranspiration ( ) Sand Filter
{ }Wastewater pond (X )Other -Describe Hauled to Down Valley Waste for their disposal
15
Will effluent be discharged into waters of the state? ( )Yes (X No
16
Percolation Test Result: (to be completed
Minutes per
by Registered Professional Engineer, if the
inch in hole No.1
in hole No.2
made soil absorption test: NIA
Engineer does the Percolation Test)
Minutes per inch in
N/A
hole No,3
No.4
Minutes per inch
Minutes per inch in hole
Name, address & telephone of RPE who
Name, address & telephone of RPE responsible
for design of the system:N/A
17
Applicant acknowidges that the completeness of the application Is conditional upon
by the local health department to be made and furnished by the applicant or by the local
the issuance of the permit is subject to such terms and conditions as deemed necessary
and reports submitted herewith and required to ..- ubmitted by the applicant are or
belief and are designed to • - relied on by lo• al . rtment of health in evaluationg the
that any fats': n or misreyre s-: -n may result in the denial of the
such further mandatiory and additional test and reports as may be required
health department for purposed of the evaluation of the application; and
to insure compliance with the rules and regulations made, information
will be represented to be true and correct to the best of my knowledge and
same for purposes of issuing the permit applied for herin. l further
application or revocation of any permit granted based upon said application
and legal acti.-; . serju .roved-x�t., r,,-
- • , - rs SI . ature Date e4")/4//) t r
STAFF USE ONLY
Per F"cc: ,
Perk Fec:
Total fc 0 0
Building Pe
It iA:
ff
Septic Permit #:4s 7
Isla ate: , . 0 ,
i3ttildina Be Piannin
„
APPROVAL r RATE
GENERAL PERMIT CONDITIONS
DOMESTIC WASTEWATER
VAULT SYSTEMS
AUTHORIZATION TO UTILIZE A VAULT SYSTEM UNDER THE GARFIELD COUNTY BOARD OF
HEALTH "INDIVIDUAL SEWAGE DISPOSAL SYSTEMS REGULATIONS"
The Garfield County Board of Health "Individual Sewage Disposal Systems Regulations" adopted in 1994
pursuant to current guidelines of the state board and adopted in compliance with Section 25-10-104(2), (3), and
(4) C.R.S., shall govern all aspects of permits, performance, location, construction, alteration, installation, and
use of individual sewage disposal systems of less than 2,000 gallon per day design capacity.
This permit specifically authorizes the entity(s) listed on page 1 of this document to install and utilize a vault
system, as of the effective dates stated on page 1, in accordance with permit requirements and conditions set
forth in part 1 hereof. Any vault system installation authorized herein shall be consistent with the terms and
conditions of the permit.
SEPTIC PERMIT NUMBER
WELL SITE LOCATIONS (APD#(s)) GV 2-31.
OPERATORS NAME Williams
A. GENERAL:
Vaulted wastewater systems are not permitted in Garfield County for any facility that will generate 2000
gallons or more of wastewater per day. A vault system as permitted by Garfield County is allowed only
for limited use occupancy with a cumulative usage period of less than one year and for occupancy of 24
or less people, only on property which cannot accommodate a sewage treatment system. Vault
systems are allowed on oil and gas well pads due to the limited development time frames and limitation
of on site disturbance set by the Colorado Oil and Gas Conservation Commission, the United States
Forest Service and the Bureau of Land Management.
A vault, as permitted. by the local board of health, shall have a minimum 1000 gallon effective capacity.
B. TERMS AND CONDITIONS
1. Minimum, horizontal distances from the various components of a system to pertinent terrain
features, including streams, lakes, water courses, springs, wells, subsoil drains, cisterns, water
lines, suction lines, gulches, dwellings, other occupied buildings and property lines, shall be in
accordance with the following "Table of Minimum Horizontal Distances".
2. No vault system shall be installed in a floodway.
3. When a system is installed in a 100 -year floodplain then the system shall meet or exceed the
requirements of the National Flood Insurance Program. The system as approved by the Garfield
County Building Official or his/her designated agent shall be designed to minimize or eliminate
infiltration of floodwaters into the system, and discharge of the system into the floodwaters.
4. Only tanks that have been certified by the Colorado Department of Public Health and
Environment shall be used for a vaulted system.
5. All tanks shall be installed in accordance with the manufacturer's specifications.
6. Watertight vaults shall not allow infiltration of groundwater or surface water and shall not
permit the accidental or intentional discharge release of wastewater or liquids to the ground
surface or to waters of the state.
1
7. Vaults shall not have an outlet unless designed to flow to another tank in series for the purpose
of increasing holding capacity. Such outlets shall be water tight,
8. Tanks shall be so constructed and installed as to withstand earth and hydrostatic pressures when
filled and when empty.
9. In locations where groundwater may cause instability problems to the vault due to flotation, the
tank shall be anchored in a sufficient manner in order to provide stability when the tank is
empty. The method of anchoring must be approved by the Garfield County Building Official or
his/her designated agent prior to installation. The local authority may require the design of the
anchoring system to be prepared by a Registered Professional Engineer.
10. Each vault unit shall be equipped with an access manhole located to permit periodic physical
inspection and maintenance of all the tank and removal of the waste contents.
11. Components shall be so designed and constructed that when installed in accordance with
manufacturer's recommendations, they shall be capable of being easily maintained, sampled,
drained, pumped, inspected and cleaned.
12. The surface of the ground over the vault system must be restricted to activity or use which will
allow the system to function as designed and which will not contribute to compaction of the soil
or to structural loading detrimental to the capability of the vault to function as designed.
