HomeMy WebLinkAboutApplicationGarfield County
JUN 2 () ZOHcommunity Development Department
GARFlt.LD CO UNTY 108 81
h Street, Suite 401
INDIVIDUAL SEWAGE
DISPOSAL SYSTEM
{ISDS)
")MMUNITY DEIJFLOPME t-ff le nwood Sp rings, CO 81601
(970) 945 -82 12
www.garfield-countv.com
TYPE OF CONSTRUCTION
iii New Insta ll ation I D
WASTE TYPE
iii Dwelling ID Transien t Use
D Ot her Desc ri be
INVOLVED PARTIES
Pro pe r ty Owner: BLM
PERMIT APPLICATION
A lteration I D Repair
I D Comm/I nd ust r ia l I Non-Domes ti c
Phon e: ( )
M ai l ing Address: 2300 River Frontage Rd , Silt. co 8 1652
Contractor: WPX Energy Rocky Mountain, LLC Phone : ( 970 ) 285-9377 ext 2209
Mail i ng Address: PO Box 370, Parachute, co 81635
En gi neer: David Fox Phon e: ( 910 ) 250-5505
M ailing Address: PO Box 370, Parachute, co 61635
PROJECT NAME AND LOCATION
Job Addres s: MV 28-4 -See plat for description.
As sessor's Par ce l Number : 240921200952 Sub . Lot Blo ck ---
Building or Ser vice Type: Temporary office & house #B edroom s: 2 Garbage Gr inde r No
Dist ance to Nea rest Communi ty Sewer Sy st em : NA
W as an ef fort m ade to conn ec t to t he Communi ty Sewe r System : NA
Typ e of ISDS D Se ptic Tank J D Aer ation Pla nt J ii Vault J D V ault Privy J D Compos ting To il et
D Recycling, Potable Use D Recycl ing J D Pi t Pr ivy J D Incineration Toilet
D Ch emica l Toil et ii 0 t h er Hauled lo Down Valley Wasle for lhelr disposal
Ground Conditi o ns Depth t o 1" Gr o und w ater table NA J Pe r ce nt Gr o und Sl ope NA
Fi na l Dispo sal by D Abso r pti on trench, Bed or Pi t I D Underground Di spersa l I D Ab ove Groun d Di sp er sa l
D Evapotranspi ration D Was t ewater Po nd J D Sand Filter
Ii Other Hauled 10 Down v aneyWasle I<>< !heir disposal
W at er Sou r ce & Typ e D W ell I D Spri ng I D Stream or Cr eek I D Ci stern
Ii Co mmunity W at er System Name DownValleySeplic and Wasle
Efflue nt Will Effl uent b e disch arged directly into wat er s of the State? D Yes 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 in sure 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 sa id application and legal action for perjury
as provided by law.
I hereby acknowledge that I have rea d understand the Notice and Certification above as well as
have provided the required ;;.in:.:..:fo~~;c:.:..:..:.:1_ ich is correct and accurate to the best of my knowledge.
OFFICIAL USE ONLY
Special Conditions:
Perk Fee : Total Fees: Fees Paid:
Building Permit Issue Date:
&a~z.1-zof
DATE
High level Alarm
tt11Pt1rllarll
11 l'nlllt
Tank Is full
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 treatmenUdisposal 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
den;iand 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.
~
MV28-4
Vault System Description
The site will temporarily office and house up to a max imum of four individu-
als during natural gas drilling activities and is expected to be completed in
one year or less . The ind iv iduals will occupy two individual tra il er offices/
houses located on the we ll pad. Office/houses have Colorado D iv isio n of
Housing compliance tags.
WPXENERGY
MY 28-4 WELL PAD
The well pad site is located in the SE 1/4 NW 1/4 of Section 4, T7S, R96W, 6th P.M.
(Lat: 39.467836 Long -108.117369)
Emergency Contact List:
Main Office: 970-285-9377 answered 24 Hours
Doug McAdams WPX Drilling Sup -970-618-7340
Scott Brady-WPX Drilling Sup 970-270-9187 Cell
Kevin McDennott-WPX Safetv 970-309-1195 Cell
Mark Mumby-Spill Contractor 970-260-I 576 Cell
This site \Viii te1nporary office and house up to a 1naxiinmn of 8 individuals during
natural gas drilling activities and is expected to con1plete in less than 6 tnonths. The
individuals \viii occupy 2 individual trailer offices/houses located on the well pad.
