HomeMy WebLinkAboutApplication.pdfGARFIELD COUNTY Building and Planning Department 108 81h Street, Suite 401 Glenwood Springs, Colorado 81601 Telephone: (970) 945-8212 Facsimile: (970) 384-3470 www.garfield-county.com
-:SiF~-O-\:'l-1iD RECEIVED SEP 1 02013 I'JARFIELD COUNTY 'AMUNITY DEVELOPMENT Small Temporary Employee Housing Administrative Checklist GENERAL INFORMATION -Submit 1 hard-copies and
one dlgltal copy of the completed application to Planning Department w/ln 48 hours following occupation. All digital documents shall be In .pdf form and should be separated Into sections
Identical to the hardcopy. (To be completed by the Small Facility Operator -e.g. well pad operator) SectionfTownship/Range Location of Housing Site: Well Pad Number: Sec 25 -7s-94W -Pad
25 Tax Parcel Number for Parcel Containing Housing Site: 245306100005 GPS andlor Lat-Long Coordinates of Housing Facility Site (Often included in APD): 39.4045621 -107.832781 Zone District:
Rifle I Maximum Number of Occupants at Permitted Site (e.Q. well pad): 8 Cumulative Amount ofTime (in Days) The Facility Will be at Location: 60 -90 days State or Federal Permitting
Agency Overseeing Reclamation, COGCC Restoration and Reveaetation and Relevant Permit Number: Date of Installation: q/C,/l , I Date of Removal: aprx IJ/IJ/U Name of Landowner: Black
Diamonds Minerals, LLC Street Address: Telephone: Email: 1600 Stout St, Suite 1710 303-973-3228 jbrumely@hdmincrals.com City: State: CO Zip Code: Denver 80202 ~ Name of Operator's Compliance
Officer: Mary Griggs (regulatory) 1 Jamey Brumley (operations) Street Address: Telephone: Email: 303-973-3228 Griggs jhrumcly@hdminerals.com 1600 Stout St, Suite 1710 303-241 -2524 Brumley
IIlgriggs@bdmillerals.com City: Denver State: CO Zip 9J~~TJ2 Company 24-Hour Emergency Contact: J amev Brumlev I Phone Number: 303·241 -2524 This Administrative Checklist must be received
by the Garfield County Planning Department within 48 hours following occul1anc~ of the Small Facilit~. A copy of this completed Administrative Checklist and all associated submittals
shall be delivered to the Garfield COlmty Sheriff's Office and retevant Fire Protection District (if applicable) within 48 hours following occupancy of the Small Facility. Additionally,
tile Garfield County Sheriff's Office and relevant Fire Protection District (if applicable) must be notified in writing (return receipt) or verified email (return receipt) within 48
hours following removal of the Small Facility. It is the Operator's resDonsibilitv to confirm and obtain verification that the Administrative Checklist has been received bv
the Sheriff's Office and Fire Protection District. Fire Suppression Requirements (Per Performance Standard Ll "A water storage tank is required to provide water to the sprinkler system
(if applicable) and initial suppression activities. The size of the water tank shall be determined based on sprinkler calculations and initial suppression demands. The relevant fire
protection district shall be responsible for determining the size of the water storage tank. If the Small Facility is not within a fire protection district, the Operator shall provide
at least 2500 gallons of water dedicated to initial fire suppression which is accessible with a dry hydrant." Required Size of water storage tank for sprinkler system and Initial suppression
activities; __________ 9allons A. Outline of Process. The Small Temporary Housing Facility(ies) Review process shall consist of the following procedures as more fully outlined in Section
4-109 of Article IV of the Unified Land Use Resolution of 2008. 1. Application to relevant protection districts and the Garfield County Sheriffs Office. 2. Application to the County
B. Review Process. Prior to submittal of any forms to the Planning Department, the applicant shall submit all documents to the relevant fire protection district(s) and the Garfield County
Sheriffs Office. All forms shall be accurately completed, Signed, dated and submitted to the Garfield County Planning Department within 48 hours following occupation of the Small Facility.