13. All metal surfaces shall be properly coated to prevent corrosion.
14. Plumbing fixtures, grease traps, building sewers, vents, sewer lines and other appurtenances
shall be designed, operated and maintained so as to comply with the minimum requirements of
the International Plumbing Code.
15. All wastewater lines used in individual sewage disposal systems shall be constructed of
compatible pipe, bonding agent, and fittings.
16. Where plastic pipe and fittings are used, the minimum wall thickness of the pipe shall conform
to ASTM Standard D 3034, or equivalent.
17. All electrical work, equipment, and material shall comply with the requirements of the National
Electrical Code.
18, A signal device shall be installed to indicate when pumping is necessary.
19. The permittee shall provide for maintenance and cleaning of the vault system through a legal
contract with a company experienced in the removal, proper handling, transport and proper
disposal of the vault contents.
20. Disposal of waste materials removed from a vault system in the process of maintenance or
cleaning shall be accomplished at a site approved by Garfield County in a manner which does
not create a hazard to the public health, a nuisance or an undue risk of pollution and which
complies with state and local rules and regulations.
21. When the use of a vault system is terminated or the vault system is relocated, the contents of a
vault shall be properly removed and disposed of and the emptied vault shall be filled with soil
or rock, or the Garfield County Building Official may allow the vault to be reused, removed and
disposed of properly.
C. RECORDS
The Permittee shall establish and maintain records. All records shall be maintained a public records and
be made available to Garfield County or other third party upon request. Required records shall include,
but not be limited to, the following:
• A copy of the permitees's current legal contract for removal of vault waste.
• A copy of this permit.
• The dates, location, and time of pumping tank contents;
• The individual(s) and company that performed tank pumping;
• The volume of waste removed from the tank;
• The location of disposal including a receipt from the receiving facility;
• Any system repair or maintenance performed including the reason for said repair or maintenance.
D. CERTIFICATION OF AN APPROVED VAULT SYSTEM INSTALLATION
2
The Permittee shall inform the Garfield County Building Official in writing of any intent to construct,
install, or alter any vault system, no greater than 48 hours after construction, and shall furnish the
Garfield County Building Department such plans and specifications to evaluate compliance with the
Garfield County ISDS Regulations.
E. REMOVED SUBSTANCES
Solids, sludge's, or other pollutants removed in the course of vault maintenance shall be removed and
disposed of in a manner such as to prevent any of this material from discharging to the ground surface
or from entering waters of the State. For all domestic wastewater treatment works, the Permittee shall
dispose of sludge in accordance with State (Regulation No. 64) and Federal (Section 405(d) of the Act)
regulations. The Permittee shall take all reasonable steps to minimize or prevent any discharge or
sludge use or disposal in violation of this permit that has a reasonable likehood of adversely affecting
the public health or environment. Permittee shall maintain a copy of a service contract and any
pumping and disposal records from the approved contracted systems cleaner and submit such
information when requested by the local regulatory authority.
F. PERMIT VIOLATIONS
Failure to comply with any terms and/or conditions of this permit shall be a violation of this permit.
The surface discharge of any pollutant identified in this permit in a manner other than is authorized in
this permit shall constitute a violation of the permit. Permit violations will be subject to enforcement
provisions as outlined in Section IV.H, IV.I and IV.N of the Garfield County Board of Health
"Individual Sewage Disposal Systems Regulations". Violations of the permit are the sole responsibility
of the Permittee.
G. ACCESS TO THE SITE
For the purpose of inspection and enforcing applicable rules, regulations, terms and conditions of any
permit issued, the Garfield County Building Official or his/her designated agent is authorized to enter
upon private property at reasonable times and upon reasonable notice for the purpose of determining
whether or not operating sewage treatment systems are functioning in compliance with this permit.
3
STATEMENT OR AUTHORITY
Pursuant to G.R.S. §38--30--172, the undersigned executes this
Statement of Authority on behalf of Puckett Land Company
, a Colorado (corporation, limited liability
Company, general partnership, registered limited liability
partnership, registered limited liability limited partnership,
limited partnership association, government agency, trust or other),
an entity other than an individual, capable of holding title to real
property (the `,Entity"), and states as follows;
The name of the Entity is Puckett Land Company and
is formed under the laws of Colorado
The mailing address for the Entity is 5460 South Quebec Street,
Suite 250, Greenwood Village, CO 80111
The name and/or position of the person authorized to execute
instruments conveying, encumbering, or otherwise affecting title to
real property on behalf of the Entity is Matthew A. Wurtzbacher,
President
The limitations upon the authority of the person named above or
holding the position described above to bind the Entity are as
follows: None
(if no limitations, insert. 'None")
Other matters concerning the manner in which the Entity deals with
any interest in real property are: GV 2-31 Pad and GM 333-31 Pad
(if no other matter, leave this section blank)
EXECUTED this
Signature:
Name typed:t'Matthew A.
TO
day of
bather
, 2009.
Signature:
Name typed:
Title (if any): President Title (if any):
STATE OF Colorado
)SS.
COUNTY OF Arapahoe
43:
The foregoing instrument was acknowledged before me this l day of
10. , 2009 by Matthew A. Wurtsba.cher , on behalf of
Puckett Land Company , a Colorado corporation
Witness my hand and official seal.
My commission expires: November 2, 2012
(Notary' Pt 1tc) (SS,AL(
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October 1,2008
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85 So. 200 East * Vernal, Utah 84078 * (435) 789-1017
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LEGEND:
PROPOSED ACCESS ROAD
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Uintah Engineering & Lard Surveying
55 South 200 East Vern.. Utah. 84078
(435) 789-1017 * FAX (435) 789-1813
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TOPOGRAPHIC
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PROPOSED LOCATION:
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