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HomeMy WebLinkAboutApplication.pdfPECEI- Garfield County J SEP 19 2014 GARFIELD COUN •AMML NI IY DE:VELOF;:. Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION TYPE OF CONSTRUCTION X New Installation 0 Alteration Repair WASTE TYPE X Dwelling 0 Other Describe 0 Transient Use 0 Comm/Industrial 0 Non -Domestic INVOLVED PARTIES Property Owner: Exxon Mobil Corp Phone: (970) 885-2654 Mailing Address: PO Box 53, Houston, TX 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: GM 21-12 - See the attached plat for description Assessor's Parcel Number: 240912200006 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 1 X Vault 0 Vault Privy I 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 i 0 Above Ground Dispersal ❑ Evapotranspiration 0 Wastewater Pond 0 Sand Filter X Other Hauled to Down Valley Waste for their disposal Water Source & Type 0 Well ❑ 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. hereby acknowledge that I have r nd understand the Notice and Certification above as well as have provided the required infor . , hich is correct and accurate to the best of my knowledge. "'At* Propel'fy Owner Print and Sign Date OFFICIAL USE ONLY Special Conditions: Permit Fee: 173.00 Perk Fee: O Total Fees: 123.00 Fees Paid: 123.00 Building Permit Septic Permit: I - 33 l Issue Date: 9-29-14 Balance Due: BLDG DIV:L 7-2f- 2 /4-'APPRO AL DATE GM 21-12 Vault System Description • C rn O -o 2 U CO ._ •w '— O_O•— ? E . O O a) O 4- 0 •(0 0 O 4) M O O O O Xaa) >0 U a) E a)c> Q •O o a) s 0..t5 >. (O/) N 0 - C 0 co U • u) O a) O • 4) _ U O c U =) (0 (0 U -p Q • C• >, C • N•— a) o C 0. O a) _N =�co O a) .L (0 - >, a) a) D N 7 _CO C O i— (0 0 L ai •r• 'a 1 O i co c_ > >+ U a) O) C .N N73 Cp E.0 C NOO.Na O >, ...„3 0 a3 a) a3 O M N E (0 m p) C o) -1-' -0 a -o O_ O) (0 O>0 0 O 6-0 (7 C C Q) O L (0 a O (n 'a a) .N (n > _ + >, E a) E N E (0 Ui -O CO O C •- Q tin a) U -a w U O N+ C O O O co Q +� a) a) — u1 O.0(O - (Oj) a) XY (A.0 N ..4. arm L Cr 0.F o Y.a _c a) X> a) U v Q e C O � (A O Vi = m (0 � (0 C Y07 + (0t _ OE'Oc0 _ a) C •5 "O co(0 0 0 • Y a) _ C C • .� .2 ` C f0 •a - X a) • O "6 � O_ N a) (• �6 O a) a c0 -C (1) >, O_ O • a) z '75 (0 (n (A a) (n N CD - 0 0 d h>-4 (7 @ a) O Q�N Z O.O_' Oo cn .(n — E >, = CO ( a) >, ca O O O (0 N C (0 O _O E O) a) 'a C >'607(7)71" O O 7 O) • oo� ._ N co Jo fl ,_ O a) O >` OO a)oc0 NO m (n a) _ "= 0 O O O a) ° — (O C N> 'a C 0)a) C Q O Q (0 C U (0 O a) O '> -a a) •� 0 (A E. u) OFA- E �CO-0 CO O as o -a a`> 2 i co' -0 •n'7 O U O (n C U U C O 1 > 0) C c o (A >, (n (0 0 N -a a) E OC O C `� U (0 (}0 0) O L (00 • O CD C SCALE: 1" = 60' DATE: 09-21-12 DRAWN BY: M.D. REV.: 02-13-13 REV.: 03-13-13 REV.: 11-18-13 REV.: 04-25-14 REV.: 05-05-14 Stock ''5128 A Yard Existing Paved Area 126 C-2.2' El. 27.6' F-1.0' El. 24.4' Y Gas Processing Equipment N__ \ Conduit Panel �5122- F-3.9 El. 21.5' Proposed Stack Yord Access Road C-1.3' --El. 30.1' FRAC. PAD (150 X 150) FINISHED GRADE = 5128.8' l - I Existing Drainage F-0.4' C-1.6' El. 30.4'. WPX Energy Rocky Mountain, LLC PLAT #2_LOCATION LAYOUT FOR GM 21-12 SECTION 12, T7S, R96W, 6th P.M. 513 Imot esT L. !