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HomeMy WebLinkAboutApplication.pdfCommunity Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com SMALL TEMPORARY EMPLOYEE HOUSING APPLICATION FORM This Application form must be completed and received by the Garfield County Community Development Department within 48 hours following occupancy of the Small Facility. In addition, documents shall be provided to the Sherriff’s Office and relevant fire protection district(s) that demonstrate and certify compliance with the following standards. Notice shall also be provided to these entities within 48-hours following removal of a Small Facility. It is the Operator’s responsibility to confirm and obtain verification that this Application has been received by the Sheriff’s Office and Fire Protection District. INVOLVED PARTIES Property Owner Name: ____________________________________ Phone: (______)_______________ Mailing Address: _____________________________ _________________________________________ City: _______________________________________ State: _______ Zip Code: ____________________ E-mail:__________________________________________________________ _____________________ Operator’s Compliance Officer Name: ________________________________________________ Phone: (______)_________________ Mailing Address: __________________________________________ ____________________________ City: _______________________________________ State: _______ Zip Code: ____________________ E-mail:_______________________________________________________________________ ________ PROJECT NAME AND LOCATION Location of Housing Site (Section/Township/Range): S____________ T____________ R___________ Well Pad Number: _________________________ Assessor’s Parcel Number: __________________ Zone District: _____________ Maximum Number of Permitted Occupants: ______________________ Number of Days the Facility will be at Location: ____________________ State or Federal Permitting Agency Overseeing Reclamation, Restoration and Revegetation (Name): (Name): __________________ (Relevant Permit Number): ___________________________________ Date of Installation: ___________________ Date of Removal: _______________________ 24-Hour Emergency Contact (1): ______________________________ Phone Number: _______________ 24-Hour Emergency Contact (2): ______________________________ Phone Number: _______________ James L. Rose P.O. Box 432 Rifle CO 81650 Encana Oil & Gas (USA) Inc. 970 285-2600 143 Diamond Avenue Paracnute CO 81635 22 7S 93W K22W 240315300046 Agricultural 8 190 COGCC 10-21-2013 05-07-2014 Safety on-Call 855-759-1855 Gas Control 970-285-2615 Encana K22W Pad -Patterson 303 Rig SEPT-10-13-7751 ELIGBILITY During times of housing shortage or in remote locations, the use of Factory Built Nonresidential Structures (as defined under C.R.S. § 24-32-3301, as amended, and Resolution #35 of the Colorado State Housing Board) utilized for a period of time not longer than 1 year or as otherwise specified, for workers who are engaged in commercial, industrial, mineral extraction, or highway operations and who are needed to support the proper execution and safety of the related operations. Temporary Employee Housing, shall not include Recreational Vehicles, except in a Small Facility. A Small Temporary Housing Facility shall have all of the following basic characteristics: Complies Y/N 1. The Small Facility and any associated infrastructure must be completely contained within a State or Federally-permitted parcel (such as a COGCCapproved oil/gas well pad) in which reclamation and revegetation are secured with the permitting agency (Permitted Site); and 2. The Small Facility is located at the Permitted Site for less than a cumulative of 1 year and at the end of the utilization period, all structures, foundations, and associated infrastructure are completely removed; and 3. The Small Facility shall have an occupancy of 8 or fewer people who are employees, contractors, or subcontractors of the operator of the small facility and are needed for on-site safety of the related commercial, industrial, extraction, or highway operation. SUBMITTAL REQUIREMENTS. The application submitted to the County shall contain the following information: 1. 