HomeMy WebLinkAboutApplication.pdfc6 Garfield County Community Development Department .' r,rCJr~' ' Vc'" 108 8th J..lU 1 jj fi/I f \ Street, Suite 401 -' :.J ,1 ~ I.i?'wood Springs, CO 81601 INDIVIDUAL SEWAGE DISPOSAL
SYSTEM (1505) PERMIT APPLICATION (970) 945-8212 www.garfield-county.com HLLO enl /AIr , :5:C :P~ -\d, -\3--"30=1-3 \ iYP'EIQF,<tg~ STRUCTION i!i New Installation 10 Alteration 1 0 Repair
WASTE TYPE i!i Dwelling 10 Transient Use 10 Commjlndustrial 1 Non-Domestic o Other Describe INVOLVED PARTIES Property Owner: Joan Savage Phone: (~) 625· 1676 Mailing Address: PO Box
1926, Rifle CO 81612 Contractor: WPX Energy Rocky Mountain, LLC Phone: (~) 285-9377 e,t 2209 Mailing Address: PO Box 370, Parachute, CO 81635 Engineer: David Fox Phone: (~) 250-5505
Mailing Address: PO Box 370, Parachute, CO 81635 PROJECT NAME AND LOCATION Job Address: RWF 23-25 · ·see the attached plat for description. Assessor's Parcel Number: 217526400177 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 oflSDS o Septic Ta nk I D Aeration Plant Iii Vault I 0 Vault Privy I D Composting Toilet D Recycling, Potable Use D Recycling I D Pit Privy I D Incineration Toilet
D Chemical Toilet iii Other Hauled to OOwn Valley Waste for thei.d isposal Ground Conditions Depth to 1$ Ground water table NA I Percent Ground Slope NA Final Disposal by D Absorption
trench, Bed or Pit I D Underground Dispersal I D Above Ground Dispersal D Evapotranspiration D Wastewater Pond I D Sand Filter iii Other Hauled to Down Valley Waste for the ir disposal
Water Source & Type DWell I D Spring I D Stream or Creek I D Cistern iii Community Water System Name Down Valley Septic and Was te Effluent Will Effluent be discharged directly into
waters of the State? DYes iii No
CERTIFICATION Applicant acknowledges that the completeness ofthe 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 and understand the Notice and Certification above
as well as ich is correct and accurate to the best of my knowledge. Property Owner Print and Sign OFFICIAL USE ONtY Special Conditions: p~~e.:: Perk Fee: TrY., Total Fees: 1'5. -Feespai~3
_ Building Permit -. r--, I ~N~~nl-3 1~ ~m. \3 Balance Due: ~ BLDG DIV: .it, I~ 11:-9l, -70 1'-, APP~ DATE
1 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, performance, 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-12-13-3073 WELL SITE LOCATIONS (APD#) RWF 23-25 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.
2 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
3 Garfield County Building Department 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 permit 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.
One aboveground sewage holding tank with 4000-gallon capacity on-site. The Vault System is displayed in both of the pictures. Sewage flows 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 capaCity 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 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 S,EPTIC DRAIN '~K 8.EFOAe: MOVING = RWF23-2S 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.
! i Section 25 T. 6 s., R 94 W. /J ' /./, , , \ ;, ,, X -,--, x I I I I \ \ I I \ \ , , , ! , , , , \ I I , ,\ \ I I I ,,I , , , \ I I , \ ,\ I ,\, , , \ ,,\ ,, ,, , \ I , , , ,\, I
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\ I /,, , \ , , , I I /! I Full Fill I I ,I I I I I I ESTIMATED EARTHWORK QUANTITIES (cy) ITEM CUT FILL TOPSOIL EXCESS PAD 36580 22947 8600 5033 o o ,, //I "in'\O", I , \ REf-PNT. I
, , I \ , 8 , I ;;; I ,I \ '' "' "1 \ ' <Ii Q. I I \ \ \ 1 t&l1 i \ \ \ \ \ \ \ \ \ \. \ \ \ \ \ \ \ ; \ \ \ , I \ , \ I , . \ \ S #2 ,J ,I l r I I I I \ I I I \ Exikt. A~cesJ, Ro1d
\ I \ I 1.) Topsoil Volume Based on 12" Soil Depth. 2.) Swell Factor of 10% Applied to Earthwork Cut Volume. Total Disturbed Area = ±10.38 ac. an SCALE: W PXENERGY. , L"-.llIlL ___ 1
WPX Energy Rocky Mountain, LLC DATE: PLAT: PROJECTc DFT: RWF 23·25 Drill Pad -Plat 2 CONSTRUCTION LAYOUT
, I I f ~ Section 25 1'.6 S, R 94 W ACCESS DESCRIPTION: 10p00 -.--0 2000 ! GRAPHIC SCALE IN FEET 1 INCH = 2000 FEET FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 323 NDRTH