••4" O•S If 1�� • 0 1,,1/46 9TF•OF .. ��p� '� Approx. C-`J�.7 Top of s� El. 29.1' I Cut Slope o\ I F-0. 7' El. 28.1' 6A130' C-2.6' /El. 28.0' 80' El. 28.4' r°STA ,5128 Existing CMP Cut/Fill Transition Line Gate \/ 12 140' Proposed GAM 411-121 1 1 N Az. 219.252222• B07 r „, Proposed GI/ 332-12 7.5' (tYp•) x BOS - -F-' J•8_ .x -�- Gate 803 [\Existinp,OpOS8d(d 343-72 Tank Proposed GAl 443-12 1 , x --x- • \ \ L 7 N Oi M N Z 90' Sta. 3-1.55 \ C-2.6' E/. 28.0' Gravel Road C-0.3' El. 25.7'- - 1x/st. GM 21-12 90' Proposed GM 531-12 Proposed GM 32-12 Proposed GI/ 342-12 A04`- -x- - f x- A03 Proposed GM 542-12 Proposed aw 43-12 -x-- GRADE a 2 4'- --� 1 \ \/ Gate \ Processing Equipment Tanks 60x45 1 84'1 Existing Buried Pipeline 80' 8A Sta. 1+80 Existing Fence Gate/ EXISTING WELL HEAD GM 321-12 Sta. 1.05 0 co 0 Separators 120x30 1 Cuttings Management Area Anchor (TYP.) Sta. 0+00'` Approx. \ Toe of Fill Slope Elev. Ungraded Ground At GM 411-12 Loc. Stake F-2.6' El. 228' Existing Access Road �5122� = 5125.7' FINISHED GRADE EL EV. AT GM 411-12 LOC. STAKE = 5125.4' UINTAH 85 So. 200 C-3.7' El. 29.1' Existing, Building Existing Sewer Cleanout Existing Manhole C-2.7' EL 28.1' 230' Offset From Power Line Line 3,28_ F-1.5' El. 23.9' 15124/ ENGINEERING & LAND SURVEYING East * Vernal, Utah 84078 * (435) 789-1017 5 PLAT PROPOSED LOCATION: GM 21-12 LEGEND: EXISTING STING RO:1D Uintah Engineering & Land Surveying 85 South 200 Past Vernal, Utah 84078 (435) 789-1017 * IMAX (435) 789-1813 N WPX ENERGY ROCKY MOUNTAIN, LLC GM 21-12 SECTION 12, T7S, R96W, 6th P.M. ACCESS ROAD \IAP X02 06 DAV 13 SF AR SCALE: 1" =2000'1 DRAWN BY: J,L.H, JREVISED: 00-00-00 11111/11114011161u,fi4triefl'ircha i A 9h.tr;411',t1111 22/22/2012 112.110:: O PM Jew Albv,loo 1 at 2 Re0 Fee:516.00 Doo Fvv,O.eo ORRFIELD 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 Cotnpany'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 Attomey-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. 1111114111/11141,1111,W1hitl IP'RIeU 11/2110.1 t 11111 gRecapptlonp: 616009 22 of 22 Rao Foe:S18 506DocaFaa:0.001GARFIELD COUNTY CO IN WITNESS WHEREOF, WPX Energy Rocky Mountain, LLC has caused this Limited Power of Attorney to he signed by one of its Vice Presidents, duly authorized by its Management Committee to grant powers of attorney this 1" day of January, 2012. WPX !.-+t.-.. RO AIN, LLC mes Its:/ ice Pr • idem 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. Games 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. �/� 114 WITNESS WHEREOF, I have hereunto set my hand and affixed my notary seal, theGN+ 1 day of4onuary 2012. rebrt.ta►y My Commission Expires: Notary Pu to l ` I . - 2.-23-Z©I After Recordation Please Return To: WPX Energy Rocky Mountian, LLC Attn: Land Dept. PO Box 370 Parachute, CO 81635 2