HomeMy WebLinkAboutApplication.pdfcG> Garfield County Community Development Department 108 8th Street, Suite 401 INDIVIDUAL SEWAGE DISPOSAL SYSTEM (1505) Glenwood Springs, CO 81601 (970) 945-8212 PERMIT APPLICATION www.
garfield-county.c~ . (jq(Q3 TYPE OF CONSTRUCTION Ii!i New Installation o Alteration o Repair WASTETVPE Ii!i Dwelling 0 Transient Use o Comm/lndustrial Non-Domestic o Other Describe INVOLVED
PARTIES Property Owner: Joan Savage Phone: (~) 625·1675 Mailing Address: PO Box 1926, Rifte, CO 81612 Contractor: WPX Energy Rocky Mountain, llC Phone: (~) 285-9377 .,12209 Mailing Address:
PO Box 370, Parachute, C0 81635 Engineer: David Fox Phone: (~) 250-5505 Mailing Address: PO Box 370, Parachute, CO 81635 PROJECT NAME AND LOCATION Job Address: IRWF 22-25 -see the attached
olat for descriolion I Assessor's Parcel Number: 217526400177 Sub. ~ -Lot Block ---Building or Service Type: Temporary office & house #Bedt ms: /I Garbage Grinder No Distance to Nearest
Community Sewer System : NA ~ Was an effort made to connect to the Community Sewer System: NA Type oflSDS o Septic Tank I 0 Aeration Plant Iii Vault I 0 Vault Privy I 0 Composting Toilet
0 Recycling, Potable Use o Recycling I 0 Pit Privy I 0 Incineration Toilet 0 Chemical Toilet Ii Other Hauled to Down Valley Waste for til ... disposal Ground Conditions Depth to 1i Ground
water table NA I Percent Ground Slope NA Final Disposal by 0 Absorption trench, Bed or Pit I 0 Underground Dispersal I D Above Ground Dispersal 0 Evapotranspiration o Wastewater Pond
I 0 Sand Filter Ii Other Hauled to Down Valley Wn le for their disposal Water Source & Type OWen I D Spring I 0 Stream or Creek I 0 Cistern ii Community Water System Name DownValleySeplicandWaste
Effluent Will Effluent be discharged directly into waters of the State? o ve( Ii NO/
CERTIFICATION 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 hereby acknowledge that I have read and understand the Notice and Certification above
as well as n which is correct and accurate to the best of my knowledge. OFFICIAL USE ONLY Special Conditions: Permit Fee: j):~3 , :t .-Perk Fee: 1116 BUildin~t (1 ~'Pr~q(}3 BLDG DIV:
""" A 1 1. APPRd~ '---" :SP 0 , eN5, B C~ 30~:;:t(}6(s(P;)1 :11"1-3.,....-Dati Total Fees: :n:.:r 3. -Fees Paid: ~1-3.-Issue Date: ~.dg. \3 Balance Due: -Rf' g-l-i·z.oB. DATE
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 I of this document to install and utilize a vault system, as of the
effective dates stated on page I, 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-8-13-2963 WELL SITE LOCATIONS (APD#) RWF 22-25 OPERATORS NAME WPX Energy Rocky Mountain LLC (Kris Meil) 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 of24 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 hislher 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. 1
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 hislher 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 ofthe waste
contents. II. 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 confonn 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 ofthe 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 2
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.! 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 hislher 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
One aboveground sewage holding tank with 4000-gallon capacity on-site. The Vault System is displayed in both of the pictures. Sewage fiows estimated to be 300 gallons/day (4 individuals