c. Submittal Requirements. The application submitted to the County shall contain the following information: i. A vicinity map indicating the section, township, and range of the subject
lot and the location of Small Facility within the subject lot and the Permitted Site; general relation to surrounding public roads, private roads, adjacent utility systems, residential
development, other actively permitted Small, Minor and Major Faciltties, natural drainage courses and municipaltties within one (1) mile of the proposed Small Facility; north arrow and
scale; GPS coordinates and current surface ownership of the subject lot. The vicinity map shall be presented on a USGS 7.5 minute series quadrangle at a scale of 1"=2000' or equivalent,
with a topography depicted at a minimum of 40' intervals. ii. Surveyed layout of the proposed Small Facility within the surveyed boundaries of the Permitted Site, including at a minimum:
sewage and wastewater disposal, trash receptacles, potable water storage, all other associated infrastructure and all other equipment located within the Permitted Site. (See Section
4-502 (C )(3) for site plan definition) iii. Identification of the private and public roadways accessing each Small FaCility. Roadways shall be marked as open, gated, and/or locked (include
combinations). Detailed directions, with mileage, shall be given from the nearest town within Garfield County, nearest Garfield County Sheriffs Office dispatch location and responsible
fire district headquarters to each Small Facility, along each roadway. iv. Name, address and phone number of surface owner of the subject lot. v. Name, address and number of at least
a 24-hour emergency response for 0 erator's erne enc field 2
operations; contact numbers for local hosp~als, emergency response, fire protection districts, Garfield County Sheriff's Office, Life/Care Flight, and applicable regulatory agencies;
site safety/evacuation plan; and any other written response plan for potential emergencies at the Permitted Site. vi. Identification of the anticipated dates of installation and removal
of the Small FaCility. The s~e plan shall include a notation of the total cumUlative length of time (number of days) that the Small Facility will be installed at the Permitted Site.
ELIGIBILITY Requirement (Section 7-808 (0)(3) -All Requirements Applicant .. Planning [)eDaitlilent Must be Satisfied to be Eligible as a Small Facility ComDlies (YIN) ComDlies (YIN)
The Small Facility and any aSSOCiated infrastructure must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission
(COGCC) approved oillgas well pad) in which reclamation and revegetation are y secured with the permitting agency (Permitted Site); and, The Small Facility is located at the Permitted
Site for less than a cumulative of one (1) year and at the end of the y utilization period, all structures, foundations and associated infrastructure are completely removed; and, The
Small Facility shall have an occupancy of eight (8) or fewer people within a Permitted Site (e.g. well pad) who are employees, contractors or sub-contractors of the operator of the small
facility and are needed for onsite . safety of the related commercial, industrial, extraction or highway operation. y Temporary employee housing facilities that do not have the three
characteristics listed above, or consist wholly or in part of Recreational Vehicles as defined above, are subject to the administrative permit requirements or the Major Impact Permit
process, standards and requirements contained in this document. 3
BuUdlng Information (Per Unit) 754 ISDS Permit Number: Signature of Operator's COillplianl~f( '" /. Officer ( Q ( By sig~-'niiiin~gilt1ihliS's"foOi~rrm,r :II vV;e;rni1J"y{ltliih;attiih~~~fn~iViliiiid
irinilt~hl's~cfchecklist is correct and accurate to the best of my knowledge) Print Name: _ ____ ______ _ 4
Eligibility, Submittal and Perfomrance StandafrJs t:;ertification . Section 7-808(0)(3) -Small Temporary Employee Housing Facilities (Small Facility(ies» in Article VII -Standards, requires
the that the following performance standards be met with each facility: Small Facilities, in the nature of Factory Built Nonresidential Structures [as defined under C.R.S. 24-32-3302(a)]
but NOT recreational vehicles [as defined under C.R.S. 42-1-102 (61), including truck, truck tractor, motor home or camper trailer], may be utilized for housing of workers on projects
related to commercial, industrial, mineral extraction or highway operations, pursuant to the standards for Small Facilities contained in subsection (2), below. Such facilities are not
subject to Garfield County building and fire codes (building code, fire code). However, Small Facilities are subject to all pertinent state (i.e. electrical permits), federal permits
and relevant fire protection district(s) code requirements. Small Facilities shall have all of the following basic characteristics: A. The Small Facility and any associated infrastructure
must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission (COGCC) approved oil/gas well pad) in which reclamation
and revegetation are secured with the permitting agency (Permitted Site); and, B. The Small Facility is located at the Permitted Site for less than a cumulative of one (1) year and at
the end of the utilization period, all structures, foundations and associated infrastructure are completely removed; and, C. The Small Facility shall have an occupancy of eight (8) or
fewer people who are employees, contractors or sub-contractors of the operator of the small facility and are needed for onsile safety of the related commercial, industrial, extraction
or highway operation. Temporary employee housing facilities that do not have the three characteristics listed above, or consist wholly or in part of Recreational Vehicles as defined
above, are subject to the administrative permit requirements or the Major Impact permit process, standards and requirements contained in this document. The Small Facility shall adhere
to the following Standards: All required submittals (as outlined in (2), above) shall be submitted to the Planning Department within 48 hours following occupation of the Small Facility.
