HomeMy WebLinkAboutApplicationCommunity Development Department
108 8'h Street, Suite 401.
Glenwood Springs, CO 81601
(970) 945-8212
www.Rarfield-countv.com
ONSITE
WASTEWATER
SYSTEM
(OWTS)
PERMIT APPLICATION
TYPE OF CONSTRUCTION
i
Mailing Address: PO Box 370, Parachute, CO 81635
X New Installation
0 Alteration
❑ Repair
Engineer: David Fox Phone: (970) 250-5505
WASTE TYPE _
PROJECT NAME AND LOCATION
I
X Dwelling 1 • Transient Use
■ Comm/Industrial
0 Non -Domestic
Was an effort made to connect to the Community Sewer System: NA
• Other Describe
Type of OWTS
0 Septic Tank
0 Aeration Plant
X Vault
0 Vault Privy
0 Composting Toilet j
0 Recycling, Potable Use
INVOLVED PARTIES
Property Owner: WPX Energy Phone:(970) 285-9377
Mailing Address: PO Box 370, Parachute, CO 81635
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 22-32 - See the attached plat for description
Assessor's Parcel Number: 240931400135 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
X Vault
0 Vault Privy
0 Composting Toilet j
0 Recycling, Potable Use
0 Recycling
0 Pit Privy
0 Incineration Toilet
0 Chemical Toilet
X Other Hauled to Down Valley Waste for their disposal
Ground Conditions
Depth to 1" Ground water table NA
Percent Ground Slope NA
Final Disposal by
0 Absorption trench, Bed or Pit
0 Underground Dispersal
0 Above Ground Dispersal
O 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. 1
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 1 have read understand the Notice and Certification above as well as
have provided the required informh is correct and accurate to the best of my knowledge.
45/. "AV
Property Owner Print and Sign
Dae
OFFICIAL USE ONLY
Special Conditions:
Permit Fee:
'75/ 2S.
Perk Fee:
DCII
Total Fees:
/5/ace
Fees Paid:
s/,23CO
Building Permit
1/ A
'
Septic Permit:
sE. - �r
Issueate:
ii
Vi,
Balance Due.u
/ 2-- 22-- I'Li/
BLDG DIV:
it r J
APPROVAL DATE
td 1?.) J14
3-a9qc99 *aa- '
SG 22-32 Pad
Vault System Description
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Rearp4iani4: C16CD4 11.10 PM gf1Marina
1 of 2 lam Fi.l$je DO Om Fame 0GARFIELD COUNTY CO
LIMITED POWER OF ATTORNEY
WPX ENERGY ROCKY MOUNTAIN, LLC ("Company") a Delaware Iimited
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: :
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 Permits, Surface Use Permits, Surface Usc
Licenses, Utilities, Snow Removal and Private Construction of County Roads;
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 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 10 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
OMNI IllilLr i tpigIOrKt 111111
Rsesptronq: 0X5004
02/2112012 12,1B,1G PN Joan Albarlco
2 of 2 Roo Fps_S15.00 Doc Fes;0.00 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 1' day of January, 2012.
STATE OF OKLAHOMA
) as.
COUNTY OF TULSA
AIN, LLC
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.
114 WITNESS WHEREOF, I have hereunto set my hand and affixed my notary seal, the
goth
day of-Jarsunsy; 2012.
February
Notary Public
My Commission Expires: 2 -25--
After
23 -
After Recordation Please Return To:
WPX Energy Rocky Mountian, LLC
Attn: Land Dept
PO Box 370
Parachute, CO 81635
rt.A
KIMBERLY J.DBr
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Section 32
T.TS.,R.96W.
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callings Tre ch { I 1 to
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(1090 cy) +\� �' U ( L
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50' 0/5
REF. PNT. O
\ \ i
0
O 0
GRAPHIC SCALE IN FEET
1 INCH a 8t] FEET
Exist Limit
of Disturbance
7 (y•
r 1� r I . ° } I ErISL SG 522-32
/ 11\\. \ O `
� 1 + W � #5 1 A2 77.30° x t.mat. SG 43232
B i 1 C 2.1' �-40' 14\ 90"(1267u. 0.0' 110'
I I t ,t 1 l •prop. SG 922.320>.i'
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r/1r F0.1' . -1 hA I
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Temp. Pump (40'x10)
AP #ol
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REF. PNT.
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/r +
ESTIMATED EARTHWORK QUANTITIES (cy)
ITEM
CUT
FILL
TOPSOIL
EXCESS
PAD
3630
1380
710
1540
PIT
1200
1200
TOTALS
4830
1380
710
2740
AP #4
-
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r
t")
AP #2
C 0.0'
ter`=
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CC
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AP 113
F 0.0'
`NOTE:
1.) 10% Swell Factor Applied to Earthwork Cut Volume.
2.) Topsoil Volume Based on 12" Soil Depth.
, 3 ) Total Disturbed Area = t8.31 ac.
REVISED: 8/18/14
s.
\ I
r /'
�'" / /
136 East Third Street
Rifle, Colorado 81650
Ph. 1'970)625-2720
Fax (970) 625.2773
BOOK -CLIFF
S1iri1 / Services, Inc.
SCALE: 1" - 80'
DATE: 7/ 21/14
Construction Plan Prepared for:
WPXENERGY. WPX Energy Rocky Mountain, LLC
PLAT: 2 0 7
PROJECT. Valle
AFT: cs
SG 22-32 Drill Pad - Plat 2
CONSTRUCTION LAYOUT
Section 32
T 75,.R 96 W.
Sopa
5
\i\\,
I
0
4
2000
GRAPHIC SCALE IN FEET
1 INCH = 2000 FEET
ACCESS DESCRIPTION:
FROM THE I-70 EXIST 97 ROUND -ABOUT, PROCEED SOUTH TO WESTERLY ALONG STATE HIGHWAY 6 ±3.0 MILES TO AN
INTERSECTION WITH A DIRTIGRAVEL ROAD, PROCEED RIGHT IN A NORTHERLY DIRECTION ±0.3 MILES TO AN INTERSECTION
WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A WESTERLY DIRECTION 11.2 MILES TO THE EXISTING SG 22-32 DRILL PAD
LOCATION, AS SHOWN HEREON.
136 East Third Sheet
RiTe, Colorado 81650
Ph (9701625.2720
Fax (970)6252773
BOOKCI.TFF
Slinky Services, Inc.
SCALE: 1" - 2000'
DATE: 7/21/ 14
PLAT: 5 of7
PROJECT: Vnfet
UFT: es
Construction Plan Prepared for:
WPXENERGY WPX Energy Rocky Mountain, LLC
SG 22-32 Drill Pad - Plat 5
ACCESS ROAD & 7OPO MAP