HomeMy WebLinkAbout20101860.tiff • •
res6 DEPARTMENT t it PI NISI IC HEALTH &ENVIRONMENT
1555 N. 17°1Avenue
Greeley,eyy CO, CO 80631 WEBSITE: www.co.weld.co.us
' ADMINISTRATION: (970) 304-6410
FAX: (970) 304-6412
PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420
FAX: (970) 304-6416
• ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415
COLORADO FAX: (970) 304-6411
AUTHORIZATION FORM
RE: PERMIT APPLICATION LS I).s I VALUATION
SALE OF PROPERTY \b \ I I I: s \MPLE
I ,Tim Goddard represent Rodney 'son for the property
(Agent/Applicant) (Owner)
located at
LEGAL DESCRIPTION: SEC 34 TWN7N RN(1 63w
41.BDIVISION NAME: N/A _ LOT N/A BLK N/A
I can be contacted at the following phone#'s: Ilona
VW k 970-381-5005 cell
Fax H
The property owner can be contacted at the following plwnc i.'s
\\orl 10-539-1787 cell
Fax�
Correspondence mailed to (only one): El Agent/Applicant
Property \\n( 1
DATE 31.a4 Lao LID
OWNER'S SIGNATURE i'� G� ci% � / "Z`; - ��
v
2010-1860
• •
SEPTIC PERMIT INFORMATION FORM
11`k
COLORADO To obtain an I.S.D.S.permit,one must file an-application for Individual Sewage Disposal System"
at the Weld County Environmental Health Se t\ice>office and pay the application fee. A"repair"fee
shall be charged for the expansion,replacement or repair of an existing system. The following
information must be provided on the septic information limn.
COMMERCIAL PERMIT RESIDENTIAL PERMIT
NEW or REPAIR $850.00 NEW or REPAIR $750.00
VAULT PERMIT MINOR REPAIR PERMIT
NEW or REPAIR$250.00 $100.00
•
PARCEL NO.: (12 DIGIT NUMBER)
LEGAL DESCRIPTION: SECTION 34 TOWNSHIP 7N RANGE 63W ACRES 11+/-
SUBDIVISION N/A Lot N/A BLOCK N/A FILING N/A
THIS INFORMATION CAN BE OBTAINED FROM ME.IF ASSESSOR'S OFFICE AT (970) 353-3845 EXT 3650
SITE ADDRESS Not establ i shed yet _
DIRECTIONS Hwy 392 North to WCR7 -1 - Northwest of Intersection
PROPERTY OWNER: Rodney Wilson
MAILING ADDRESS: 37900 WCR 61 ( II\ Eaton ST CO ZIP 80615
HOME PHONE:( ) WORK PHONE(9 7 0 5 3 9 - 17 8 7 FAX( )
EMAIL ADDRESS: _
APPLICANT NAME: Marcum Midstream 1995- 1 Pusiness Trust
MAILING ADDRESS: 8207 W. 20th Street I In Clieeley ST CO ZIP 80634
HOME PHONE: ( ) WORKPHONE(970 356 -5560 FAX( 97(D 356-5563
EMAIL ADDRESS:
DESCRIPTION OF BUILDING(EX:HOUSE,MOBILE HOME, M(lD14 AR, SHOP,OFFICE) Shop
IF OBTAINING A REPAIR PERMIT,WHAT IS BEING REP A I R I:I)7
NUMBER OF PERSONS 15 IN I I O0D PLAIN AREA? YES/ate
NUMBER OF BEDROOMS N/A PERCOLATION HOLES MUST BE MARKED FOR
INSPECTION OR A$50.00 FEE WILL BE CHARGED
BASEMENT PLUMBING YES/NO
( INStISTRACT 25 . 01
BATHROOMS: FULL '/. %3 1
IDIBLIC WATER SUPPLY YES/® NAME
PRIVATE WATER SUPPLY 0/NO WELL/CISTIRN PERMIT# being processed
•
•
�� HIGH PLAINS ENGINEERING & DESIGN, LLC
• 721 4th STREET, SUITE D, FORT LUPTON, CO 80621 • PHONE: (303)-857-9280 • FAX: (303)-857-9238
March 19, 2010
Conquest Water Services
Attn: Jim Goddard
8207 West 20th Street, Suite B
Greeley, CO 80634
RE: To provide an onsite wastewater system design for the proposed
commercial site at Parcel #071334000004, a Part of the S1/2 of Section 34,
T7N, R63W of the 6th P.M., Weld County, CO
Job # 10-2091
SEPTIC SYSTEM DESIGN DATA:
The percolation test for the site performed by High Plains Engineering &
Design, LLC (Report No. 10-2091) had an average percolation rate 25.5
minutes per inch (mpi) at a standard depth of 36-inches below grade. No
limiting layer or water table was found in the 13' profile hole.
