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ECEiV
AUG 242014
Garfield County
unity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
GARFIELD COUNTY www.garfield-county.com
MMUNITY DEVELOPMENT
ONSITE WASTEWATER
TREATMENT SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
X New Installation I 0 Alteration
f 0 Repair
WASTE TYPE
X Dwelling
0 Other Describe
INVOLVED PARTIES
Property Owner: Bureau of Land Management Phone: (970) 876-9000
Mailing Address: 215 S 10th Street, SAC City IA 50583-2137
Contractor: WPX Energy Phone: (970) 285-9377
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: SG 43-28 - See the attached plat for description
Assessor's Parcel Number: 240921200952 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 OWTS
0 Septic Tank
0 Aeration Plant
XVault
I ❑ Vault Privy
0 Composting Toilet
❑ Recycling, Potable Use
0 Recycling
0 Pit Privy
0 Incineration Toilet
❑ Chemical Toilet
X Other Hauled to Down Valley Waste for their disposal
Ground Conditions
Depth to 1St Ground water table NA
Percent Ground Slope NA
Final Disposal by
0 Absorption trench, Bed or Pit
0 Underground Dispersal
0 Above Ground Dispersal
0 Evapotranspiration
0 Wastewater Pond
0 Sand Filter
X Other Hauled to Down Valley Waste for their disposal
Water Source & Type
0 Well
0 Spring
0 Stream or Creek
0 Cistern
X Community Water System Name Down Valley Septic and Waste
Effluent
Will Effluent be discharged directly into waters of the State? 0 Yes X 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 - understand the Notice and Certification above as well as
have provided the required informat'•p wjl ich is correct and accurate to the best of my knowledge.
Property Owner Print and Sign
Date
glicy
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
j 2 � . oo
Perk Fee:
Total Fees:
1)-3-0D
Fees Paid:
0-3 - Ob
Building Permit
----
Septic Permit:
S - ,3(I2 0
Issue Date:
1- 21 14-
Balance Due:
,
A
BLDG DIV: `^'^ i 4
; J S-21- ` l 4
APPROVAL DATE
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W E > ° 11,
Section 28
T. 6 S., R 96 W
1
X
Property Boundary
Topsoil Stockpile Area
X X X
• NE QP2-
C 13.3'
aylight Line
0
BO
GRAPHIC SCALE IN FEET
1 INCH = 80 FEET
P3 /
C 5.4'
60'o/s Ref. Pnt
N Az. 130.69°
175':
SE P4 /
F 3.51 50'o/s Ref.
1 P�7
UV
N M1
C 16.7'
gg
WW
-Obi--"7C-----7C--7�
Co C°
Edge of Proposed :-7lp �C-
Upper Pad ,
F 2. P6
F 2.51
I
5410
X0`.0/S ....
"IEEE PNT.
150' NE M2
C 12.8'
„tneaoVa 553/
5k /
\e0yti&d16J //
OfFot ?a / ,�,/
a : ; li Pto9. / / '/
NW �M6 it l
*NOTE: .. .'150' / /IC�J_3�
1.) Topsoil Volume Based on 12" Soil Depth
Prop. GM 7,28-34-3 -HN1
2.) 10% Swell Factor Applied to Earthwork Cut Volume. Prop."Gfvt`7J28-24 33-HN1 2'
3.) Total Disturbed Area = ±11.7 ac. - i' REVISED: 8/11/14
150'
„)9s
CuUFill
Line
NAz.136.$1°/
95'
Ph 1970 625-.2720 BOOKCLIFF
L 1
Fax (970) 625.2773
�� Sury Services, Inc.
SCALE: 1" = 80'
DATE: 6/5/ 14
PLAT.' 2A of 7
PROJECT: Valley
DFT' es
i
10
BB
S P5
F 9.0'
Daylight Line
Lipper Pad
EM3
C 10.4'
NI
r-- Daylight Line
3C
c
CC
-7
SE M4
55'
F 3.0'
Construction Plan Prepared for:
WPXENERGY. WPX Energy Rocky Mountain, LLC
GM 323-28 Drill Pad - Plat 2A
CONSTRUCTION LAYOUT
Section 28 --1\--A-
T.
--T. 6S.,R96W
`.
w137
w
F 0.4'
IV M1
C 16.7'
x.
0-
Edge of Proposed — o
Upper Pad °p
176'
SWgP6.
F2.5'
7�EF. PNT.
