Garfield County Building & Planning Department

108 8th Street Suite 401

Glenwood Springs, CO 81601-

Phone: {970)945-8212 Fax: {970)384-3470

Project Address

4110 CR 213 DEBEQUE, CO 81630-

Owner Information

OXY USA WTP LP

Parcel No.

216921400026

Address

760 Horizon DR

Subdivision

Grand Junction CO 81506

Permit NO. SEPT -1-12-2345 Pennit Type: Septic Permit

Work Classification: New Permit Status: Approved

Issue Date: 3/19/2012 Expires: 03/19/2013

Section Township Range

Phone Cell

Contractor{s) Phone Primary Contractor Required Inspections:

Proposed Construction I Details Septic for a MINOR temporary employee housing .

FEES DUE

Fee

Septic Fee - New

Total:

Monday, March 19, 2012

Amount

$73.00

$73.00

Valuation: $0.00

Total Sq Feet: 0

FEES PAID

lnv Total Paytype Amt Paid Amt Due

lnv # SEPT-1-12-21629 $ 73.00 Credit Card $73.00

$0.00

For Inspections call : 1 (888)868-5306

Inspection IVR

See Permit Record

Building Department Copy

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GARFIELD COUNTY SEPTIC PERMIT APPLICATION I 08 8'11 Street, Suite 40 I, Glenwood Springs, Co 8160 I

Phone: 970-945-82 12 I Fax: 970-384-3470 / Inspection Line: 888-868-5306 fi ld www.gar te -countv.com

Parcel No: (this information is available at the assessors office 970-945-9134) 2 169-2 14-00026

605-13-22 Minor 1505

Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description

_t.-H\0 ll~l~, b'BF<\U 605-13-22 Well Pad NWSW Sec. 5, T6S, R97W, 6th PM, Garfield County, CO Lot Size: Lot No: Block No: Subd./ Exemption:

10,303 n/a n/a n/a Owner: (property owner) Mailing Address Ph: All Ph:

OXYUSA WTP LP 760 Horizon Dr. Ste. 1 01 Grand Junction 81506 970-263-3668 970-985-1835

Contractor: Mailing Address Ph:n/a All Ph: n/a n/a n/a

Engineer: n/a Mailing Address Ph: n/a All Ph: n/a n/a

PERMIT REQUEST FOR: (X) New Installation ( ) Alteration ( ) Repair

WASTE TYPE: ( )Dwelling ( )Transient Use ( )Commercial or industrial ( )Non- Domestic wastes ( X)Other- Describe Temoorarv Emolovee Housing Facilitv sewaae vault

BUILDING OR SERVICE TYPE: I t::IC1U CIIIIJIVVt::t:: "lVU">I I \.I Ullll"> ">t::VVC1\.It:: VC1Uil">

Number of bedrooms n7a Garbage Grinder ( )Yes ( X)No

SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( )SPRING ( )STREAM OR CREEK (x)CISTERN If supplied by COMMUNITY WATER, give name of supplier: Down Valle~ Se12tic from various 12otable water s~stems

DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM: I own or 1-'aracnute Was an effort made to connect to the Community System? no distance too far

YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN GROUND CONDITIONS:

Depth to 1'1 Ground Water Table a~~- 80' Percent Ground Slope < 10%

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 FINAL DISPOSAL BY: ( )Absorption trench, Bed or Pit ( )Underground Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter ( )Wastewater pond (x)Other- Describe Town of New Castle wastewater treatment facilit~ or other J2ermitted site

Will effluent be discharged directly into waters of lhe state? ( )YES (x)NO

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, address & telephone of RPE responsible for design of the system:

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 l eg~~ /}/1'/) o!?...__

OWNERS SIGNATURE DATE

1.)()1)\t \':>SUe \Jf\f\1-L Hrc \-\ - II I ~ ~ 1- 9 ~p . STAFF USE ONLY

Permit Fee: !.\~·\"2..-VI~ Perk Fcc: Total fees: Building Permil #:

t-3 Fn6 1-3 BtCO- ~~yy Septic Permit #: Issue Date:

"'5FPt -l-\~-cr~45 Building & Planning Dept:

L/z~:z-ftP~~ APPROVAL DATE

Down Valley Septic, LLC P.O. Box 1929 • Rifle, CO 81650 970-625-5556 www.dvseptic.com

June 15, 2011

Occidental Petroleum

Attn: Daniel Padilla

Fred Jarman

Director - Garfield County Building and Planning Department

108 81h Street, Suite 401

Glenwood Springs, CO 81601

Re: Hauler Affidavit for temporary housing units in Cascade Creek

Dear Daniel,

Please accept this letter as certification that Down Valley Septic, LLC provides septic hauling and portable restroom services for Occidental Petroleum.

I certify that Down Valley Septic, LLC will provide above services for Occidental Petroleum for the temporary housing un its in Cascade Creek. Service will be provided as needed. Down Valley Septic is available 24 hours a day, 7 days a week, and 365 days a year.

age and portable restroom waste will be disposed of at a state certified location .

. · 0 v // (Signature)

5 c_o tt YY\ o~ c

(Printed name)

Please contact me if you need any additional information at 970-625-5556

Thank you,

Scott Moyer

Down Valley Septic, LLC

(Date)

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