HomeMy WebLinkAbout04528GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
111+05 EN ca S YS
108 Eighth Street, Suite 401
Glenwood Springs, Colorado 81601
Phone (970) 945-8212
INDIVIDUAL SEWAGE DISPOSAL PERMIT
PROPERTY ,/ /y �}y I/Men
�^ 4 , 1e,
`� 2
�} yJ earl/ Present Address \' '2 Me 4 i) J G PhoneQ (o3 —
Owner's Name ��n��l net. g —�-°/ n z j� n j�
System Location, ?Vv'"I t net. ) 1 t V7S f �O JW i Q 4'"I�i�i Ili �v l -IID
Legal Description of Assessor's Parcel No. �j r 7 - 1 g - 00 —1 /-1
SYSTEM DESIGN
Permit 4 5 2 3
Assessor's Parcel No.
This does not constitute
a building or use permit.
Septic Tank Capacity (gallon)
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
Other
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
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
aarReld-rnnn-v rnm
.HID
Y ? iV I I ZO—DS
n.....__ -_
Permit Fee:
-] 3.00
Parcel No: (this information is available at the assessors office 970-945-9134) 217719300141
2
Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
Appx 3.5 Miles SW of the City of Rifle, CO SW4 Sec 19, Twn 6S, Rng 93W 6th PM
3
Lot Size: 53.2 Lot No: n/a Block No: n/a Subd.lExemption: n/a
4
Owner: (property owner)
Gary Knaus
Mailing Address 132 Meadow CT
Carbondale, CO 81632
Ph:
970-963-1485
Alt Ph:
5
Contractor:
Laramie Energy II, LLC
Mailing Address 6 Q1 38 1/4 Rd
Grand Junction, Co 81506
Ph:
970-683-5419
Alt Ph:
6
Engineer: n/a
Mailing Address
Ph:
Alt Ph:
7
PERMIT REQUEST FOR: (x) New Installation ( ) Alteration ( ) Repair
8
WASTE TYPE: ( )Dwelling ( )Transient Use (x)Commercial or industrial )Non- Domestic wastes
( )Other - Describe
9
BUILDING OR SERVICE TYPE: Sewage vaults assoc 1ted with temporary employee housing
Number of bedrooms n/ a Garbage Grinder ( )Yes (x)No
10
SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( )SPRING ( )STREAM OR CREEK (gCISTERN
If supplied by COMMUNITY WATER, give name of supplier: Water hauled to locat ion by Thirsty Water
11
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: City of Rifle, Apprx. 3.5 miles
Was an effort made to connect to the Community System? No - distance to far
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS: 10%
Depth to 15r Ground Water Table appx . 80 f t Percent Ground Slope
13
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (1505) PROPOSED:
( )Septic Tank ( )Aeration Plant (x)Vault ( )Vault Privy ( )Composting Toilet
( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet
( )Other- Describe
14
FINAL DISPOSAL BY:
( )Absorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
( )Wastewater (x)Other-Describe Garfield CO land fill/other permitted facility
pond
15
Will effluent be discharged directly into waters of the state? ( )YES (x)N0
16
PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes n/ a per inch in hole No.1 Minutes n/a per inch in hole No.3
Minutes n/a per inch in hole No.2 Minutes n/a per inch in hole No.
Name, address & telephone of RPE who made soil absorption test:
Name, & telephone of RPE responsible for design of the system:
address
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,„ „,,, ,„,,, ...
Wayne P. Bankert,'«i`".,,,,-0- "ria"` .`�n%
�4awem4,-wbanMenga nm:rcrcry.
17
OWNERS SIGNATURE DATE
Y ? iV I I ZO—DS
n.....__ -_
Permit Fee:
-] 3.00
...—
Perk e:
--
Total fees:
00
�7 3'
Building Permit #:
Septic Permit #:
— I "r/
Issue Date:
cr'
' \ —Z/IVJ
4 —
I ��e1
Bui Bing&PI�n, Dept
moi►
1�,. 7
cSn
`` ti.c^�
7c DATE
APPROVAL /
GENERAL PERMIT
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 L5 2 b
) 67i GA
GA
WELL SITE LOCATIONS (APD#(s)) 19 I P 5:4 Cti3) A'>td -c fai
OPERATORS NAME 1 rig, tk-yzAAt h C nit Krt4u1 S)
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 fora 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.
1.0. 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.
E. 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.
F. 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.
G. 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.
H. 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.
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
0
z
W
X
gt248
1 0
omo$N
3"0
0
s s!
SANITARY TEE & PIPES
6'DIA SCH 40 PVC
RISER PIPE. FOR 24INOMINAL) ACCESS OPENING
FULL PLATE BAFFLE (48' INVERT) WITH 3-4.0IA HOLES
LIFTING LUG
HOLD DOWN STRAP LOCATION
November 4, 2008
To Whom It May Concern:
Down Valley Septic, LLC
P.O. Box 1929 • Rifle, CO 81650
970-625-5556
www.dvseptic.com
Laramie Energy II
North Mamm Peak Operations
Please accept this letter as certification that Down Valley Septic will provide sewage
collection, and portable restroom service for Larande Energy II Hunter Mesa Operations.
1 certify that Down Valley Septic will provide the above services for Laramie Energy II
for the Drilling, Completion, Construction, Man camps, and Administration units on the
North Mamm Peak Operations. Service will be provided every three days, unless needed
more frequently. Down Valley Septic is available 24 hours a day, 7 days a week, and 365
days a year. Collection sewage will be disposed of in the Rifle Landfill or other certified
disposal facility.
Please contact me if you need any additional information at 970-625-5556.
Thank you,
Scott Moyer
COO
Down Valley Septic, LLC
SPECIAL POWER OF ATTORNEY
The undersigned, Bruce L. Payne, President of Laramie Energy II, LLC, a Delaware
limited liability company (hereinafter referred to as the "Company"), does hereby appoint
Wayne P. Bankert of 601 28 IA Road, Suite D, Grand Junction, Colorado (hereinafter referred to
as "Agent") to act as attorney-in-fact on behalf of and in the name of the Company for the
purpose of acquiring permits and authorizations for the development of the Company's oil and
gas properties from agencies and offices of the U.S. Government and of the State of Colorado,
including, but not limited to, the Bureau of Land Management, the U.S. Forest Service, the
Colorado Department of Wildlife, and the Colorado Department of Health and Environment and
to execute such documents in the name of the Company as may be incidental to such purposes,
including without limitation: (a) rights of way authorizations, (b) special use authorizations, (c)
temporary use authorizations, and (d) road use permits. This Power of Attorney shall be
effective as of February 25, 2008 and shall remain in effect until revoked by the Company.
Any party dealing with Agent shall be entitle to rely upon his authority to act on behalf of
the Company unless and until such party has received written notice that the same has been
revoked.
Executed this 2? day of February 2008.
LARAMIE ENERGY II, LLC
c.
L. Payne, President
STATE OF COLORADO )
)ss
COUNTY OF DENVER )
The foregoing instrument was acknowledge before me this 2? day of February 2008, by
Bruce L. Payne as President on behalf of Laramie Energy II, LLC.
Witness my hand and official seal.
My Commission expires:
Notary Public
KAREN PRICE
NOTARY PUBLIC
STATE OF COLORADO
My Commission Fxn
11.
200e
cn
0