Enforcement shall be in accordance with this Resolution. The Small Facility shall demonstrate and certify compliance with the following standards: A. Small Facility must comply with
all applicable federal, state and local laws and regulations. B. The Small Facility shall NOT contain recreational vehicles as defined in Section 7-808 (D). 5
C. In no case shall unsafe water be used for drinking nor shall raw sewage or contaminated water be discharged on the ground surface. The operator shall conduct monthly tests (or quarterly
if an on-site disinfection system is installed) and maintain records of stored potable water samples specific for coli form bacteria. Any tests indicating coli form contamination must
be disclosed to the Garfield County Board of Health or designee within 72 hours from the time the contaminated water was tested. D. Each Small Facility shall be maintained in a clean,
safe and sanitary condition, free of weeds and refuse. Any hazardous or noxious materials that must be stored at the Small Facility for operational or security reasons must be managed
in accordance with all 'applicable federal, state and local laws and regulations, E. At least one thirty (30) gallon (4 cubic feet) wildlife-proof refuse container shall be provided
for each Factory Built Non-Residential Structure unit. Said container(s) must be durable, washable, non-absorbent metal or plastic with tight-fitting lids. F. Refuse shall be disposed
of weekly, at a minimum. Operators must keep appropriate records, to be provided to the County or any interested third party upon request, to demonstrate that refuse is collected in
a timely fashion and disposed of at a licensed facil ity. G. Outdoor food storage is prohibited. H. Factory Built Non-Residential Structures equipped by the manufacturer with a fire
sprinkler system, fire detection system, andlor alarm system shall be inspected, tested, and maintained in accordance with the requirements of the relevant fire protection district(s)
and the Colorado Division of Housing. I. Single-station carbon monoxide alarms shall be placed in each Factory Built NonResidential Structure. J. One (1) or more approved fire extinguisher(s)
of a type suitable for flammable liquids, combustible materials and electrical fires (Class ABC), or dry chemical, shall be located in each Factory Built Non-Residential Structure and
placed in accordance with applicable fire protection district andlor Colorado Division of Housing codes. K. Domestic animals are prohibited at all Small Facilities. L. A water storage
tank is required to provide water to the sprinkler system (if applicable) and initial suppression' activities. The size of the water tank shall be determined based on sprinkler calculations
and initial suppression demands. The relevant fire protection district shall be responsible for determining the size of the water storage tank. If the Small Facility is not within a
fire protection district, the Operator shall provide at least 2500 gallons of water dedicated to initial fire suppression which is accessible with a dry hydrant within each Permitted
Site for a Small Facility. M. The operator shall document all emergency situations requiring action by any government agency or fire protection district, in writing, and such documentation
shall be presented to the Planning Department within 24 hours of the occurrence. N. All required Access Permits shall be obtained from the Garfield County Road and Bridge Department
or the Colorado Department of Transportation. 6
O. The Garfield County Sheriff's Office and relevant fire protection district(s) shall be notified and provided with all documentation as outlined in these regulations, within 48 hours
following occupation of each Small Facility. In addition, the Garfield County Sheriff's Office and relevant fire protection district(s) shall be notified either by hard-copy or electronically
within 48 hours following removal of all Small Facilities. The Planning Department shall be copied on all such notification, whether hard copy or electronic. P. The Operator shall maintain
records identifying workers, whether employees, contractors or sub-contractors, and document the dates that each worker is housed at the Small Facility. Such records shall be provided
to the County or any additional third party upon request. Q. The Operator shall obtain a certification inspection conducted by a third-party Professional Engineer Licensed in the State
of Colorado. The certification shall verify that at the time of inspection the identified Small Facility meets or exceeds the standards set forth in Article 7.808 D. 2. of the Garfield
County Land Use Code of 2008, as amended. This certification shall be on forms provided by the Garfield County Planning Department. The certification shall be provided to the Garfield
County Planning Department within 48 hours following occupation of the Small Facility. R. The Operator shall accurately complete all required forms provided by the Garfield County Planning
Department identifying the location of the facilfty (Sectionrrownship/Range, relevant Tax Parcel Number, and GPS coordinates or Latitude/Longitude coordinates); relevant zone district;
maximum number of occupants; cumulative amount of time (in days) that the Small Facility will be at the specified location; identification of the State or Federal permitting agency overseeing
reclamation, rehabilitation and revegetation of the Permitted Site and relevant permit number; date of installation; date of removal; name and contact information of the landowner; name
and contact information of the Operator's Compliance Officer; 24-hour emergency contact information for the Operator; building information (make, manufacture year, serial number, size
(square feet)); signature and contact information of the Operator's Compliance Officer. S. Wastewater Disposal: 1) Vault System: All vault systems shall be designed and installed to
accommodate the maximum number of persons (eight or less individuals), who will inhabit the Small Facility. In addition, all vault systems shall be equipped with an overflow alarm device.