175'
541°
0
/•.' ,�1
NW M6
1C 6.6'
0
sk
150' NE M2
C 12.8'
•
'd+
5S1an
eta d j
t5ti3t� ryA53/ /
0
Jef6&Qg<Pa&d�\eJ '/ /
Ex. CMP
15o'Cj,
Prop. GM.7 8-4-3�-HN1
Prop._GM 4'33 HN1�i
°Cyon -- � 3 :.
rf , E� P°7
�!
PYroposed 24" _
CMP Culvert
/II
-- 5450-.
W M8
EX. COI1C.
/
—E/PVC Irrig.
Valve
150'
/
F 7.2'
Daylight Line
01
5001 Pte
1(9
"-- —5440—
*NOTE:
1.) Topsoil Volume Based on 12" Soil Depth.
2.) 10% Swell Factor Applied to Earthwork Cut Volume.
3.) Total Disturbed Area = ±11.7 ac.
150'
'14„,„ �
�9t?
_ _1
Cut/Filf
Line
N Az.136.81/ .
95'
5460— -
�'1
55'
i
ab,300+1 I
/ 11
/ / I 2 11
j / 1
O 1
150' S M6 -
SW M7 / F16.2'
F11.5'
//�
0
S P5
�F9.0
Daylight Line
- Upper Pad
EM3
C 10.4'
1
CC
80
GRAPHIC SCALE IN FET
1INCH=80FE T
(00
f //f/
I'
/'
-DD,-/ l
/ —
Daylight Line
SSE M4
F 3.0'
I' o
` 0
SE M5
F 10.2'
1
0
50' 0/S O
REF. PNT.
Ex. Track Trail
op
N
N
2
/ 0 \
V1 \ ,
,(
Ph (97010$ 220
Fax (970) 625-2773
BOOKCLIFF
Survey Services, Inc.
REVISED.. 8/11/14
Ex. PVC Irrig:
Valve .. 501
�.) � 59.1e Ptea
CJ
SCALE: 1" = 80'
DATE: 6/5/ 14
PLAT 2B of 7
PROJECT: Vallee
DFT: CS
Construction Plan Prepared for:
WPXENERGY.
lingrkr WPX Energy Rocky Mountain, LLC
GM 323-28 Drill Pad - Plat 2B
CONSTRUCTION LAYOUT
Section 28
T. 6S,R96W
1000
0
2000
GRAPHIC SCALE IN FEET
1INCH = 2000 FEET
ACCESS DESCRIPTION:
FROM THE INTERSECTION OF THE 1-70 FRONTAGE ROAD AND COUNTY ROAD 215 AT PARACHUTE, PROCEED IN A
NORTHWESTERLY DIRECTION ALONG COUNTY ROAD 215 ±4.6 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD,
PROCEED LEFT IN A SOUTHWESTERLY DIRECTION ±0.1 MILES TO THE EXISTING GM 323-28 LOCATION, AS SHOWN
HEREON.
136 Fast Third Street
Rifle, Colorado 81650
Ph. (970)625 2720 �/�/��
Fax (970) 625-277.,"�j����iiii
BOOKCLJFF
SuryServices, Inc.
SCALE: V' = 2000'
DATE: 6/5/ 14
Construction Plan Prepared for:
WPXENERGY
WPX Energy Rocky Mountain, LLC
PLAT: 5 of
PROJECT: Valley
DFT: es
GM 323-28 Drill Pad - Plat 5
ACCESS ROAD & TOPO MAP
R111:Itl AMM'Illlu�N�itlliirlill'W4t�iiii,1 E61N'411111
02 237201212:10s00PM Jean Rlbarloo
1 or 2 Rao FeerS10.00 Doe Feet0.00 GARFIELO 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 casements;
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 Ibat 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.
t
v
1111PIPNKItMrWCIe4CE 1411.11111 11111
Reoeptlonp: 816009
02127/2012 12.16:10 PM Jean R`berleo
2 er 2 Rao Fee:S16.e0 Doe reele.00 GARFIELD 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 i" day of January, 2012.
WPX RO ¶ o TAIN, LLC
By.
es
Its:/ ice Pr• 'dent
STATE OF OKLAHOMA
) as.
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)). Barnes personally known to me to be the Vice President of
WPX Energy Rocky Mountain, LLC a Delaware limited liability company, who acknowledgcd 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, theZ)P 1
day of4anxazy;2012,
Felon(a.ry
// Notary Public
My Commission Expires: 2, — 25 2 0124
After Recordation Please Return To:
WPX Energy Rocky Mountian, LLC
Attn: Land Dept.
PO Box 370
Parachute, CO 81635
2