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HomeMy WebLinkAboutApplication.pdfCommunity Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 OCT 1 5 2113 www.garfield -c SCt .com GApf MELC} MMONTY Dr. '1? CY lv INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PERMIT APPLICATION ! •F OPE OF CONSTRUCTION Property Owner: Puckett Land Company Phone: ( 303 ) 763 -1003 Mailing Address: 5460 S Quebec St, Ste 250, Greenwood Village, CO 80111 Contractor: WPX Energy Rocky Mountain, LLC Phone: ( 970 ) 285 -9377 ext 2209 - New Installation Engineer: David Fox Phone: ( 970 ) 250-5505 © Alteration • Repair WASTE TYPE 217129100005 Sub. Lot Block Temporary office & house #Bedrooms: 2 Garbage Grinder No Sewer System: connect to the Community NA 7 Non- Domestic = Dwelling • Transient Use ❑ Recycling ❑ Pit Privy ❑ Incineration Toilet • Comm /industrial • Other Describe Ground Conditions Depth to ft Ground water table NA Percent Ground Slope NA Final Disposal by ❑ Absorption trench, Bed or Pit 0 Underground Dispersal ❑ Above Ground Dispersal ❑ Evapotranspiration ❑ Wastewater Pond INVOLVED PARTIES Property Owner: Puckett Land Company Phone: ( 303 ) 763 -1003 Mailing Address: 5460 S Quebec St, Ste 250, Greenwood Village, CO 80111 Contractor: WPX Energy Rocky Mountain, LLC Phone: ( 970 ) 285 -9377 ext 2209 Mailing Address: PO Box 370, Parachute, CO 81635 Engineer: David Fox Phone: ( 970 ) 250-5505 Mailing Address: PO Box 370, Parachute, CO 81635 PROJECT NAME AND LOCATION Job Address: GM 11 -28 - Please see plats for description. Assessor's Parcel Number: Building or Service Type: Distance to Nearest Community Was an effort made to 217129100005 Sub. Lot Block Temporary office & house #Bedrooms: 2 Garbage Grinder No Sewer System: connect to the Community NA Sewer System: NA Type of ISDS ❑ Septic Tank ❑ Aeration Plant Ill Vault ❑ Vault Privy ❑ Composting Toilet ❑ Recycling, Potable Use ❑ Recycling ❑ Pit Privy ❑ Incineration Toilet ❑ Chemical Toilet NI Other Hauled la Dawn Valley waste for their disposal Ground Conditions Depth to ft Ground water table NA Percent Ground Slope NA Final Disposal by ❑ Absorption trench, Bed or Pit 0 Underground Dispersal ❑ Above Ground Dispersal ❑ Evapotranspiration ❑ Wastewater Pond ❑ Sand Filter IN Other Hauled to Down Valley Waste for their disposal Water Source & Type ❑ well ❑ Spring ❑ Stream or Creek ❑ Cistern B Community Water System Name Down Valley Septic and Waste Effluent Will Effluent be discharged directly into waters of the State? ❑ Yes Ill 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. 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. 1 hereby acknowledge that I have read /an�j understand the Notice and Certification above as well as have provided the required informatj6n which is correct and accurate to the best of my knowledge. Property Owner Print and Sign 1O/P4/1 x_ Date OFFICIAL USE ONLY Special Conditions: Permit Fee: -4-3 Perk Fee: Eflb Total Fees: 33•- Fees Paid: 73 T Building Permit Septic Permit: Issue Date: Balance Due:„...-- BLDG DIV: QiAY ! W3 _� A PPROVAL 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, perfounance, 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 1 of this document to install and utilize a vault system, as of the effective dates stated on page 1, 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 -10 -13 -3022 WELL SITE LOCATIONS (APD #) GM 11 -28 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 of 24 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 his /her 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 his/her 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 of the waste contents. 