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HomeMy WebLinkAboutApplication- Garfield County r:-:-n 1 ,_ ~,., ..... Community Development Department 108 3th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION www .garfield-county.com TYPE OF CONSTRUCTION x New Installation I D Alteration I D Re p air WASTE TYPE X Dwelling I D Transient Use j D Comm/Industrial I D Non-Domestic D Other Describe INVOLVED PARTIES Property Owner: WPX Ener~ Rock~ Mountain1 LLC Phone:(970) 285-9377 Mailing Address: PO BOX 3701 Parachute 1 CO 81635 Contractor: WPX Ener~ Rock~ Mountain1 LLC Phone: (970} 285-9377 Mailing Address: PO Box 3701 Parachute 1 CO 81635 Engineer: David Fox Phone: {970} 250-5505 Mailing Address: PO Box 3701 Parachute 1 CO 81635 PROJECT NAME AND LOCATION Job Address: GR 14-28 Pad -See the attached Qlat for descriQtion Assessor's Parcel Number: 217133200019 Sub. Lot Block -- Building or Service Type: Tem12orarv 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 TypeofOWTS D Septic Tank I D Aeration Plant I X Vault I D Vault Privy I D Composting Toilet D Recycling, Potable Use D Recycling I D Pit Privy I a Incineration Toilet D Chemical Toilet XOther Hauled to Down Vallelr'. Waste for thelr disl!osal Ground Conditions Depth to 111 Ground water table NA I Percent Ground Slope NA Final Disposal by a Absorption trench, Bed or Pit I D Underground Dispersal I D Above Ground Dispersal 0 Evapotransplratlon a Wastewater Pond I D Sand Filter X Other Hauled to Down Vallelr'. Waste for thelr dlSl!OSal Water Source & Type 0 Well I a Spring I a Stream or Creek I D Cistern X Community Water System Name Down Vallelr'. Se11tic and Waste Effluent Will Effluent be discharged directly Into waters of the State? 0 Yes XNo 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 1 fo mation which is correct and accurate to the best of my knowledge. OFFICIAL USE ONLY Special Conditions: Permit Fee: Perk Fee: ~ Building Permit Septic Permit: ~ ~0 :1>1s.JJL. (;}·1e ·1s '1~ '&)S.7').'/(pJS't- Issue Date: 2-1 8-J?' DATE One aboveground sewage holding tank with 4000-gallon capacity on-site. The Vault System is d isplayed i n 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 treatmenUdisposal 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. e GR 14-28 PAD 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 individuals will occupy two individual trailer offices/ houses located on the well pad. Office/houses have Colorado Division of Housing compliance tags. LIMITED POWER OF ATIORNEY WPX ENERGY ROCKY MOUNTAIN, LLC ("Company") a Delaware limited liability company, bnving its principal place of business in the City of Tulsa, County of Tulsa, Slate of Oklahoma, docs hereby make, constitute and appoint Bryan S. Hobard with the full authority hereinafter provided, the true and lawful Auomcy-in-Fact of the Company, authorized and empowered on behalf of the Company and in the Company's name, nnd for the sole and exclusive benefit of the Company and not on behalf of any other person, corporation or associntion, in whole or in part, to enter into, execute, deliver, ftJe and accept all instruments and documents affecting the real property or real estate rights of the Company as more spccificaUy set forth below: : J . Applications and documcntalion 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, Utt1ities, Snow Removal and Private Construction of County Roads; 2. Agreements and other documentation that grant easements, rights of way, licenses, or pennits to Company and also instrwnents where the Company grants such rights to others; 3. Agreements that assign easements, rights of way, licenses, pennits or surface leases in connection with the Company's operations; 4. Releases and Partial Releases of easements and rights of way; S. Agreements allowing encroachments onto easements and rights of way owned by Company and landowner instrument:& and conveyances on others c:ascments; 6. Agreements subordinating mortgage rights to casement or lease ; 7. Agreements relating to the modification and relocation of Company facilities; 8. Rental or lease agreements for surface use or od1er 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 commorcial pwposes or otherwise in cOMection with the Company's operations; 1 O. Agreements to obtain Wa1l:1' services, eleclrical, gas or oil services or the provision of other utility services utilized by Company's facilities; J 1. Agrcc:ments modifying, amending, renewing, extending. ratifying forfeiting, canceling and terminating any and an of the aforementioned types of instruments and documents. Wl'X ENERGY ROCKY MOUNTAIN, LLC hereby declares that each and every act, mailer and thing which shall be given, made and done by Bryan S. Hotard in connection with the exercise of any or oll of the aforesaid powers shall be as good, valid and effectual to all intents and purposes as if the same bad 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 remllin in full force and effect until terminated by Company. • llMIMY'i1al'Mi\'l'.MW.Hl1~11tr~la'l:fil/J l.,_IH l lftl Rccept.bnM: 8115194 1212Tl2112 12111111 Pl'I Jean lllberlco 2 or 2 "'"° Fn1s11.ee Doc F .. Jl ,00 GRRFllil.D COWl'Y co IN WITNESS WHEREOF, WPX Energy Rocky Mowttain, LLC has caw;ed lhis Limited Power of Attorney to be signed by one of its Vice Presidents, duly authori7.ed by its Monagement Committee to grant powers ofattomey this 1" day of January, 2012 . ACKNOWLEDGMENT STATE OF OKLAHOMA ) ) SS. COUNTY OF 1ULSA ) BEFORE ME, the undersigned authority, a Notary Public in and for said County and State, on this day personally appeared, Jeny D. Barnes personally known to me lo 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 ATIORNEY authorized by Company's Management Committ~. IN WITNESS WHEREOF. I have hereunto set my hand and affixed my notary seal, thetQ.th day of.lefttfllf)'; 2012. F~f My Commission Expires: After Recordation Please Return To: WPX Energy Rocky MolUltian, LLC Attn: Land Dept. POBox370 Parachute, CO 81635 IGMlllR.V J. OEHT --·--.. --._=::.::::- 2 Section 28 T. 6 S., R. 96 W. r--· \ I I __ ,,. --- / / ,,. / I c ,/ / / / I / I " I I I ,,1 I,, , , "I I I I I I I I / J 36 Eosl Third Slrt!CI Rifle, Caklrado 81650 Ph. (970) 625·2720 Fax (970) 625-2773 / SCALE: DATE: PLAT: ..::2:..:o..,f .... 7 _____ 1 PRaJECT: -'~""a.,.lle::..:11....._ ____ 1 DFT: ~cs.._ _____ 1 0 80 GRAPHIC SCALE IN FEET I INCH = 80 FEET ESTIMATED EARTHWORK QUANTITIES (cy) ITEM CUT FILL TOPSOIL EXCESS GR 14-28 Drill Pad -Plat 2 CONSTRUCTION LAYOUT Section28 T. 6 s., R. 98 w. ACCESS DESCRIPTION: ------GRAPHIC SCALE IN FEET 1 INCH = 2000 FEET FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 215 AT PARACHUTE, PROCEED NORTHERLY ALONG COUNTY ROAD 215 ±3.9 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A SOUTHWESTERLY DIRECTION :t.1 .3 MILES TO THE GR 1~28 DRILL PAD LOCATION, AS SHOWN HEREON.