x 75 gpcd). Sewage holding tank needs to be emptied approximately every 13 days (4000 gallons/300 gallons per day). Wastewater vault is equipped with overfiow alarm device. Williams
utilizes the services of a licensed contractor to removed and haul the wasterwater to a state certified treatment/disposal facility. One potable aboveground water tank of approximately
4000 gallons capacityon-site. Posted on the front of the Tank there is a Sign that states "Potable Water Only". Potable water demand is estimated to be 300 gallons/day (4 individuals
x 75 gpcd). Required minimum fire suppression demand is 2500 gallons. Total potable and fire suppression demand is estimated to be 4000 gallons. Road access to the site is maintained
year round through the services of private road maintenance and SEPTIC ~ ORAIN T"". BEFORE MOVING = RWF22-2S Vault System Description The site will temporarily office and house up to
a maximum of four individuals during natural gas drilling activities and is expected to be completed in one year or less. The individuals will occupy two individual trailer offices/houses
located on the well pad. Office/houses have Colorado Division of Housing compliance tags. ~
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Total Disturbed Area = ±S.71 ae. SCALE: DATE: 'H-' I f " ,: ; I ~ , WPX Energy Rocky Mountain, LLC PLAT: PROJECT: -""='--____ 1 DFT: RWF 22-25 Dnll Pad --Plat 2 CONSTRUCTION LAYOUT
Seclioll 25 1: 6S., R94 W. ACCESS DESCRIPTION: 10r00 ----0 2000 ! GRAPHIC SCALE IN FEET lINCH= 2000 FEET FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 323 NORTH OF RULISON,
PROCEED SOUTHERLY ALONG COUNTY ROAD 323 ±1 .1 MILES TO THE INTERSECTION WITH COUNTY ROAD 309, PROCEED LEFT IN AN EASTERLY DIRECTION ±2.3 MILES TO THE INTERSECTION WITH COUNTY ROAD 320,
PROCEED RIGHT IN AN EASTERLY DIRECTION ±6.1 MILES TO THE INTERSECTION WITH COUNTY ROAD 317 (Beaver Creek Road), PROCEED RIGHT IN A SOUTHERLY DIRECTION ±1,7 MILES TO THE INTERSECTION
WITH A DIRT/GRAVEL ROAD, PROCEED RIGHT IN AN WESTERLY DIRECTION ±0.6 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED RIGHT IN A NORTHERLY DIRECTION ±O,6 MILES TO THE RWF 22-25
DRILL PAD LOCATION, AS SHOWN HEREON. --------!WPXENERGY , SCALK -WPX Energy Rocky Mountain, llC DATE: PLAT: PROJECT: -""''''''-____ 1 RWF 22-25 Ddll Pad -Plat 5 ACCESS ROAD & TOPO MAP
August 22, 2013 MI'. Fred Jarman, Director Garfield County Building and Planning Department lOS S'h Street, 4'h Floor Glenwood Springs, CO SI60 I RE: RWF 22-25 Drilling Pad Locations,
Garfield County, Colorado Deal' Mr. Jarman: This letter authorizes WPX Energy Rocky Mountain, LLC to represent me in the submittal and processing of the required Garfield County Small
Temporary Employee Housing (STEH) and Individual Sewage Disposal System (ISDS) permits on the above drilling pad locations. Sincerely,
POWER OF ATTORNEY KNOW ALL MEN BY TJ-IESE PRESENTS, that the undersigned, reposing special (rust and confidence in .rOHN W. SAVAGE, JR.; ROY E. SAVAGE, MARSHALL T •. SAVAGE or DANIEL
W. SAVAGE, afPO Box 1926, Rille, CO 81650, ofthe County of GARFIELD, State of COLORADO, have made, constituted and appointed and by these pre~ sents do make, constitute and appoint them
8S my true and lawful attorneys to act for me and in my name, place and stead for my sale use and benefit, with full power and authority to do and perform each Dnd every act necessary.