The system is designed for 8 full time office employees and 15 employees
that report to the site and depart to remote sites (drivers).
ABSORPTION AREA FOR BED
8 FULL TIME WORKERS @ 15 GALLONS PER DAY (GPD) = 120 GPD
15 DRIVERS @ 5 GPD = 75 GPD
TOTAL FLOW (Q) = 195 GPD
FOR WELD COUNTY (BED):
A = Qx1.5x1.3xV T A = 195x1 .5x1.3xV30.0 = 595 SQ. FT.
3.5 3.5
Dimensions of bed: "Rock and Pipe" System; 18' x 48' with 3 rows of 40
lineal feet (LF) of 4" diameter perforated pipe, or 12' x 68' with 2 rows of 60
LF of 4" diameter perforated pipe.
The 12 inch layer of aggregate shall consist of clean, washed, graded gravel
or rock to range in size from 3/4 inch to 2-1/2 inches with an average size of
1-1/2 inches. The rock shall extend from 2 inches above the top of the pipe,
• level across the bed, to 6 inches below the bottom of the pipe. The top of
the rock shall be covered with landscape fabric, untreated building paper, or
a 2 inch layer of straw or hay to prevent the gravel from becoming clogged
by earth backfill.
• •
Shredded tires are an approved alternate for the rock in this type of system.
• Contact this firm to discuss suppliers and/or specifications.
Alternate: Using infiltrator units in bed system: 20' x 64' bed with 4 rows of
14 Q4 standard infiltrators.
NOTE: The Engineer and Health Department will inspect the site when
perforated pipe or infiltrators, distribution box, rock or shredded tires and
septic tank are in place. A final inspection may be made when the system is
completed.
SEPTIC TANK SPECIFICATIONS:
Install a 1000-gallon minimum capacity leak-proof septic tank, with two (2)
compartments or units in series.
NOTES:
1. Provide a minimum of five CO feet between the distribution box and
the septic tank or any building
2. Provide a minimum of five (5) feet of solid pipe between the
distribution box and the laterals.
Installer to provide schedule 80 pipe when trenching below road or
• driveway. The absorption "bed" area shall be isolated from all vehicular
travel, parking, grazing and storage areas.
A lift pump may be required for this system if minimum specifications of 1/8"
per foot of fall between the house, septic tank and the distribution system
cannot be met (refer to lift pump detail). The absorption bed components
are required per County Code to be within 36" of final grade.
All construction is to be in accordance with Weld County Colorado
Department of Public Health and Environment's Individual Sewage Disposal
System Regulations.
Certification:
I hereby certify that the septic system shown on this plan was made by me
or under my direct supervision d is accurate to the best of my knowledge
or belief. p REG(ST
o? ;•sc ...o,.F9
Fo `o
73.
33548
• Todd M. Schroeder, PE 4
�IIi Gr
•
• •
SITE MAP
Parcel # 071334000004
Part of the S1/2 of Section 34, T7N. R63W of the 6th P.M.
Weld County, CO
BR, 1\E I•
Mil PIN:. Ill
FDISTRIBt1TION
3 ROWS OF40LF. BOX
• OF 0"PERF.PIPE
•
LIFT PUMP 1000 GAL.MIN.
is (IF NEEDED)
SEPTIC TANK
4 1' CPC
l4
CP
P
ersY
535'
WELD COUIN1 RIIAD ;1
LEGEND
All locations shnr.n ab, c arc based on specific information furnished by others or estimates
0 Percolation Test Hole made in the field by Nigh Plains Engineering&Design personnel. The locations,distances,
directions,etc er not the trwll of a property survey but are approximations and are not
X Percolation Profile Hole warranted to be exma h is the owner/uilder's responsibility to define property-boundaries and
ensure all onsne nupro.iments are located within the platted site and out of inappropriate
-Soil Profile Hole easements. 411 di-dim .,n'm he verified prior to excavation.
