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INDIVIDUAL SEWAGE DISPOSAL PERMIT
GARFIELD COUNTY BUILDING AND SANITATION DEPARTMENT
108 Eighth Street, Suite 401 4 5 11
Glenwood Springs, Colorado 81601 Permit
Phone (970) 945-8212 Assessor's Parcel No.
PROPERTY
Owner's Name
System Location
This does not constitute
a building or use permit.
hcypn Present Address Phone
2-1DD P-V)av ue--)J
Legal Description of Assessor's Parcel No.P CY) 01)4
SYSTEM DESIGN
7.ci l
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
7,2
Septic Tank Capacity � (2.'
j
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
108 8th Street, Suite 401, Glenwood Springs, Co 81601 i#t -1-(pPhone: 970-945-82121 Fax: 970-384-34701 Inspection Line: 970-384-5003 lb
www,P5
artield-couniv.com
I
Perk Fee:
Parcel No: (this information is available at the assessors office 97ft-945-9134)
2139-163-00-014
2
Per t ft:
I 16
Job Address: ('d an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description 2700 Clear Creek Road, P.O. Box 296,
De Beque, CO 81630 - CPF located 2.5 miles north-northeast of end of CR 211 - about 19.5 north-northeast of De Beque
3
Building & Planning Dept:
LoASize: Lot No: Block No: Subd.I Exemption:
4
Owner: (property owner)
Chevron U.S.A. Inc.
Mailing Address Atten: Ken Jackson
11111 South Wilcrest Drive
Houston, TX 77099
Ph:
(281) 561-4991
Alt Ph:
(281) 435-0666
5
Contractor.
Down Valley Septic and Drain
Mailing Address 005 Power Line Road
Rifle, CO 81650
Ph:
(970) 6254556
Alt Ph:
6
Engineer Mark Nothaft *
URS -Washington Division
Mailing Address 7800 E. Union Ave.,
Suite 100, Denver, CO 80237
P (303) 843-2092
AR Ph:
7
PERMIT REQUEST FOR: {X) New Installation ( ) Alteration ( ) Repair
B
WASTE TYPE: ( )Dwelling ( )Transient Use (x)Commercial or industrial ( }Non- Domestic wastes
( )outer - Describe
9
BUILDING OR SERVICE TYPE: Temporary construction trailers to support Central Production Facility construction
Number of bedrooms None Garbage Grinder (X)Yes ( }No
10
SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( }SPRING ( )STREAM OR CREEK ( }CISTERN
If supplied by COMMUNITY WATER, give name of supplier.
11
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Communitysystem?
19+ miles to De Beque, CO
Temporary requirement- no effort made due to the lack of infrastructure.
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS:
Depth told Ground Water Table >20 ft Percent Ground Slope NA - tank storage
13
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
( )Septic Tank ( )Aeration Plant ( }Vault ( }Vault Privy ( }Composting Toilet
( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( }Chemical Toilet
(> Other- Describe On-site storage tank - waste transported off site to Rifle wastewater treatment plant
14
FINAL DISPOSAL BY:
( )Absorption trench, Bed or Pit ( )Underground
( }Wastewater pond (yjOther-
Dispersal ( )Above Ground Dispersal ( }Evapotranspiration ( }Sand filter
Describe Waste transported to Silt, CO, wastewater treatment plant
15
Will effluent be discharged directly Into waters of the state? ( }YES (x)N0
16
PERCOLATION TEST RESULT: (to be oompteted by Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes per inch in hole No.10 Minutes per inch in hole
No.3
No.4
Minutes per inch in hole No.11 Minutes per inch in hole
Name, address & telephone of RPE who made soil
Name, address & telephone of RPE responsible
Applicant acknowledges that the completeness of
the local health department to be made and furnished
issuance of the permit is subject to such terms and
reports submitted herewith and required to be submitted
and are designed to be relied on by the local department
understand th s tion or . representation
and legal action far ury a o ' law.
