HomeMy WebLinkAboutApplication.pdfRECEIVED
JUL 2 4 101
U
ARFIELD CC
Garfield Dunt -vP
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
INDIVIDUAL SEWAGE
DISPOSAL SYSTEM
(ISDS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
Property Owner: Mead, Vickie R & Ronald D. Phone: ( 970 ) 625-5398
Mailing Address: 7109 County Road 320, Rifle, CO 81650-9686
Contractor: WPX Energy Rocky Mountain, LLC Phone: (970 ) 285-9377 ext 2209
= New Installation
•
Alteration
•
Repair
WASTE TYPE
Job Address: RWF 43-23 - See attached plat for description.
Assessor's Parcel Number:
Building or Service Type:
Distance to Nearest Community
Was an effort made to
217524300176 Sub. Lot Block
Temporary office & house #Bedrooms: 2 Garbage Grinder No
= Dwelling • Transient Use
NA
• Comm/Industrial
Non -Domestic
■ Other Describe
❑ Recycling, Potable Use
0 Recycling 0 Pit Privy 0 Incineration Toilet
❑ Chemical Toilet
B Other Hauled to Down Valley Waste for their disposal
Ground Conditions
Depth to ft Ground water table
NA Percent
Ground
INVOLVED PARTIES
Property Owner: Mead, Vickie R & Ronald D. Phone: ( 970 ) 625-5398
Mailing Address: 7109 County Road 320, Rifle, CO 81650-9686
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: RWF 43-23 - See attached plat for description.
Assessor's Parcel Number:
Building or Service Type:
Distance to Nearest Community
Was an effort made to
217524300176 Sub. Lot Block
Temporary office & house #Bedrooms: 2 Garbage Grinder No
Sewer System:
connect to the Community
NA
Sewer System: NA
Type of ISDS
0 Septic Tank 0 Aeration Plant IN Vault 0 Vault Privy 0 Composting Toilet
❑ Recycling, Potable Use
0 Recycling 0 Pit Privy 0 Incineration Toilet
❑ Chemical Toilet
B Other Hauled to Down Valley Waste for their disposal
Ground Conditions
Depth to ft 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
@ 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. 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
have provided the required infti n which is correct and accurate to the best of my knowledge.
Property Owner Print and Sign
aD/5/
rte
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:13 00
Perk Fee: I-,(
Total Fees:
3
06
Fees Paid: ,-1,3 ' ,` )
Building Per
S 'c Permit:3 I S
Issue Date:
Balance Due: e
BLDG DIV: 1,` _X11(_
7_24- 20)4)
AP' ROV OW
DATE
. ft> b )) ✓ 3o -2P1 I U221 I- � 24 -14
RWF 43-23
Vault System Description
k .0 0
.c a).$
/ sof
\6
°\o
/
/ x\
n 0 § 0
E v
@ ,5 0
ca E,. >
o x
o_.—
o=ae
® c R o
® ®o F
0 S ° 0
ea
7//
� To
\
0 0)-o a
o =- 0)
7777
'-(1)
o c / c
0-70%
\ � _.
c f \ E
a G° 00
f f 0) c
3 > m 2
/ ®c 0 0
R2o=2
s GO 0)
( /f 2$
• ƒ2-0
\/° e
e 0
CO
0 k \ °
20)
5§D\i§0)
e@u=2o@
/�®\$\
o
1.7',
n •- E
#aw =o"
= 0 x m a 0=
/f\®//
• °• o 0w
• k • > w
Ga =E
Cc7X0)
% � 2 ct
-c 2-220
/& 02-\0®
°( 22ofp
E 2 c n o e c
CU
e/ «®mE
f / 0 -0 2-f
k\ leu)\§ƒ
>°k %
/®EE&
e E_E
Eo%J3
- \� 47-
0- \�72
o• Ee®
45=m=o
c \
2/\�2
k@22�
O ®±2-3
o afm==L f/2 N- i @ .1v
GEw=m—` c c 0 \e
co u) .2 ,- 7 o a >46 m
1.. it o G 7000E
$ 2To �/�/ 022/ us§�,\
7E0)0. ID 17; /k k? /E2�4.-
n
oƒ 0 2
iV
m 0&$ 2 2 m\$
\2/ E\\�\\ 2f) E§
(/) a)
� �
0700—
> -CS 2c o =
\���®ak 0 COc ���§/
°\220\/ ®772CCS 2/® k• -0c
//22-/f% /E 0. %/\/ }/>S
Section 23
T. 6S,R94W
6th P.M. GRAPHIC SCALE IN FEET
71NCH• 80 FEET
�•
' ,/ i / / // / /f / /� /' / ,' /L<xist. Fencer/ / // / / /�
/' // '/ / // i / / / / /'/ '/ yy9° �� / / �/ / /� // // //