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 Facilities, natural drainage courses and municipalities 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. 2. 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. 3. 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 Sheriff’s Office dispatch location and responsible fire district headquarters to each Small Facility, along each roadway. STANDARDS 1. Small Facilities shall comply with all applicable Federal, State (i.e. Building Codes and electrical permits), and local laws and regulations (i.e. fire code), but are not subject to County Building Permit. 2. Water Systems. a. Water systems shall comply with standards set forth in section 7-705.B. Water systems must comply with all applicable State and local laws and regulations. b. All potable water systems must include a meter and the Operator must keep a record of the daily usage. c. For sites to which potable water is hauled, Operators shall: i. Keep appropriate records, to be provided to the County upon request, to demonstrate that water supplied to a site is from an approved source and that wastewater is YYY disposed at an approved facility. ii. For water facilities not permitted by the CDPHE, the Operator must conduct monthly tests (or quarterly if an on-site disinfection system is installed) and maintain records of potable water samples specific for coli form. Any tests indicating coli form contamination must be disclosed to the County Public Health Department. iii. Water systems facilities permitted by the CDPHE must obtain all necessary State permits or demonstrate that applications for any necessary permits have been submitted prior to a determination by the County that an application is complete. iv. Maintain compliance with State regulations at all times during operation. d. In no case shall unsafe water be used for drinking nor shall raw sewage or used water be discharged onto the ground surface. 3. Wastewater Systems. a. Wastewater systems shall comply with standards set forth in section 7-705.C. Wastewater systems must comply with all applicable State and local laws and regulations. b. Wastewater may be disposed of using either an OWTS or a vault-and-haul system. A vaultand-haul system must demonstrate the following: i. Year-round access is available and maintained for safe and regular access for sewage hauling vehicles; ii. The Operator can demonstrate and guarantee an arrangement for hauling sewage; iii. The Operator will maintain all records, including but not limited to, trip logs/reports and landfill receipts; iv. The sewage disposal records will be maintained as public records to be available to the County upon request; v. The facility will not exceed a cumulative of 1 year at the approved location; and 4. The facility has been designed to accommodate 75 gallons of wastewater per person per day or an amount derived from engineered calculations taken from metered usage rates at a similar facility that has been reviewed and approved by the County. 5. 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. 6. Wildlife-proof refuse containers must be provided for trash. Outdoor food storage is prohibited unless facilities are provided that prevent the attraction of animals to the Major Facility site. 7. Fire Protection and Suppression. a. Provisions for giving alarm in case of fire and fire suppression must be installed per fire codes and as required by the fire protection district. b. Single-station carbon monoxide alarms must be placed in each Manufactured Home or Recreational Vehicle unit. c. 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: ________________________ gallons 8. Domestic animals are prohibited. 