Vault systems shall be designed to accommodate a minimum of 75 gallons of wastewater per person per day. If a vault system is proposed or has been approved, the Operator must: a. Demonstrate
that year-round vehicular access is available and maintained for safe and regular access for sewage hauling vehicles. b. Maintain all sewage disposal records including but not limited
to trip logs/reports and landfill receipts as public records, available to the County and/or any other interested third party upon request. c. (b) Individual Sewage Disposal System (ISDS):
If an ISDS is proposed, then it shall be designed, installed and operated to accommodate the maximum number of persons who will inhabit the Small 7
Facility (eight or less individuals) and shall otherwise be permitted and operated in accordance with the Garfield County 18DS regulations as contained in SOCC Resolution Number 1994H-136.
I hereby attest that I am the designated Compl/ance Officer for the aforementioned Small Temporary Employee Housing Faclllty(les). I attest that I have read and understand the standards
to which the Facility(ies) shall be Installed and operated. I attest that the Faclllty(ies) will be constructed and maintained In accordance with all applicable Garfield County, State
of Colorado and Federal regulations and standards. In addition, I attest that I have read and understand the enforcement provisions as described In Article 12 of the Garfield County
UnifIed Land Use Resolution of 2008. Further, I understand that non-compliance with any of the provisions as outlined In Article 7-808 (0) (3) of the Garfield County Unified Land Use
Resolution of 2008 shall be enforced in accordance with Articie 12. Signature of Operator's Compliance Officer: ______________ _ Print Name: ___________ ~ ___________ _ Title: _______________________
___ _ Phone Number: _______________________ _ Email: __________________________ _ I hereby attest that I am a Licensed Professional Engineer in the State of Colorado. I attest that I
have conducted a visual Inspection of the Small Facility Identified in this Administrative Checklist, as installed, and, based on Information from that inspection I certify that the
Small Facility complies with the standards set forth in Article 7-808 (0) (3) ofthe Unified Land Use Resolution of 2008. PE Certification Number PE Stamp Date of Inspection Print Name
and Title Signature 8
NOIlh MBm.m. Pe4k Directions to TPR #1 well (Black Diamond Minerals) 11llil~ [ill] W0 ------------------------------~----_, 1 * Travel south from Rifle -Co Rd 320 to 317 -Co Rd 317 to
USFS 824 -USFS Rd 824 to "red gate" --travel past red gate to location (red gate is entrance to BDM private property) lhlJ ~ 11JOI rml "0 Q ,~. "<> [ill] •• INl ,.( f J' ,S'~~ ~ ~ [ill]
Page 1 of 2 Map data 020 13 Goog!e· E
BLACK DIAMOND MINERAIS, LLC LOCAll0N LAYOUT FOR 32-36, 1l'R No drilling on this pad currently. Pad is currently used for storage and camp for rig crew. Trash will be disposed at Pad
25A in 1/:;~~~:::;:::":::4~;':~~~ wildlife
SCill: 1° _ eO' DATE: 08-04-08 DRA'iolI ay, D.R.a. R''''"d: 07-02-100.R.B. MWD (l ) Change House to) BLACK DIAl/GIlD !II!IERAl8. LLC CONSTRUCTION LAYOUT FOR TPR WELL PAD 25A SECTION
25, T75. R94W, 6th P.~4. SW 1/4 SE 1/4 seA l E .IS MBt 2 of 14,1 7---,.· ..••• ~d UlmAH ENCIN8ERlA'Q &: L4ND SURVEYING