HomeMy WebLinkAboutApplication.pdfGarfield County Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com :5t~-o Oth er Describe INVOLVED PARTIES Property Owner:
BLM Mailing Address: 2300 River Frontage Road, Silt, CO 81652 Contractor: WPX Energy Rocky Mountain, LLC Mailing Address: PO Box 370, Parachute, CO 81635 Engineer: David Fox Mail ing
Address: PO Box 370, Parachute, C081635 PROJECT NAME AND LOCATION Job Address: PA 22-21 -See attached plat for description Assessor's Parcel Number: 217322200951 Sub. Phone: (~) 876·9000
Phone: (~) 285·9377 ext 2209 Phone: (~) 250-5505 Lot Block ---Building or Service Type: Temporary office & house #Bedrooms: 2 Garbage Grinder No Distance to Nearest Community Sewer System:
NA Was an effort made to connect to the Community Sewer System: NA Type of ISDS o Septic Tank I 0 Aeration Plant I II Vault I 0 Vault Privy I 0 Composting Toilet o Recycling, Potable
Use o Recycling I 0 Pit Privy I 0 Incineration Toilet o Chemical Toilet Ii Other Hauled to Down Val ley Waste lor their disposal Ground Conditions Depth to l ' Ground water table NA
I Percent Ground Slope NA Final Disposal by 0 Absorption trench, Bed or Pit I 0 Underground Dispersal I 0 Above Ground Dispersal 0 Evapotranspiration o Wastewater Pond I 0 Sand Filter
Ii Other Hauled to Oowo Valley Waste for their disposal Water Source & Type OWen I 0 Spring I 0 Stream or Creek I 0 Cistern ii Community Water System Name OownValloy Sopllcand Waste
Effluent Will Effluent be discharged directly into waters of the State? DYes 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 com pliance with rules and regulations made, information and reports submitted herewith and required to be submitted by the
applica nt are or will be represented to be true and correct to the best of my knowledge and belief and are designed to be re lied on by the local department of hea lth in eva luating
the same for purposes of issu ing 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 Property Owner Print and Sign OFFICIAL USE ONLY Special Conditions: permitFjtU Perk Fee: If(:, Building ! ermit I ~e~l:d-~4 BLDG DIV: ~\\.rb APPROVAL '-/Pltln{ Q .\'3 .1)
c~30;5i-~ltY4> In·3.-hich is correct and accurate to the best of my knowledge. Total Fees: 1-3. Fees Paid: -1'--Issue Date: Balance Due: '1-a. . 2.J~) d"?' DATE PL
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 overflow 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 construction contractor. , • SEPTIC e PA22-21 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. '--"
LIMITED POWER OF ATTORNEY WPX ENERGY ROCKY MOUNTAIN, LLC ("Company") a Delaware limited liability company, having its principal place of business in the City of Tulsa, County of Tulsa,
State of Oklahoma, does hereby makc, 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, and for the sole and exclusive benefit of the Company and not on behalf of any other person, corporation or association,
in whole or in part, to enter into} execute, deliver, file and accept all instruments and documents affecting the 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, Sman 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 Consbuction of County Roads; 2. Agreements and other documentation that grant easements,
rights of way, licenses, or permits to Company and also instruments where the Company gtants such rights to others; 3. Agreements that assign easements, rights of way, licenses, pennits
or surface leases in connection with the Company~ operations; 4. Releases and Partial Releases of easements nnd rigbts of way: 5. Agreements allowing encroachments onto easements and
rights of way owned by Company and landowner insbuments and cOllveyances 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 oUler surface use agreements and all notices related to the pipeline agreements;
9. Agreements for the purchase or sale of real property and for the lease of real property for residential or commercial pnrposes or otherwise in connection with the Company's operations;
10. Agreements to obtain water services, electrical, gas or oil services or the provision of other utility services utilized by Company's facilities; 11. Agreements modifYing, amending,
renewing, extending, ratifying forfeiting, canceling and terminating any and all ofthe aforementioned types of instruments and documents. WPX ENERGY ROCKY MOUNTAIN, LLC hereby declares
that each and every act, matter and thing which shall be given, made and done by Bryan S. Hotard in connection with the exercise of any or all of tbe aforesaid powers shall 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.
IN WITNESS WHEREOF, WPX Energy Rocky Mountain, LLC has caused Ihis Limited Power of Attorney to be signed by one of ils Vice Presidents, duly authori7.ed by its Management Committee
to grant powers of altorney this 1" day of January, 2012. AIN,LLC ACKNOWLEDGMENT STATE OF OKLAHOMA ) ) SS. COUNTY OF TULSA ) BEFORE ME, the und.rsigned 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 Vice President of WPX Energy Rocky Mountain, LLC a Delaware limited liability
company, who acknowledgcd to me thal he has executed the above LIMITED POWER OF ATTORNEY authorized by Company's Management Committe •. IN WITNESS WHEREOF, I have hereunto set my hand
and affixed my notary seal, theZolh day of.J&ftuary, 2012. F.elor-uruy Notary Public My Commission Expires: 2. -2-3-20ILj. After Recordation Please Return To: WPX Energy Rocky Mountian,
LLC Attn: Land Dept. POBox 370 Parachute, CO 81635 2
Section 21 T. 6 S, R 9S W. EARTHWORK QUANTITIES (cy) 'NOTE: 1.) No Additional Earthwork Anticipated at Site. 2.) Total Disturbed Area = ±5.95 ac. REV/SED: 1/21/13 , , o 80 i ! GRAPHIC
SCALE IN FEET 1 INCH'" 80 FEET cc -"-:-~:-:-::-__ SCALE: WPXENERGY. WPX Energy Rocky Mountain, LLC DATE: PLAT: PROJECT: -"'= '-----1 DFT: PA 22·21 Drill Pad -Plat 2 CONSTRUCT10N LA YOUT
Sectioll 21 r: 6 S ., R 95 W. ACCESS DESCRIPTION: 1000 0 2000 "",---! GRAPHIC SCALE IN FEET lINCH= 2000 FEET FROM THE INTERSECTION OF 1ST STREET AND COUNTY ROAD 215 AT PARACHUTE, PROCEED
IN A NORTHEASTERLY DIRECTION ON STATE HIGHWAY 6, .3.4 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A NORTHEASTERLY DIRECTION , .0.3 MILES TO AN INTERSECTION WITH
A DIRT/GRAVEL ROAD, PROCEED LEFT IN A NORTHERLY DIRECTION, .3.2 MILES TO THE EXISTING PA 22-21 DRILL PAD LOCATION, AS SHOWN HEREON . • , --------!WPXENERGY . ~> '30"'","';h!S"'" SCALK
WPX Ene'gy Rocky Mountain, LLC i Rifle, ColoradoB1650 DATE: Ph. (970) 625·2720 PLA1': l F",(970)625·2773 PA 22-21 Drill Pad -Plat 5 • PROJECT: -"'='-____ 1 DVI' ACCESS ROAD & TOPO MAP
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