HomeMy WebLinkAboutApplication.pdfCommunity Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PERMIT APPLICATION
TYPE OF CONSTRUCTION New Installation Alteration Repair WASTE TYPE Dwelling Transient Use Comm/Industrial Non-Domestic Other Describe _________________________________________________
___________________ INVOLVED PARTIES Property Owner: _________________________________________ Phone: (______)_________________ Mailing Address: ______________________________________________________
_________________ Contractor: _____________________________________________ Phone: (______)_________________ Mailing Address: _______________________________________________________________________
Engineer: ______________________________________________ Phone: (______)_________________ Mailing Address: _______________________________________________________________________ PROJECT
NAME AND LOCATION Job Address: ___________________________________________________________________________ Assessor’s Parcel Number: _________________Sub. _____________________ Lot ______
Block _____ Building or Service Type: _________________________ #Bedrooms: __________ Garbage Grinder ___ Distance to Nearest Community Sewer System: _____________________________________________
Was an effort made to connect to the Community Sewer System: ______________________________ Type of ISDS Septic Tank Aeration Plant Vault Vault Privy Composting Toilet Recycling,
Potable Use Recycling Pit Privy Incineration Toilet Chemical Toilet Other ______________________________________________ Ground Conditions Depth to 1st Ground water table _____________
Percent Ground Slope _________________ Final Disposal by Absorption trench, Bed or Pit Underground Dispersal Above Ground Dispersal Evapotranspiration Wastewater Pond Sand
Filter Other ______________________________________________________________________ Water Source & Type Well Spring Stream or Creek Cistern Community Water System Name ___________________
______________________________ Effluent Will Effluent be discharged directly into waters of the State? Yes No n n James Rose PO Box 432 Rifle, CO. 81650 970 Encana Oil & Gas (USA)
Inc. 285-2600 143 Diamond Avenue, Parachute, CO. 81635 TriState Land Surveying, Inc 435 781-2501 180 N. Vernal Avenue, Vernal, Utah NE 1/4 NE1/4 S 22, T7S, R93W /Directions provided
w/site plan (attached) 240315300046 Factory Built Non-Residential n n water hauled to municipality Vault and haul system-water received from CDPHE certified water hauler n n Encana K22W
Pad -Patterson 303 Rig
1 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 SEPT-10-13-3039 WELL SITE LOCATIONS (APD#) K22W Pad – Patterson 303 Rig OPERATORS NAME Encana Oil & Gas(Renata Busch)
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.
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.
2 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 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
3 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.
PAYMENT AGREEMENT FORM GARFIELD COUNTY (“COUNTY”) and Property Owner (“APPLICANT”) ______ ____ ______________________________________________________________________ agree as follows:
1. The Applicant has submitted to the County an application for the following Project: __________________. 2. The Applicant understands and agrees that Garfield County Resolution No.
98-09, as amended, establishes a fee schedule for each type application, and the guidelines for the administration of the fee structure. 3. The Applicant and the County agree that because
of the size, nature or scope of the proposed project, it is not possible at this time to ascertain the full extent of the costs involved in processing the application. The Applicant
agrees to make payment of the Base Fee, established for the Project, and to thereafter permit additional costs to be billed to the Applicant. The Applicant agrees to make additional
payments upon notification by the County, when they are necessary, as costs are incurred. 4. The Base Fee shall be in addition to and exclusive of any cost for publication or cost of
consulting service determined necessary by the Board of County Commissioners for the consideration of an application or additional County staff time or expense not covered by the Base
Fee. If actual recorded costs exceed the initial Base Fee, the Applicant shall pay additional billings to the County to reimburse the County for the processing of the Project. The Applicant
acknowledges that all billing shall be paid prior to the final consideration by the County of any Land Use Change or Division of Land. I hereby agree to pay all fees related to this
application: Billing Contact Person:_____________________________________ Phone: (_____)___________________ Billing Contact Address: __________________________________________________________________
_ City: ______________________________________________ State: _______ Zip Code: ________________ Billing Contact Email: _____________________________________________________________________
Printed Name of Person Authorized to Sign: ___________________________________________________ ______ ________________________________ (Signature) (Date) K22W Renata Busch 143 Diamond
Avenue Parachute CO 81635 renata.busch@encana.com Renata Busch 10-29-2013