9. The Operator shall obtain a certification inspection conducted by a qualified professional engineer. The certification shall verify that at the time of inspection the identified Small Facility meets or exceeds the requirements of this section. BUILDING INFORMATION (per unit) Unit 1 Make: Serial Number/Unit ID #: Division of Housing Insignia (provide copy) Square feet of unit: Unit 2 Make: Serial Number/Unit ID #: Division of Housing Insignia (provide copy) Square feet of unit: Unit 3 Make: Serial Number/Unit ID #: Division of Housing Insignia (provide copy) Square feet of unit: OWTS PERMIT Permit #: I hereby attest that I am the designated Compliance Officer for the aforementioned Small Temporary Employee Housing Facility. I attest that I have read and understand the standards to which the Facility shall be installed and operated and that the Facility shall be constructed and maintained in accordance with all applicable Garfield County, State of Colorado and Federal Regulations and standards. I have read the statements above and have provided the required attached information which is correct and accurate to the best of my knowledge. ____________________ __________________________________ __________________________ Signature of Compliance Officer Date I hereby attest that I am a Licensed Professional Engineer in the State of Colorado and that I have conducted a visual inspection of the installed Small Temporary Housing Facility identified in this application. Based upon my inspection, I certify that the Small Temporary Housing Facility complies with the standards as forth above and as codified in the Garfield County Land Use and Development Code. PE Certification Number: PE Stamp Date of Inspection: Name and Title: Signature OFFICIAL USE ONLY File Number: __ __ __ __ -__ __ __ __ Fee Paid: $_ n/a________________________ (1) Teton Buildings LLC (2) Teton Buildings LLC (1) 24096 (2) 21486 (1) 840 (2) 840 (3) Teton Buildings LLC (4) Atco Structures (USA) Inc (3) 24095 (4) 21519 (3) 840 (4) 812 (5) Ameri Tech Buildings (5) 20161 (5) 528 SEPT-3039 10-29-2013 PE Stamp is located on the Site Plan Legend 0--0 Existing Road --Proposed Road ~ P: (435) 781-2501 F: (435) 781-2518 Tri State Land Surveying, Inc. 180 NORTH VERNAL AVE. VERNAL, UTAH 84078 DRAWN BY: D.C.R. REVISED: 07-15-13 D.C.R. DATE: 05-13-2013 SCALE: 1:100,000 N ENCANA OIL & GAS (USA) INC. Well Pad (K22W) Sec. 22, T7S, R93W, 6th P.M. Garfield County, CO. SHEET TOPOGRAPHIC MAP A ENCANA OIL & GAS (USA) INC. WELL PAD (K22W) SECTION 22, T7S, R93W, 6th P.M. PROCEED IN A SOUTHEASTERLY DIRECTION FROM RIFLE, COLORADO ALONG STATE HIGHWAY 13 APPROXIMATELY 0.5 MILES TO THE JUNCTION OF U.S. INTERSTATE 70 TO THE EAST; TURN LEFT ONTO U.S. INTERSTATE 70 AND PROCEED APPROXIMATELY 3.6 MILES TO EXIT 94 AT THE JUNCTION OF U.S. INTERSTATE 70 AND MAMM CREEK ROAD TO THE SOUTHEAST; TURN RIGHT AT EXIT 94 ONTO MAMM CREEK ROAD AND PROCEED SOUTHERLY THENCE SOUTHEASTERLY APPROXIMA TEL Y 0.4 MILES TO THE INTERSECTION OF THIS ROAD AND GARFIELD COUNTY AIRPORT ROAD TO THE SOUTH; TURN RIGHT ONTO GARFIELD COUNTY AIRPORT ROAD AND PROCEED SOUTHERLY THENCE WESTERLY APPROXIMATELY 1.9 MILES TO THE INTERSECTION OF THIS ROAD AND WEST MAMM CREEK ROAD TO THE SOUTH; TURN LEFT ONTO WEST MAMM CREEK ROAD AND PROCEED IN A SOUTHERLY THENCE WESTERLY DIRECTION APPROXIMATEL Y 7.5 MILES TO THE INTERSECTION OF THIS ROAD AND AN EXISTING ROAD TO THE SOUTH; TURN LEFT AND PROCEED IN A SOUTHERLY DIRECTION APPROXIMATELY 0.2 MILES TO THE BEGINNING OF THE PROPOSED ACCESS FOR THE (K22W) WELL PAD TO THE WEST; TURN RIGHT AND FOLLOW THE PROPOSED ROAD STAKES IN A WESTERLY THENCE NORTHERLY DIRECTION APPROXIMATELY 327 FEET TO THE PROPOSED (K22W) WELL PAD. TOTAL DISTANCE FROM RIFLE, COLORADO TO THE PROPOSED WELL LOCATION IS APPROXIMATELY 14.2 MILES. Document No: encana . EMERGENCY RESPONSE I'LAN ERP-0021 Revised BylOate: /---.......... U.S.A. DlYISION natural gas Reviewed By/Date: ~ ERPCommlOS.14.10 SITE SI'ECIFIC SAFETY AND