One above ground \Yater tank of approximately 500 Barrels capacity on each site.
One potable aboveground water tank of approximately 4000 gallons capacity
on-site. Potable water demand is estimated to be 300 gallons/day ( 4individuals x
75 gpcd).Required minimum fire suppression demand is 2500 gallons.Total
potable and fire suppression volume required is estimated to be 400
gallons.Water supply appear adequate with 4000 gallons of storage with refills
scheduled at 5-day intervals.Dry hydrants observed on water tank.
Access Description:
FROM COUNTY ROAD 215 TURN LEFT+/-2.0 MILES FROM PARACHUTE. PROCEED+/-2.7 MILES TO MY 28-4 DRILL PAD
LOCATION AS SHOWN.
EXISTING ROADS
Uintah Engineering & Land Surveying
85 South 200 East Vernal , Utah 84078
(4 35) 789-101 7 *FAX (4 35 ) 789-1813
N
ACCESS ROAD 10 18 13 El
MAP MONTH DAY YEAR
DATE: 05-02-13
DRAWN BY: M.D. l
REVISED: 05-17-13
REVISED : 08-13-13
REVISED: 09-30-13
REVI SED: 10-17-13
REVISED: 11 -18-13
REVISED: 03-05-14 /"
SCA LE: 1" = 80'
Existing
Pipeline
" ' '-~xisting
'-f.ulvert
""-Existing
"-Road
"D" t
UINTAH ENGI NEERING & LAND SURVEYING
86 So: 200 East • Vernal, Utah 840'18 • (436) '189 -101'1
WPX Energy Rocky Mountain, LLC
PLAT #2A LOCATION LAYOUT FOR MV 28-4
SECTION 4, T7S, R96W, 6th P.M.
////
SCALE: 1" = 80'
DATE: 10-17-13
DRAWN BY: M.D.
REVISED : 11-06-13
REVISED : 03-15-14
, I
Yds.
UINTAH ENGINEERING & LAND SURVEYING
85 So. 200 Ea~ • Vernal, Utah 84078 • (485) 789-t0t7
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,
Slate of Oklahoma, does hereby make, constilute 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
perntlttiug requirements for including, but not limited to, Independent Sewage Disposal
Systems, Small Temporary Employee Housing, Major Impact Reviews, Limited Impact
Reviews, Oil end Gas well permitting, Driveway Access, County Road Maintenance,
Temporary Living Quarters, Temporary Use Permits, Surface Use Pennits, 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 Compeny 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;
I 0. Agreements to obtain water services, electrical, gas or oil services or the provision of
other utility services utilized by Compeny's facilities;
11. Agreements modifying, amending, renewing, extending, ratifying forfeiting, cenceling
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 remnin in full force and effect until terminated by Company.
• 1111 Wfi'.i. l'M1to\A',MW,Nr\r~tlilr1+1.:lrti:rtlt l'i"-~·~ 11111 ReQeption~: lt68&4
02127/2012 12118110 Pl'I J-.n Albarleo
2 of 2 Rec Fea:S16.f!0 Doc Fee:fJ.90 GMFlB.D COUNTY CO
IN WITNESS WHEREOF, WPX Energy Rocky Mow1tain, LLC has caused this
Limited Power of Attorney to be signed by one of its Vice Presidents, duly authorized by ils
Management Committee to grant powers of attorney this !" day of January, 2012.
ACKNOWLEDGMENT
STATEOFOKLAHOMA )
) SS.
COUNTY OF TIJLSA )
BEFORE ME, the undersigned authority, a Notary Public in and for said County and Slate,
on this day personally appeared, Jerry D. Barnes personally known to me lo 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 au1horized by Company's
Management Committee.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notary seal, the2oJh
day of..Jenuery, 2012.
F.eioruruy
My Commission Expires:
After Recordation Please Return To:
WPX Energy Rocky Mountian, LLC
Attn: Land Dept.
POBox370
Parachute, CO 81635
2