OWNERS SIGNATURE
absorption test: NA
for design of the system: NA
17
the application Ls conditional upon such further mandatory and additional test and reports as may be required by
by the applicant or by the local health department for purposed of the evaluation of the application; and the
conditions as deemed necessary to insure compliance with rules and regulations made, information and
by the applicant are or will be represented to be true and correct to the best of my knowledge and belief
of heatth in evaluating the same for purposes of issuing the permit applied for herein. I further
may result in the denial of the application or revocation of any permit granted based upon said application
0/9/0 a,
DATE
'Perm't application prepared by URS - Washington Division, 7800 E. Union Avenue, Denver, CO 80237; 303-843-2219 (office);
303-526-6514 (cell); Atten: Sally Cuffin
STAFF USE ONLY
Permit Fee:
Perk Fee:
Total fees:
Building
I
Per t ft:
I 16
Septic Permit #:
Issue Date:
Building & Planning Dept:
APPROVAL DATE
ilggl: 4÷
1
i i
1 i
_ 11
0000
00
Di
o o
N
URS
Washington Division
PICEANCE BASIN
NATURAL GAS DEVELOPMENT PROGRAM
Chevron
GARFIELD COUNTY, COLORADO
Calculations for ISDS for Central Processing
Facility Temporary Office Buildings
1
0
Approved for Construction
A
Prelim. Issued for Review/Comments
REV.
DESCRIPTION
BY
CHKD
APVD
RVWD
DATE
REVISIONS
CLIENT: CHEVRON North America Exploration and Production
PROJECT: Piceance Basin Natural Gas Development Program
JOB NO.: 29454
DOC. NO.: Not Applicable
C:1Documents and Setlingslgatec5341Desktop\Copy of Chevron Temporary office Buildings Calculalions.doc
Washington Division
Chevron
1111110
1111011
Date:
10/10/08
CALCULATIONS FOR CENTRAL PROCESSING
FACILITY TEMPORARY OFFICE BUILDINGS
PICEANCE BASIN NATURAL GAS
DEVELOPMENT PROGRAM
Doc. No.
Not Applicable
Rev:
0
Page:
2 of 2
Chevron Temporary Office Buildings
Sewage holding tank sizing based on the following:
1. International Private Sewage Disposal Code -2003 (see attachments)
2. 18 people at the site
3. 20 gallons per day per person
4. 5 day holding capacity
5. 2,000 gallon minimum holding tank capacity
18 people x 20 gpd = 360 gallons/day x 5 days = 1,800 gallons
Use 2,000 gallon tank (minimum tank capacity)
Approved by Mark Nothaft, P.E. (State of Colorado) of URS Washington Division
Signature
\( / /8/06, �'
q2...
N M.
Date
(0 re)
/0 -7 -OS
�. FE/sT
G /11 VRDN TEMPo,('A/Z V orpfce 5u1L D/NG s
SEWAGE /-/OZ-12/NG TANK 5 /Z/A16 BASED
a,c/ m' FeLLoW/NG :
1. /A/TERNAT/oNAL Pg1 VA7'e 51V45 p/5Po5A L G606-24063
2. /8 PLOPLE AT T//f 5/T&
3. 20 C,ALLoN5 PEP DAY PF -R Pegs() N
4. S PAY I/OLDING CAPACtTY
5. Z, 00 0 GALLci / Al/AladUM MEDIIv6 TANK CaPAG!Ty
!S PEOPLE X 20 GPD = 366 ALLMM/5/DAY
X 5 OAys = / SO4 6ALLoa s
1156 2, ODD T ALL 014 TAA// (M/M/UUM 7AluX G4PAc1 rj`)
' TANKS
TABLE 802.7.2—continued
ADDITIONAL CAPACITY FOR OTHER BUILDINGS
BUILDING CLASSIFICATION
CAPACITY (gallons)
Restaurants (24 hour)—kitchen and toilet wastes (per seating space)
60
Retail stores—customers
1.5
Schools (per classroom -25 pupils per classroom)
450
Schools with meals served (per classroom -25 pupils per classroom)
600
Schools with meals served and showers provided (per classroom)
750
Self-service laundries (toilet waste only, per machine)
Automatic clothes washers (apartments, service buildings, etc.—per machine)
50
300
Showers—public (per shower taken)
15
Swimming pool bathhouses (per person)
10
For SI: 1 gallon = 3.785 L.
SECTION 805
HOLDING TANKS
805.1 Approval. The installation of a holding tank shall not be
approved where the site can accommodate the installation of
any other private sewage disposal system specified in this code.
A pumping and maintenance schedule for each holding tank in-
stallation shall be submitted to the code official.
805.2 Sizing. The minimum liquid capacity of a holding tank
for one- and two-family dwellings shall be in accordance with
Table 805.2. Other buildings shall have a minimum 5 -day hold-
ing capacity, but not less than 2,000 gallons (7570 L). Sizing
shall be in accordance with Table 802.7.2. Not more than four
holding tanks shall be installed in series.
TABLE 805.2
MINIMUM LIQUID CAPACITY OF HOLDING TANKS
NUMBER OF BEDROOMS
TANK CAPACITY
(gallons)
1
2,000
2
2,000
3
2,000
4
2,500
5
3,000
6
3,500
7
4,000
8 -
4,500
For SI: 1 gallon = 3.785 L.