EYACUATION PLAN Approved By/Date: ERPCommf05.14.10 FACILITYI SITE Patterson 303 GPS In fo rmation INFORMATION Parachute Site Location Name: K22W South Piceance Latitude: 39.430537 Emergency Notifi cation Number: 970-625-8095 Garfield Dis2atch Longilude: 107.761 565 Sile Phone Number: 303-353-5354 Elevation· 6530 Legal Description: Qtr NE 1/4 Qtr NE 1/4 Sec 22 Twn 7S Rng 93W Mai ling Address: Emergency Directions to the Emergency Directions: TOTAL distance 9.7 Miles leaving Grand River Medical site, rig supen'isors, and Center: Right on Airport Rd travel 2.1 mil es! Tum right on (Cr 3 19) travel 7.0 mi les to emergency evacuation plan: end of payment contin ue forward 0.5 miles turn left travel down lease road 0.1 mi les to the entrance to the K22W location (Patterson 303) (Eneana Rig Supervisors: Charlie Brown and Michael Olsen.) Evacuation Plan: Not ify Garfield Di spatch. In the event of any natural upset. such as wild fire, be prepared for emergency response. First ident ify the source and prepare to evacuate lIsing vehicles if safe to do so. If primary vehi cle travel route to K22W is blocked, dete rmine if staying on location is the safest response. If evacuation is imminent and vehicle travel 100 hi gh a ri sk, travel by foot away from the dan ge r to a secure preselected muster location. If poss ible, prior to evac uation, secure the well by insta lling TIW val ves in the casing or drill pi pe, closing and manually locki ng down the pipe rams, and closing the annu lar preventer. The final step before evacuation if safe to do so is to shut down all rig power. EMERGENCY RESPONSE NUMBERS Contact Location Number Pol ice! Sheriff ~~fi el~ Di sp~tc h 970-625-8095 -----Fire .--___ ~ ~~ficld Dispatch 970-625-80~ Ambulance Garfield Dispatch 970-625-809-' ------_..--_. Hospita l _ --_.. .. _--Rine Grand River Medical Center 970-625-64 18 Hospital SI. Mary's Care Flight 1800-332·4923 ._. .-...... -..... -I Ye"D _ .--No: xD CallGarfield Dispatch -Is '~ I l " access ible from this location? COMPANY CONTACTS Name Position Location Telenhone Cellularl Other Matt Abe ll SP D ri llil'l &....9.~0...!:!P Lead Denver 720-4 68-')618 Cell -.--.------John Grubich SP DriI IX~ll~intende nt Parachute 970-379-6735 Cell }::.es Fuglevand --~~_prill ing£i_f? ld S,:!pervisor Parachute _ 4.0.6_ -69....0.... -162-4 -_. ----Ce-ll . --_._------f---Denver -_ ....... _ ....... -. __ ..... _---Gage Soehner __ SP Driliil'l.g Enginef?r_ ---_.. ... _. -720-95... ...1.._ -07.3.....2.-Cell Safety On Call -----Parachute .-_ 970-210-8755 Cell ....... _. --_ ........ _ ........ ---Enviro On Call Parachute 970-3 19-9 173 Cell Nearest Eneana Field_ Of.fi_ce-: Parachute _ 970-285-2600 Land Li ne Nearest Encana Contro l Room Number: Parachute -9-7-0-_28.. 5.. -26 15 Gas Control Land Line -----_-Union Telep!2ne (24-Hour EmergcnC}" l:_all cc~~ 877-386-2200 _. -_... ... _---------Crisis Manager, North America Calgary 403-645-3333 l.ncontrollcd nOl'umenl When I'rinled Document No: encana_ EMERGENCY RESPONSE PLAN ERP-0021 Revised By/Date: ~ --U.S.A. DIVISION ~ natural gas Reviewed By/Date: SITE SPECIFIC SAFETV AND EVACUATION I'LAN ERPComml05.14.10 Approved ByIDate: ERPComm/05.1 4.10 DESIGNATED MUSTERING POINTS (Workerasscmblvareas) Primary: K22 W Location Entrance Secondary: Establish evacuation plans and meet in safe location north comer of locat ion. Alarm Procedures: Follow rig evacuation alarm procedures Prepared I Gavin Poole 1 John Grubich 1 Les Fuglevand Date: 10/1312013 Bv: Revision Date: SITE SAFETY/EVACUA TlON PLAN II Site Location Name: I South Piceance K22W II Drawing below was completed at the pre move planning meeting and will be posted along with the SSEP at rig supervisor office, rig floor, rig manager office, and tra ining trailer. -------._----------------------. . --it. ..... -V I. '\' Ie N ,~, "t>,,~ ---;-...---..... ~,,~\"-. ' . ~V\.~~. ~ ~ . . SMOI( ' . . .. , 1' ..... , " " .. J1.1\c. 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