11. 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 conform 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 of the 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 Depaituient 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.I 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 pennut issued, the Garfield County Building Official or his/her 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 High level Alarm 11 light or Alarm Is Present Tank Is Fell GM 11 -28 Vault System Description The site will temporarily office and house up to a maximum of four individu- als 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. One aboveground sewage holding tank with 4000- gallon capacity on -site. The Vault System is displayed in both of the pictures. Sewage flows esti- mated 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 ca- pacity on -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 gal- lons /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 gal- lons. Road access to the site is maintained year round through the services of pri- vate road maintenance and construction contractor. POTABLE WATER ONLY SEPTIC 2008 Privote Alum. Cop 0.4' High WPX Energy Rocky Mountain, LLC PLAT #2_LOCATION LAYOUT FOR GM 11 -28 SECTION 28, T6S, R96W, 6th P.M. Existing Drainage Existing Pipelines errrr•rrrr • Q.- . oSTE' ..Y Approx. Top of _ f� /Cut Slope i 0 7 ' C -20.7' Install 60" CMP I 624.7'N ENCANA OIL & GAS (USA) INC " Sta. 4 +72 4%...2008 PrilHte Alin , 40 0:7' High Property Line Sta. r 3 +72 ,043 C -8.4 ,'' El. 612.4'- 5``�� „Private Alum Cop Gt 1' High SCALE: 1" = 80' DATE: 04 -25 -12 DRAWN BY: C.A.G. REV.: 02 -05 -13 M.D. REV.: 02 -20 -13 M.D. REV.: 03 -20 -13 M.D. REV.: 06 -24 -13 M.D. REV.: 06-26-13 M.D. REV.: 07 -02 -13 M.D. N Az 322.529167' g Transition Line Prop. G%I 41 -21 140' J Existing Drainage Proposed Access R ----Prop. Gil/ 323- 1 Prop. 7$I 413-21 GII 2J-21-- Prop. GM 313 -21 N F-27' Pro aII' 14 -21 Wqa 7,A 11x121 6D1.3' Prgo GX:1 11 - ?8 \ Prop tV 344 -20 El 598.8" '9. PUCKETT LAND COMPANY EL 603.9' tl 10' ` `` `? Prop" ' 3 -2: Prop. GA/ 514 -21 Prap. GAI 314 -21 Prop. 0A1 521 -28 trop. GAI 411 -28 Prop. CAI 322 -28 . CAI 422 -28 Prop. GU 311 -28\ Prop. GM 522 -28 \ Prop. GU 701 -28'! l \N (NI \\, Sic. 2 +20 F-6.2' EL 5978' \(\ \\\ 164\%\\\\c‘\\\:§\\\\a\ Sta. 0 +00 Approx. of Fill Slope 2 Con t our Elev. Ungraded Ground At FINISHED GRADE EL EV. AT F-0 Existing Fence ---5 o Loc. Stake = 5603.9 UINTAH ENGINEERING & LAND SURVEYING LOC STAKE = 5604.0";,-- = -- 85 So. 200 Eas • Vernal. Utah 84078 • (436) 789 -1017 LEGEND: EXISTING ROADS )( )( )( )( )( )( EXISTING FENCE PROPOSED ACCESS ROAD EXISTING PIPELINE Uintali Engineering & Land Surveying 85 South 200 East Vernal, Utah 84078 (435) 789 -1017 * FAX (435) 789 -1813 N WPX Energy Rocky Mountain, LLC GM 11 -28 SECTION 28, T6S, R96W, 6th P.M. ACCESS ROAD MAP 13 YEAR SCALE: I 2000' 1 DRAWN BY: 1M. THE ISED; -g-00 0621 MONTH DAY 5 PLAT EllriiIMIRIAMeitliileliWIRCIM Ft Mil RseepttenR: SA737p8,7 e�1 01 7 Ru F*, $ 1.ee 00 :espO.10;£ 1QD Calm CO STATE 4T OF AUTHORITY Pursuant to C_R.S, 538 -30 -172, the undersigned executes this Statement of Authority on behalf of Puckett Land Company a Colorado (corporation, limited liability company, general partnership, registered limited liability partnership, registered limited liability limited partnership, limited partnership association, government agency, trust or other), an entity other than an individual, capable of holding title to real property (the "Entity"), and states as follows; The name of the Entity is Puckett Land Company and is formed under the laws of