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Home My WebLink AboutApplication.pdfRECE Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945 -8212 www.garfield- county.com Garfield County OCT 2 9 Z013 GARFIELD GOUN fY )MM1JNITY DEVELOPMENT INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PERMIT APPLICATION TYPE OF CONSTRUCTION Property Owner: Clough Sheep Company LLC Phone: ( 970 _ ) ILO - JUL4 Mailing Address: PO Box 686, Rifle, CO 81650 New Installation • Alteration ❑ Repair WASTE TYPE PROJECT NAME AND LOCATION Job Address: Liuuyrr Lit - occ If re duduireu plat iur uUSUIipuuri. = Dwelling • Transient Use Building or Service Type: Temporary office & house #Bedrooms: 2 Garbage Grinder NO ❑ Comm /Industrial I Non - Domestic • Other Describe Type of ISDS ❑ Septic Tank ❑ Aeration Plant !a Vault ❑ Vault Privy ❑ Composting Toilet ❑ Recycling, Potable Use INVOLVED PARTIES Property Owner: Clough Sheep Company LLC Phone: ( 970 _ ) ILO - JUL4 Mailing Address: PO Box 686, Rifle, CO 81650 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: Liuuyrr Lit - occ If re duduireu plat iur uUSUIipuuri. Assessor's Parcel Number: 217521100022 Sub. 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 ❑ Septic Tank ❑ Aeration Plant !a Vault ❑ Vault Privy ❑ Composting Toilet ❑ Recycling, Potable Use ❑ Recycling ❑ Pit Privy ❑ Incineration Toilet 0 Chemical Toilet la Other Hauled to Down Valley Was far their disposal Ground Conditions Depth to ft Ground water table NA Percent Ground Slope NA Final Disposal by ❑ Absorption trench, Bed or Pit ❑ Underground Dispersal ❑ Above Ground Dispersal ❑ Evapotranspiration ❑ Wastewater Pond ❑ Sand Filter N Other Hauled to Down Valley Waste for their disposal Water Source & Type ❑ Well ❑ Spring ❑ Stream or Creek ❑ Cistern N Community Water System Name Down Valley Septic and Waste Effluent Will Effluent be discharged directly into waters of the State? ❑ Yes E 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 an . n • erstand the Notice and Certification above as well as have provided the required informatio w ich i. correct and accurate to the best of my knowledge. Property'bwner Print and Sign KO/ 1-3 Date OFFICIAL USE ONLY Special Conditions: P mit _eee) Perk Fee: Tota ee : Feed P ct Building Permit Se. ti Permit: — Issue Elate: 0160 "t3 B n e l BLD * D1V: BLDG � A`PRO r- titi_ 07Zoi b DATE _w_.. —mow... High Level Alarm If BM or Alarm is Present Tank Is Full Clough 2A 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 Tess. 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. SEPTIC 12 WIWAM9 VALLEYtQough 2A10ough 2.44w9,13/16/2012 1249:12 fM Section 21 Mk-, \ l T 6 S., R. 94 W ' r/ \ I / r 1 I. \ \ r nI 1 1 ' \ `\ 4Liszurbaiice ist. Limit n n ' \ \ \ '11 Xr 1 I • \ \yam l I' 1 f\ \r 6 \J I �l lit T 1 I hti \ \�d\ on • 1 KPit i . A ' n i 1 gtoc i 0 REF. PNT; 50' ais ` ' I Proposed r I /NE/#31 I 1 1 Daylight Lind./ 112' ti, A / C/5.5 2' IE #4 50 m 4 �` f Q 1 F D. D' 8 �� / 4 1 � 11 / 011-' �` r 1 a i 1 or ENO �N l f 11 C �0[iC1-- .�_r -- -r_ ,1sl Fat, °' h r I� t? f. X33 1 11 ,s� 1 I`,-- \ 45" ?mss`„ / z X / I Ap #i `N / �` / �1 E st. CLOUGH 2 -R� jC ,` n C 6.6' / „i `` �� ' _ II , /�� 4l. IIi / I N r ✓' I L" Prop. RW 911 -28D 1 .— CD. -1' NAz.166.9 .98° /N #2 B ,��c C 7.5` AC 1 n1y n f.4 0 Cut/Fill Line 112' 150' Exist. Grnd. EI. = 5276.7 Prep. Pad E1.= 5276.6 W / F 1.4' / 150 ", ESTIMATED EARTHWORK QUANTITIES (cy) ITEM CUT FILL TOPSOIL EXCESS PAD 5930 3741 500 1689 PIT 0 0 TOTALS 5930 3741 500 1689 e� �/ Proposed 1 e�16 50' 0/S _ Daylight Line e REF. PNT. ®. Al" �ry ,..or s • �Q51 ea dX /� }Ge� to Pr / 5tacupr j Exist. Limit of Disturbance O� X 0 80 GRAPHIC SCALE IN FEET 1 INCH = 80 FEET zX 0 SE #5 n F2.6' )1 rL<" I ix E #6 F 3.3' SE #7 F7.9' X `NOTE: 1.) Topsoil Volume Based on 12" Soil Depth. 2.) 10% Swell Factor Applied to Earthwork Cut Volume. 3.) Total Disturbed Area = ±3.92 ac. 136 East Third Street Rifle, Coiorado 81650 Ph, (970) 625 -2720 Fax (970) G25- 277.dm�1.g BOOKCI.IFF Survey Services, Inc. SCALE: 1 " = 80' DATE: 8/ 16/13_ PLAT 2 of 7 PROJECT: Vallee DET: cws AA BB CC Construction Plan Prepared for: WPXENERGY. WPX Energy Rocky Mountain, LLC Clough 2A Injection Well - Plat 2 CONSTRUCTION LAYOUT Section 21 7: 6S.,R 94 W _J\-'3.