X X-Fence
FIGURE 1
\
COLORADO DIVISION OF WATER RECES \ \ Office Use Only • Form GWS-45(07/2009
DEPARTMENT OF NATURAL RESOUR
1313 SHERMAN ST, RM 818, DENVER, CO 80203
phone—info:(303)866-3587 main:(303)866-3581
fax:(303)866-3589 http://www.water.state.co.us y
'ENERAL PURPOSE
ater Well Permit Application
Review instructions on reverse side prior to completing form.
The form must be completed in black or blue ink or typed.
1.Applicant Information 6. Use Of Well (check applicable boxes)
Named applicant Attach a detailed description of uses applied for.
CONQUEST DISPOSAL SERVICE
❑ Industrial ❑ Dewatering System
Mailing address ❑ Municipal ❑ Geothermal(O production or 0 reinjection)
8207 W 20TH STREET,SUITE B ❑ Irrigation O Other(describe):
' city State Zip code 0 Commercial
GREELEY CO 80634 7. Well Data(proposed)
Telephone# E-mail(Optional)
(970)356-5560 970-356-5560 Manmum pumping rate Annual amount to be withdrawn
15 spm 1/3
2.Type Of Application (check applicable boxes) acre-fe
Total depth Aquifer
® Construct new well O Change source(aquifer) 300 ALL UNNAMED
❑Replace existing well 0 Reapplication(expired permit) feet
❑Use existing well O coGCC well 8. Land On Which Ground Water Will Be Used
❑Change or increase use 0 Other: Legal Description(rnay be provided as an attachment):
3. Refer To (if applicable)
Well permit if Water Court case** —._.. . _.
Designated Basin Determination Well name or if
4. Location Of Proposed Well (Important! See Instructions) (If used for crop irrigation,attach a scaled map that shows Irrigated area.)
County A. #Acres B. Owner
WELD SE 1/4ofthe SE i,4
—
Ill
'on Township NaS Range EcrW Principal Meridian _
7 7 o ❑ 63 ❑ ® 6TH C List any other wells or water rights used on this land:
Distance of well from secfai lines(section lines are typically not property tines)
Ft.from❑N ❑s Ft.from LIE ❑W 9. Proposed Well Driller License#(optional):1397
For replacement wells qtly—distance and drection from dd well to new well 10. Signature Of Applicant(s) Or Authorized Agent
feet direction -The making of false statements herein constitutes perjury in the second
Well location address(Include City,State,Zp) 0 Check If well address is same as in item I. degree,which is punishable as a class 1 misdemeanor pursuant to C.R.;
24-4-104(13)(a). I have read the statements herein,know the contents
thereof and state that they are true to my knowledge.
Sign here(Must be original signature) Date
Optional: GPS well location information In UTM' - st chllrGe$unit for .. J
required settings as follows: - a oaf ::-relif C2`{/2i6i
P t e8 title
Format must be UTM r ��//
❑Zone 12or❑Zone13 Easy L / 6
Units must be Meters ..—_._ Office Use Only y- �a r�
Datum must be NAD83 Northing
Unit must be set to true north USGS map name DWR map no. Surface dev.
Was GPS unit checked for above? O YES Remember to set Datum to NAD83
5. Parcel On Which Well Will Be Located Receipt area only
(YOU MUST ATTACH A CURRENT DEED FOR THE SUBJECT PARCELL
A. Legal Description(may be provided as an attachment):
ft of acres in parcel C. Owner _.. .._ ACIUAMAP
CONQUEST DISPOSAL WE,
D. Will this be the only well on this parcel?OYES ONO(If no—fist other wells) WR
CWCB
TOPO
E. State Parcel ID#(optional):
MVLAR
SB5 DIV WD SA MD
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