Colorado The mailing address for the Entity is 5469 S. Quebec St.. -- ••_••• r :i The name and /or position of the person authorized to execute instruments conveying, encumbering, or otherwise affecting title to real property on behalf of the Entity is Eric _g. Stearps. its President The limitations upon the authority of the person named above or holding the position described above to bind the Entity are as follows: One nunitred Thousand Do11aNg (if no limitations, insert "None") Other matters concerning the manner in which the Entity deals with any interest in real property are: (if no other matter, leave this section blank) BIIECOTSA this 23rejday of , 20J Signatur xane(typed or printed: It. E. Puckett Title (if any): Board Chairman STATE OF CO Or'pd0 )SS.' cmAn'y OF AUalla]1Qf. The foregoing instrument was acknowledged before me this 23rd day of Aum,ci" 20fl by 1; R. Purkptt , on behalf of Pnrka41- Sanrt crrmpsny as_ Board Chairman Witness my hand and official Beal. my caaanission expires: 0,111,3 (got- Public) (SEAT,) 05/09 RAYMOND S. ANDERSON NOTARY PUBLIC STATE OF COLORADO My Wrings/On Expims 003 {ry a: PUCKEIT LAND COMPANY 5460 So. Quebec St., Suite 250 Greenwood Village, CO 80111 VUCKETT Land Company September 6, 2013 Mr. Fred Jarman, Director Garfield County Building and Planning Department 108 8th Street, 4th Floor Glenwood Springs, CO 81601 RE: GM 11 -28 Drilling Pad Location Garfield County, Colorado Dear 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 location. Sincerely, Puckett Land Company By: Name: Eric R. Steams Title: President 5460 S. Quebec St., Ste. 250 • Greenwood Village, Colorado 80111 • 303 -763 -1000 • Fax: 303- 763 -1040 Lill MCI t 1111 111 Oeocc�ppilonN: 11160 ®4 7127!2012 12:18. 3 PM leA,, Alb rrioo t of 7 Rao s:ea;ii8.00 Coo Feet@.V9 AIRFIELD COUNTY CO 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 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, 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: : 1. 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 Use Licenses, Utilities, Snow Removal and Private Construction 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 grants such rights to others; 3. Agreements that assign easements, rights of way, licenses, permits or surface leases in connection 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 easements; 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 other 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 purposes 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 of the 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 the 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 Attorney shall remain in full force and effect until terminated by Company. 1 ■If1I�W�!'( 144 ,N1��I�lr+rtPi+I�C�> f l�+ Ir' C( 1411.11.4 11111 Raueptlonq: 618004 12071212 Fts0 B Poe FbA0D ca FIEifl COUNTY CO IN WITNESS WHEREOF, WPX Energy Rocky Mountain, LLC has caused this Limited Power of Attorney to be signed by one of its Vice Presidents, duly authorized by its Management Committee to grant powers of attorney this l" day of January, 2012. D. rnes Its•/ ice Pr ident STATE OF OKLAHOMA COUNTY OF TULSA ) ss. AIN, LLC ACKNOWLEDGMENT 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 Vice President of WPX Energy Rocky Mountain, LLC a Delaware limited Iiability company, who acknowledged to 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 notary seal, the day ofd; 2012, Feileuarif NotaryPuuIio r My Commission Expires: 2, J 2.3- 2 0114 After Recordation Please Return To: WPX Energy Rocky Mountian, LLC Attn: Land Dept. PO Box 370 Parachute, CO 81635 _a_Ay WMYJ.DENT 1.1".fCYlp�Wprp�0nl1a 2