\\ 'la ugh�A `DRILL,, -r * PADS LOCATIOf yg 0 , Exist..Access f Road S_ _ - lea S•�Fti4 0 1000 2000 GRAPHIC SCALE IN FEET 1 INCH 2000 FEET ACCESS DESCRIPTION: FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 323 (RULISON ROAD) NORTH OF RULISON, PROCEED NORTHEASTERLY ON STATE HIGHWAY 6 11,9 MILES TO THE INTERSECTION WITH COUNTY ROAD 246 (DUMP ROAD), PROCEED LEFT IN A NORTHWESTERLY DIRECTION ±0.1 MILES TO AN INTERSECTION WITH A PAVED ROAD, PROCEED RIGHT IN A NORTHEASTERLY TO NORTHERLY DIRECTION ±0.8 MILES TO THE EXISTING CLOUGH 2A DRILL PAD LOCATION, AS SHOWN HEREON. 136 East Third Street Rifle, Colorado 81 650 Ph. (9701625 2 720 Fax (970) 625 -2773 ...iiiiit Sury Services, Inc, SCALE: 1 " = 2000' DATE: 8/16/13 PLAT: 5 of PROJECT:: Vallee Construction Plan Prepared for: WP?(!"NGY WPX Energy Rocky Mountain, LLC DFT CWS Clough 2A Injection Well - Plat 5 ACCESS ROAD & TYPO MAP WPXENEf Y, September 18, 2013 Clough Sheep Company, LLC Attn: David Ryan McKenzie P.O. Box 686 Rifle, Colorado 81650 RE: Proposed RWF 911 -28D Injection Well Township 6 South, Range 94 West, 6th P.M. Section 21: S' /ISW' Garfield County, Colorado Dear Mr. McKenzie, Per the Water Injection Agreement dated February 1, 2012, by and between Clough Sheep Company, LLC and WPX Energy Rocky Mountain, LLC ( "WPX "), a memorandum of which was recorded at Reception 11814345 in the official records of the State and County named above, paragraph four slates "In the event that WPX Is unable to convert the Wells into latter injection 14'ells, Clough hereby grants WPX the right to drill up to three (3) water r1 jectiou wells from new or existing pads in Sections 20 and 21, Township 6 South, Range 94 West, 6i" P.M " WPX would like to drill the Proposed RWF 911 -28D Injection Well from the existing Clough 2A pact located in the SW'4 of Section 21, Township 6 South, Range 94 West, 6111 P.M. If you are in agreement with WPX adding the proposed RWF 91 I -28D injection well to the existing Clough 2A pad location, please acknowledge your acceptance of the foregoing by signing and inserting the date of execution below and returning one original to the WPX address listed below. If you have any questions or concerns, please contact John Doose at (970) 263 -2726 (0) or (970) 379 - 5688 (C). Sincerely, WPX Energy Rocky Mountain Bryan S. I- lotard Field Land Team Lead — Piceance Basin THE FOREGOING IS AGREED TO AND ACCEPTED this Vt. day of September, 2013. Clough Sheep Company, LLC Rye Name: David Ryan McKeir ie Title: Manager 1058 County Road 215 1 P.Q. Box 370 1 Parachute CO 81635 1 970.285.9377 Tel 1 970.285.2047 Fax 1 vnvw.wpxenergy.corn 1111 i'i jl+ tHILM Mire t ifta1t+Ithk 11I1 Igtvga.102Viti a.� ,,, A{b tt 1 or 4 ftso rss;fiO.00 Doo An ologrIELD COLWTY 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. Agreetnents 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 ofreal property for residential or commercial purposes nr 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 Attomey -in -Fact shall lawfully do or cause to be done by virtue hereof. This Limited Power of Attorney shall remain in hill force and effect until terminated by Company. y Nllfly'�l'If}I ;N lylltp�l�l fi�i�1>EI�C(i�tIIAN 1118 RroeptionN: 61li0a4 9214712012 F2s1a114 O Jefn irtVWRFIECO Cowry Co 2of 2Rea I21:1.69GacFn fl 9 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" clay of January, 2012. WPX RO TAIN, LLC By. rnes Its' ice Pr ident STATE OF OKLAHOMA COUNTY OF TULSA ss. ACKNOWLEDGMENT BEFORE ME, the undersigned authority, a Notary Public in and for said County and State, on this day personally appeared, Jerry 11 Barnes personally known to me to be the Vice President of WPX Energy Rocky Mountain, LLC a Delaware limited liability 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 of teary; 2012, F „ Ali L. Notary Pu'lio f My Commission Expires: 2, - 2_5- 201/4 After Recordation Please Return To: WPX Energy Rocky Mountian, LLC Attn: Land Dept PO Box 370 Parachute, CO 81635 itliAleYJ.DDIT M gyro �w:�°u4+reAeH 2