HomeMy WebLinkAboutApplication.pdfGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.Rarfield-countv.com
INDIVIDUAL SEWAGE
DISPOSAL SYSTEM
(ISDS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
Property Owner: JWT Land Company Phone: ( 970
Mailing Address: PO Box 87, Neola UT84053
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
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
0 Septic Tank
= Dwelling
•
Transient Use
0 Composting Toilet
• Comm/Industrial
0 Recycling
Non -Domestic
• Other Describe
❑ Chemical Toilet
® Other Hauled to Down Valley Waste for their disposal
Ground Conditions
Depth to 15` Ground water table NA
Percent Ground Slope NA
Final Disposal by
0 Absorption trench, Bed or Pit
0 Underground Dispersal
0 Above Ground Dispersal
INVOLVED PARTIES
Property Owner: JWT Land Company Phone: ( 970
Mailing Address: PO Box 87, Neola UT84053
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: IPA 24-6: See attached olat for description
Assessor's Parcel Number: 240707200026 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
0 Septic Tank
0 Aeration Plant
NI Vault
0 Vault Privy
0 Composting Toilet
❑ Recycling, Potable Use
0 Recycling
0 Pit Privy
0 Incineration Toilet
❑ Chemical Toilet
® Other Hauled to Down Valley Waste for their disposal
Ground Conditions
Depth to 15` Ground water table NA
Percent Ground Slope NA
Final Disposal by
0 Absorption trench, Bed or Pit
0 Underground Dispersal
0 Above Ground Dispersal
❑ Evapotranspiration
0 Wastewater Pond
0 Sand Filter
B Other Hauled to Down Valley Waste for their disposal
Water Source & Type
0 Well
0 Spring
0 Stream or Creek
0 Cistern
Ila Community Water System Name Down Valley Septic and Waste
Effluent
Will Effluent be discharged directly into waters of the State? 0 Yes B 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.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required inform • which is correct and accurate to the best of my knowledge.
Property Owner Print and Sign
6/23/14
Date
OFFICIAL USE ONLY %„ 0�
Special Conditions:
P mit Fee: arl
P rk Fe
Total Fees: co
Fees Paid:
Building Permit
S • •tic P ' .
Issue Date:
B Ian Vit:
BLDG DIV
6----
, 2oA
o
APP OVA ) DATE
ei.& 39/28o�
�3 as vCo. 3o -t 1
IlIII W1%J'1 1441V,1011, 111I III
Reception4; 915004
02/27/2012 12.10:10 PM Jean Albert=
1 or 2 Rae F40:$19.00 Doo Fee:0.00 GARFIELD 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 frill
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 arid
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 sante 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'
12111M. I40.III4 a 111
Reoeption11: 615004
02/27/2012 12,18:10 PM Jean Rlberlco
2 of 2 Rec Fee:$16.60 Doe Fee:0.00 GARFIELD COUrITY 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 ls` day of January, 2012.
WPX ROS �TAIN, LLC
B. -
Its:
D.
ice Pr
es
ident
STATE OF OKLAHOMA
ss.
COUNTY OF TULSA
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 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%(�i-t 1
day ofd; 2012.
FatOrLarit
Notary Public
My Commission Expires: 2.. -2_3 20I1
After Recordation Please Return To:
WPX Energy Rocky Mountian, LLC
Attn: Land Dept.
PO Box 370
Parachute, CO 81635
rte
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*NOTE: DRILL PAD
1.) Use Excess Pit Material to Complete Pad
Surfaces.
2.)Topsoil Volume Based on 12" Soil Depth.
3.) 10% Swell Factor Applied to Cut Volume.
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Daylight Line
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ESTIMATED EARTHWORK QUANTITIES (cy)
ITEM
CUT
FILL
TOPSOIL
EXCESS
PAD
5973
3090
3200
-317
PIT
0
0
TOTALS
5973
3090
3200
-317
W #2
r- -"-""I
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P'PNT
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•
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C 6.8'
SW #1
C7.4'•
N'I
130' ``
\ Prop}PA 34-6 3Prop. PA444-6
Prop. PA 44A77, BPr op. PA 544.6
A 68
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Prop. PA 333-6 n Prop. PA . 43-6
Prop. PA 33-6A3 l 3 p, PA'343-6 110'
l A4B4\
Exit. Limit it,
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/ 130'
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Section 6
T. 7 S., R 95 W.
100
GRAPHIC SCALE IN FEET
1 INCH =100FEET
3
D
4995� Plea 50' 0/6
J _
REF. FJNT.
FP#3
F 0.4' \ J FP_#4 = 124
F,1��_=—...... �r
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o,
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(
FP #2
I5.0'
•
Xf
t
Cuttings Trench °
(9440 cy) I
80'x 400'x 12'
*NOTE: FRAC PAD
1.) Use Excess Pit Material to Complete Pad
Surfaces.
2.)Topsoil Volume Based on 12" Soil Depth.
3.) 10% Swell Factor Applied to Cut Volume.
4.) Total Disturbed Area = 6.15 ac.
ESTIMATED EARTHWORK QUANTITIES (cy)
ITEM
CUT
FILL
TOPSOIL
EXCESS
PAD
6460
5032
3200
-1772
PIT
9440
9440
TOTALS
15900
5032
3200
7668
I
FP #1
C 6.6'
80'
C 20'
It
r
\ FP#9
/C 3.9'
/1
r
1
I Excess Pit
1 t Material
r
\ro r w �:
r / ,i
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Az/134.13° \�I
II
r184'
T
Cui/Fill
Line
191
rr
r.
=136 East Third Street
Rtf7e, Colorado 81650
Ph. /970J 625-2720 BO /� TT�1 ],IFF
Fax (970J 625-277.d�/l�ljj ii�� rtf'l�(,r`/ jJ
%�///// SUM Services, Inc.
SCALE: 1" = 100'
DATE: 8/23/ 13
DD
mil
e
•
r
r
1
II
II
c 3C 1C
REVISED: 3/10/14
Construction Plan Prepared for:
WPXENERGY WPX Energy Rocky Mountain, LLC
PLAT: 2 of 7
PROJECT. WPX Valley
DFT.• os
PA 24-6 Drill Pad - Plat 2
CONSTRUCTION LAYOUT
.0 Williams Valley )>A 29.6 (234)10A 2960ns 10/23/20/
0 1000 2000
GRAPHIC SCALE IN FEET
1 INCH = 2000 FEET
ACCESS DESCRIPTION:
FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 215 AT PARACHUTE, PROCEED IN A
NORTHEASTERLY DIRECTION ±0.4 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED
RIGHT IN A SOUTHERLY DIRECTION ±0.3 MILES TO THE PA 24-6 DRILL PAD LOCATION, AS SHOWN HEREON.
p3c Olo 625 '
p& -0062,5-v7.3
L OOKVLI l
Survey Services, Inc.
SCALE: 1 " = 2000'
DATE: 8/23/ 13
PLAT: Sof 7
Construction Plan Prepared for:
WPX! NRGY WPX Energy Rocky Mountain, LLC
PROJECT:: WPX Valleu
DFT: es
PA 24-6 Drill Pad - Plat 5
ACCESS ROAD MAP