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HomeMy WebLinkAboutApplicationcea: Garfield County Community Development Department nECE Th "108 8th Street, Suite 401 ·' .:JIVE AJ1enwood Springs, CO 81601 ONSITE WASTEWATER TREATMENT SYSTEM (OWTS} PERMIT APPLICATION {970) 945-8212 www .garfield-county.com GAR FI ELD CO UNTY ;~1MUNITY Lfvi>'e '()°f':lJ'oNsTRuc110N x New In sta ll atio n I D Alteration I D Repa ir WASTE TYPE X Dwe lling I D Tran sie nt Use I D Comm/Industrial I D Non-Domesti c D Other De sc ribe INVOLVED PARTIES Property Owner: Chevron Texaco Phone: {713) 372-1450 Mailing Address : PO Bo x 285 Ho u ston TX Contractor: WPX Energy Phone : (970} 285-9377 Mailing Address: PO Box 370 Parachute CO 81635 Engineer: David Fo x Phone : (9 70} 250-5505 Mailing Address: PO Box 370 Parachute co 81635 PROJECT NAME AND LOCATION Job Address: GM 442-20 -See the att ached Qlat for descriQtion Assessor's Parcel Number: 217118200008 Sub. Lot Block -- Building or Servi ce Type: Te mQorar:v 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 OWTS 0 Septic Tank I D Aeration Plant I X Vault I 0 Vau lt Privy I D Composting Toilet D Rec ycl i ng, Potabl e Use 0 Recyclin g I 0 Pit Privy I 0 Incineration Toilet 0 Chemical Toilet X Other Haul ed to Down Va llel'. Waste for their dis11osa l Ground Conditions Depth to 1'1 Grou nd water t abl e NA I Percent Ground Slop e NA Final Disposal by 0 Absorption trench, Bed or Pit I 0 Und erg round Dispersa l I 0 Above Ground Dispe rsa l 0 Evapotranspiration 0 Wa stewat er Pond I 0 Sand Fil ter XOther Hauled t o Down Vall el'. Wa ste for their d is11osa l Water Source & Type 0 W ell I 0 Spring I 0 Stream or Creek I 0 Cistern X Co mmunity W at e r System Name Down Vallel'. Se11tic and Waste Effluent Will Effluent be disch arge d directly into w aters of the State? D Yes XNo CERTIFICATION Applicant acknowledges that th e comp leteness of th e application is conditional upon such further mandatory and additiona l test and reports as may be required by the local health department to be made and furnished by the applicant or by the lo ca l health department for purposed of the evaluation of the app lication; and the issuance of the permit is subject to suc h terms and conditions as deemed necessary to in sure compli ance with rules and regulations made, inform ation and reports submitted herew ith and req uired to be submitted by the applicant are or will be represented to be tru e 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 sa me for purposes of issuing the permit applied for herein . I further understand that any falsification or misrepresentation may re su lt in the denial of the appl i cat ion or revocation of any permit granted based upon sa id application and lega l actio n for perjury as provided by law. I hereby acknowledge that I have r OFFICIAL USE ONLY Sp eci al Conditions: Perk Fee: Permit Fee : 00 ~/ r:<.- nd understand the Notice and Certification above as well as hich is correct and accurate to the best of my knowledge . Date I Fees Paid: ~- 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 treatment/disposal 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 demand 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. = GM 442-20 Vault System Description The site will temporarily office and house up to a maximum of four individu- als during natural gas drilling activities and is expected to be completed in one year or less. The individu als will occupy two individual trailer offices/ houses located on the well pad. Office/houses have Colorado Division of Housing compliance tags. SCAL E: 1" = 60' I \ \ \ \ \ \ I \ \ Existing\ \Culvert \ \ Exist. Overhead Power Line (Abandoned, WPX Energy Rocky Mountain, LLC Prop. CM 11-21 Prop. CM 311-21 Prop. CM 411-21 ~ Prop. CM 12-21 'e' Prop. CM 312-21 120• Prop. CM 412-21 Exi;t. CM 442.!:.20.J \ ·' I Exis t. CM 542-20 • / I I Exist. CM 42-fO • J z I I I ~C-1.0 1 111''11 El. 576.0' I 7.5' Spacing 1 I JN Az. 90'00'00" I \ ""-Exist. CM 642-io • / ' I I '-Exist. CM 342-20 • .>< • / , . -'--I n Exist. Fence.C--> '-......... ~ ,__ ,/ -...... / LEGEND : EXISTING ROA D PROPOSED AC:C ESS ROAD -• -• -• -• -• -EX I ST I NG POWER LI NE m Ui nt a h E n g in eel'i n g & La nd S m veyin g 85 Sou lh 200 EnNt V..-ru n l , 1.ltnh 840 78 (435) 7H9-1017 " FAX (435) 789-1 8 1 3 N WPX ENERGY ROCKY MOUNTA IN, LLC WELL PAD 442-20 SECTION 20, TGS , R96W, 6t h P.M. A C CESS ROAD 1os 111112 11 & T 0 P 0 ~I A P MONrnl DAY n :AR SCAL E: I" =2000'1 DRAWN BY: J.L.G IREV: 01·23·13 M.B. • 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 nnme, 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 al1 in~trun1cnts 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 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 Pennits, Surface Use Pennits, Surface Use Licenses, Utilities, Snow Removal and Private Construction of County Roads; 2. Agreements and other documentation that grant easements, righl~ of way, licenses, or pennits 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 facilitioo; 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 nnd for the lease of real property for residential or commercial purposes or otherwise in co1U1ection 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 termioated by Company. IN WITNESS WHEREOF, WPX Energy Rocky Mountain, LLC has caused tl1is 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 I" da)' of January, 2012. ACKNOWLEDGMENT STATEOFOKLAHOMA ) ) 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, the2o/h day of Jaftu"'Y, 2012. Fci:>r-uruy My Commission Expires: After Recordation Please Return To: WPX Energy Rocky Mountian, LLC Attn: Land Dept. P0Box370 Parachute, CO 81635 2