/1 /rte /� X1 �%<, /7 � / 'X X / / X T --/X -7-----A„
o / / 7� / /
l / , ,s I lr l lr h�°/ / is //'R PIVT. / , / i /hO�° // j / // i /
/ 1 h / / 1 , / / / / / / / /
/ /
A ' /// t / N)4V #5 �� l 1/ /
/11/
/ / / %/ �/ 947.5' ,� —,/ • - NE #7/ // AA
/ 6'2`r 6' / i 11 i 182.115' N #6 // i / / // C 7.5' /
/ / 1 1 1 \
, cli
' / , / �/ / �,�� �0n��> \\ \ \\ `\ \\\\ .�\ D` fiDaylfghtLine
. �. / ,. a a\�a/ \` \ \\ \ \\ \ \ , \\v\ l\ i r '
// ,7/ ,�' /' '� \reiiP \�u1JFil!\ \ \ \\ $\ \ ,\ i 11 •N
Exist. /
// , / �'' �' \,Lim \\ \ o \\ `\ `\ �`\ \ \\ l
Fence / / ' ��� //' ��' �l(r \I
Io 1 \ \. \ \ \
1 / / / ///'//
// // / O "' \\ \� 1 \ \ \ \ \
I '? c\ 7
/ 1 I/ 1 (\1j', 0'x10/ /' O -, \ \ I \\\ \ N.\ \\
\
// / h 1 / Rap( Pit '' /�,, \ \ \`
/,�r
I rrly
J X LinePope
40
/ % / /
/1 /
/' , '��J
/ / 1// / 1 i r/ / /% // /' /rte~ ---
_ _
' /� / i I r // / '' �' /'/ - -�
/ // ,/ / ,I 1 I 1 / ,� // ' '' v
Daylight/ , / / / , M �/� M �p/ M �/ /' / / 1��.
/ ' M/ J.
N/(N /V / //' / / 'D
Line / / / _ /
l' / / / / . �' /// /'' /µ4g2' r' / m `1h" `" 1" 4 // /' / ' '/(c31
'0/
1 / /1 ' N9dd0aP .,E #zz,�# #flz.s c#/ .' / / E #8
r i #4 / /17'
/
/ / zz.s / / ID/
1 F 0,// / 1y'/ ‘--/r`'. Nl / 110' // /C14.9'
I , / / / �M 1� N CJ ATA I,IN / /
1 r h" / / / / / ,/ Oce%/ ��x / // / / I
A / ,j / / • / / / /' /
/ / / / / / / /// C:)// / // / , /
D �n 1 I 1 , / / ,/ / ,/' / / / / /
o -I1
1
°' � I 1 I c� / // i 1' / // / /
/
Property t 1 d 11 IN\I i / i i I / ,/ /% /
Line \ 1 I I 1 11 1 / �(/ // 1
/ / / / /
1 1 txut/Fill ♦ l / /
1 1 1 . . p \ < Cuttings/Trench/
1 \ \ 1\, 11 ; t\ �\•\\ Line, • ' ♦\ \ `�\10�X\165) `\
f
1 / F.PA '. 135'.\ \ z;
ACCESS DESCRIPTION:
FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 323 (RULISON ROAD) NORTH OF RULISON, PROCEED
SOUTHERLY ALONG COUNTY ROAD 323 (RULISON ROAD) ±1.1 MILES TO THE INTERSECTION WITH COUNTY ROAD 309 (RULISON
PARACHUTE ROAD), PROCEED LEFT IN AN EASTERLY DIRECTION ±2.3 MILES TO THE INTERSECTION WITH COUNTY ROAD 320
(RIFLE RULISON ROAD), PROCEED RIGHT IN AN EASTERLY DIRECTION ±4.3 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL
ROAD, PROCEED LEFT IN A NORTH TO NORTHWESTERLY DIRECTION ±0.4 MILES TO THE RWF 43-23 DRILL PAD LOCATION, AS
SHOWN HEREON.
BOOKCLIFF
Surve Services, Inc.
SCALE: 1 " = 2000'
DATE: 6/4/ 10
PLAT: 5 of 9
Construction Plan Prepared for:
wfms. Williams Production, RMT
PROJECT: Williams Val1eu
DFT: otos
RWF 43-23 Drill Pad - Plat 5
ACCESS ROAD MAP -
1111
Whirlirc;W'MWa11III
1ar2R•pppa?Pesti
i6.0Oooa0.8tFila
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 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. 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 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 be done by virtue hereof. This Limited Power of
Attorney shall remain in full force and effect until terminated by Company,
v
■1111x117Ad4h11NLfMt'PNKI1111#1411k1V ith 11111
R000ptions: 816004
02/27/2012 12118:10 F8 dean Alberto*
2 or 2 Rao Fo01S1 .Da Doe Fee:D.OD ORRFIELD COUNTY 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 l'l day of January, 2012.
WPX RO F. AIN, LLC
By
tries
Its'. ice Pr ident
ACKNOWLEDGMENT
STATE OF OKLAHOMA )
) ss.
COUNTY OF TULSA
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, theG(lf+ 1
day of4anuary; 2012.
Notary Pu'
My Commission Expires: 2. -23' 23-20114
After Recordation Please Return To:
WPX Energy Rocky Mountian, LLC
Attn: Land Dept.
PO Box 370
Parachute, CO 81635
2