OF RULISON. PROCEED SOUTHERLY ALONG COUNTY ROAD 323 .1 .1 MILES TO THE INTERSECTION WITH COUNTY ROAD 309, PROCEED LEFT IN AN EASTERLY DIRECTION '2.3 MILES TO THE INTERSECTION WITH COUNTY
ROAD 320, PROCEED RIGHT IN AN EASTERLY DIRECTION .6.1 MILES TO THE INTERSECTION WITH COUNTY ROAD 317 (Beaver Creek Road), PROCEED RIGHT IN A SOUTHERLY DIRECTION .1 .7 MILES TO THE INTERSECTION
WITH A DIRT/GRAVEL ROAD, PROCEED RIGHT IN AN WESTERLY DIRECTION .0.6 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED RIGHT IN A NORTHERLY DIRECTION ±0.2 MILES TO THE RWF 23-25
DRILL PAD LOCATION, AS SHOWN HEREON. ! Ir~~5;ri=:::; I -S-CA-LR--------lWPX' ENERGY WPX Energy Rocky Mountai.n , LLC I ~rn > PLAT, ¥ PROJECT, -""""'--___ 1 RWF 23-25 Drill Pad -Plat
5 I un:· ACCESS ROAD & TOPOMAP ~~~~~~~~~~~~~~~d
August 6, 2013 Mr. Fred Jarman, Director Garfield County Building and Planning Department 108 81h Street, 41h Floor Glenwood Springs, CO 8160 I RE: RWF 11-35, RWF 23-25, RWF 43-25 Drilling
Pad Locations, Garfield County, Colorado Deal' 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 locations. ~;' <:;;~~ Nallle: /J,/JlA 7/-9.( ft-T Title:
__________ _
LIMITED POWER OF ATTORNEY WPX ENERGY ROCKY MOUNTAIN, LLC ("Company") a Delaware limited liability company, having its principal place of business in tbe City of Tulsa, County of Tulsa,
Slale of Oklahoma, does hertby make, constitute and appoint Bryau S. Hotard with the full autbority 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 tbe 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, fiJe and accept all instruments and documenls affecting the real property or real estate rights of the Company as more specifically
set forth below: : I. Applications and documentalion associated with Garfield County or Rio Blanco pennitting 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 Usc Licenses, Utilities, Snow Removal and Private Construction of County Roads; 2. Agreements and other documentation that grant easements,
righl' of way. licenses, or permits to Company and also instruments where the Company grants such rights to others; 3. Agreemenls that assign easements, rigbts of way, licenses, permits
or surface leases in connection with the Company's operations; 4. Releases and Partial Releases of easements and rigbts of way; 5. Agreements allowing encroachments onto easements and
rights of way owned by Company and landowner instrumenls and conveyances on others casements; 6. Agreements subordinating morlgage rights to easement or lease; 7. Agreements relating
to the modification Rod relocation of Company faciliti",,; 8. Rental or lease agreements for surface us. or oUler surfacc use agreements and all notices related to the pipeline agreements;
9. Agreements for the purcbase 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 tenninating nlly and all ofthe nforementioned types of instruments and documents. WPX ENERGY ROCKY MOUNTAIN, LLC hereby declares
tbat each and every act, matter and thing wldch 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 aDd 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 he done by virtue bereof. This Limited Power of Attorney shall remain in full force and effect until terminated by
Company.
• 1111 A\I"*I'IAI~,MW,Wm.ltIJlll"l+II:l;r.:rtIJ l,*jI,~,~ 11111 Rer;epUonll: 815884 92/27/2&12 12,,8=10 PH de.,. Alberico 2 of 2 Reo Fe.lSte,tle Doe F •• =II,eo GARFIELD COUNTY CO IN
WITNESS WHEREOF, WPX Energy Rocky Mountain, LLC has caused Ulis Limited Power of Attorney to be signed by one of its Vice Presidents, duly authorized by its MDnagement Committee to grant
powers of attorney this I" day of January, 2012. ·~~~rtmITAIN, LLC ACKNOWLEDGMENT STATE OF OKLAHOMA ) ) ... COUNTY OF TIJLSA ) 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 liability
company, who acknowledged to me that he has executed tbe 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, thetolh day of!enuary, 2012. Fciwo.Yj My Commission Expires: After Recordation Please Return To: WPX Energy Rocky Mountian, LLC Attn: Land Dept. POBox 370
Parachute, CO 81635 2