as fully as I might do ifpcrsonally present Any of my appointed attorneys may act for mc. Any acts undertaken by any of them in my name may be done by anyone or more of them, No such
act shall require the joinder, consent, or signature of more than one of my appointed attorneys. My said attonleys shall have full power and authority to do and perfonn all acts necessary
to be done in regards the same wiLh fuJI power of revocation, hereby radtying and confirming allthat said attorney shall lawfully do or callSOto be done by virtue orlhis Power of Attorney
and the powers contained herein. This Power of Attorney shall not be affected by disability of the principal. Daro: e/'8 /" P( cipal: Joan L. Savage fP--STATE OF iloiDJ1.ACO ) COUNTY
O'r~~ ) ss. The foregoing instmmcnt was acknowledged before me on Joan L. Sllvage, Witness my hand and official SOf I My commission expires: {Q/lf1o/] . by C'\Doc:Ulll<nts and Setl;~gs\l"h9
Sa>agelMy DooJmmts\S~vL1&v 1000n L\f.'~!~ rl!1lninll DocS\I'Ol'lif of Anomer RE doc; clea~: ~J8n(l!o ]")6'00 PM,printed: 5i17120! I 12: !3,OO pM, rllge I nJ'1
LIMITED POWER OF ATTORNEY WPX ENERGY ROCKY MOUNTAIN, LLC ("Company") a Delaware limited liabi lity company, having its principal place of business in tbe Cily of Tulsa, County of Tulsa,
State of Oklahoma, does hereby make, constitute and appoint Bryan S. Hotard with the full authority hereinafter provided, the true and lawful Attorney-in-Fact of the Company, authorized
and empowered on behalf of the Company and in the Company's name, alld for the sale and exclusive benefit of the Company and not on behalf of any other person, corporation Or association,
in whole or in pan, to enter into, execute, deliver, file and accept all instruments and documents affecting tbe real property or real estate rights of the Company as more specifically
set forth below: : I. Applications and documentation associated with Garfield County or Rio Blanco permitting requirements for including, but not limited to, Independent Sewage Disposal
Systems, Small Temporary Employee Housing, Major Impact Reviews, Limited Impact Reviews, Oil and Gas well permitting, Driveway Access, County Road Maintenance, Temporary Living Quarters,
Temporary Use Permits, Surface Use Permits, Surface Usc Licenses, Utilities, Snow Removal and Private Construction of County Roads; 2. Agreements and other documentation that grant easements,
righl' of way, licenses, or permits to Company and also instrumenls where the Company grants such rights to others; 3. Agreements that assign easements, rights of way, licenses, permits
or surface leases in coMection with the Company's operations; 4. Releases and Partial Releases of easements and rights of way; 5. Agreements allowing encroachments onto easements and
rights of way owned by Company and landowner instruments and conveyances on others casements; 6. Agreements subordinating mortgage rights to easement Or lease; 7. Agreements relating
to the modification and relocation of Company facilities; 8. Rental or lease agreements for surface use or oU,er surface use agreements and all notices related to the pipeline agreements;
9. Agreements for the purchase or sale of real property nnd for the lease of real property for residential or commercial purposes or otherwise in connection with the Company's opomtions;
10. Agreements 10 obtain water services, electrical, gas or oil services or the provision of other utilily services utilized by Company's facilities; 11. Agreements modifying, amending,
renewing, extending, ratifying forfeiting, canceling and terminating ony and all ofthe aforementioned types of instruments and documents. WPX ENERGY ROCKY MOUNTAIN, LLC hereby declares
that each and every act, matter and thing wllich shall be given, made and done by Bryan S. Hotard in connection with the exercise of any or all of the aforesaid powers sball be as good,
valid and effectual to all intents and purposes as if the same had been given, made and done by WPX Energy Rocky Mountain, LLC in its limited liability company presence and it hereby
ratifies whatsoever Attorney-in.Fact shall lawfully do or cause to be done by virtue hereof. This Limited Power of Attomey shall remain in full force and effect until terminated by Company.
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1111 ~jr'", l'IAJIoVi.r.lW, N!ll rtltl.trr+ll:lrI\:JiIIII"I\~'~ 11111 ReCQpt!ontl: 815004 0212r12012 12,18:10 P/'I Jun Albl.rlco :2 or 2 R.o FOe.1Sf8,t10 Doc Fe(l:O.eo I'JRRFJELO COUNTY
co IN WlTNESS WHEREOF, WPX Energy Rocky Mountain. LLC has caused Ulis Limited Power of Attorney to be signed by one of its Vice Presidents. duly authorized by its Management Committee
to grant powers of attorney Ihis 1" day of January, 2012. 'f"" .... »ii!l"u,,,TAlN. LLC ACKNOWLEDGMENT STATE OF OKLAHOMA ) ) ... COUNTY OF TULSA ) BEFORE ME, the undersigned authority.
a Notary Public in and for said County and State. on this day personally appeared. Jerry D. Barnes personally known to me to be the Viee President of WPX Energy Rocky Mountain, LLC a
Delaware limited liability cOlllpany, who acknowledged 10 me that he has executed the above LIMITED POWER OF ATTORNEY authorized by Company's Management Committee. IN WITNESS WHEREOF.
I have hereunto set my hand and affixed my nOlary seal, theZol-h day oH"" • ..,.. 2012. FciYuruj My Commission Expires: After Recordation Please Return To: WPX Energy Rocky Mountian,
LLC Attn: Land Dept. POBox 370 Parachute, CO 81635 2