805.3 Construction. Holding tanks shall be constructed of
welded steel, monolithic concrete, glass -fiber reinforced poly-
ester or other approved materials.
805.4 Installation. Tanks shall be located in accordance with
Section 802.8, except the tanks shall be not less than 20 feet
(6096 mm) from any part of a building. Holding tanks shall be
located so the servicing manhole is located not less than 10 feet
(3048 rnm) from an all-weather access road or drive.
805.5 Warning device. A high-water warning device shall be
installed to activate 1 foot (305 mm) below the inlet pipe. This
device shall be either an audible or an approved illuminated
34
alarm. The electrical junction box, including warning equip-
ment junctions, shall be located outside the holding tank or
housed in waterproof, explosionproof enclosures. Electrical re-
lays or controls shall be located outside the holding tank.
805.6 Manholes. Each tank shall be provided with either a
manhole not less than 24 inches (610 min) square or a manhole
with a 24 -inch (610 mm) inside diameter extending not less
than 4 inches (102 mm) above ground. Finish grade shall be
sloped away from the manhole to divert surface water from the
manhole. Each manhole cover shall have an effective locking
device. Service ports in manhole covers shall be not less than 8
inches (203 mm) in diameter and shall be 4 inches (102 nun)
above finished grade level. The service port shall have an effec-
tive locking cover or a brass cleanout plug.
805.7 Septic tank. The outlet shall be sealed where an ap-
proved septic tank is installed to serve as a holding tank. Re-
moval of the inlet and outlet baffle shall not be prohibited.
805.8 Vent. Each tank shall be provided with a vent not less
than 2 inches (51 mm) in diameter and shall extend not less than
12 inches (305 mm) above finished grade, terminating with a
return bend fitting or approved vent cap.
2003 INTERNATIONAL PRIVATE SEWAGE DISPOSAL CODE®
TANKS
TABLE 802.7.2
ADDITIONAL CAPACITY FOR OTHER BUILDINGS
BUILDING CLASSIFICATION
CAPACITY (gallons)
Apartment buildings (per bedroom—includes automatic clothes washer)
150
Assembly halls (per person—no kitchen)
2
Bars and cocktail lounges (per patron space)
9
Beauty salons (per station—includes customers)
140
Bowling centers (per lane)
125
Bowling centers with bar (per lane)
225
Camp, day use only—no meals served (per person)
15
Campgrounds and camping resorts (per camp space)
100
Campground sanitary dump stations (per camp space) (omit camp spaces with sewer connection)
5
Camps, day and night (per person)
40
Car washes (per car handwash)
50
Catch basins—garages, motor fuel -dispensing facilities, etc. (per basin)
100
Catch basins—truck washing (per truck)
100
Churches—no kitchen (per person)
3
Churches—with kitchen (per person)
7.5
Condominiums (per bedroom --includes automatic clothes washer)
150
Dance halls (per person)
3
Dining halls—kitchen and toilet waste—with dishwasher, food waste grinder or both (per meal served)
11
Dining halls—kitchen waste only (per meal served)
3
Drive-in restaurants—all paper service (per car space)
15
Drive-in restaurants—all paper service, inside seating (per seat)
15
Drive-in theaters (per car space)
5
Employees—in all buildings, per employee—total all shifts
20
Floor drains (per drain)
50
Hospitals (per bed space)
200
Hotels or motels and tourist rooming houses
100
Labor camps, central bathhouses (per employee)
30
Medical office buildings, clinics and dental offices
Doctors, nurses, medical staff (per person)
Office personnel (per person)
Patients (per person)
75
20
10
Mobile home parks, homes with bathroom groups (per site)
300
Motor fuel -dispensing facilities
10
Nursing and rest homes—without laundry (per bed space)
100
Outdoor sports facilities (toilet waste only—per person)
5
Parks, toilet wastes (per person -75 persons per acre)
5
Parks, with showers and toilet wastes (per person -75 persons per acre)
10
Restaurants—dishwasher or food waste grinder or both (per seat)
3
Restaurants—kitchen and toilet wastes (per seating space)
30
Restaurants—kitchen waste only—without dishwasher and food waste grinder (per seat)
9
Restaurants—toilet waste only (per seat)
21
Restaurants (24-hour)—dishwasher or food waste grinder (per seat)
6
(continued)
2003 INTERNATIONAL PRIVATE SEWAGE DISPOSAL CODE®
33
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