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HomeMy WebLinkAboutApplicationNOV 6 201 Garfield Count] Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.earfield-countv.com ONSITE WASTEWATER TREATMENT SYSTEM (OWTS) PERMIT APPLICATION TYPE OF CONSTRUCTION Property Owner: _WPX Energy Phone:(970)285-9377 Mailing Address: PO Box 370, Parachute, CO 81635 X New Installation • Alteration 0 Repair WASTE TYPE Engineer: David Fox Phone: (970) 250-5505 Mailing Address: 670 Canyon Creek Drive, Grand Junction, CO 81507 X Dwelling ❑ Transient Use • Comm/Industrial • Non -Domestic D Other Describe Was an effort made to connect to the Community Sewer System: NA Type of OWTS 0 Septic Tank 0 Aeration Plant X Vault INVOLVED PARTIES Property Owner: _WPX Energy Phone:(970)285-9377 Mailing Address: PO Box 370, Parachute, CO 81635 Contractor: WPX Enerev Phone: (970) 285-9377 Mailing Address: PO Box 370, Parachute, CO 81635 Engineer: David Fox Phone: (970) 250-5505 Mailing Address: 670 Canyon Creek Drive, Grand Junction, CO 81507 PROJECT NAME AND LOCATION Job Address: SG 23-32 Pad - 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 0 Recycling, Potable Use 0 Recycling 17 Pit Privy 0 Incineration Toilet 0 Chemical Toilet X Other Hauled to United Site Services for their disposal Ground Conditions Depth to P` Ground water table NA Percent Ground Slope NA Final Disposal by 0 Absorption trench, Bed or Pit 0 Underground Dispersal 0 Above Ground Dispersal D Evapotranspiration 0 Wastewater Pond 0 Sand Filter X Other Hauled to United Site Services for their disposal Water Source & Type 0 Well 0 Spring 0 Stream or Creek 0 Cistern X Community Water System Name United Site Services 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. 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 raV�e ead and understand the Notice and Certification above as well as have provided the re • uired iinf• rm : ion which is correct and accurate to the best of my knowledge. Property Ownrrint and Sign Date' OFFICIAL USE ONLY Special Conditions: Permit Fee: 3c-- b b Perk Fee: Total Fees: tau Fees Pald: • bD Building Permit 51-04-39S-- Septic Permit: SST- 39471. _. Issue Date: Balance Due9c BLDG DIV: L 11491/5— APPROVAL DATE f 4 b J ads oo3y r it/bfir SG 23-23 Pad Vault System Description ai3 44 9$c -- §•-•c C eg(E c_022 /.C2§ @a ��" CO u ■ o o- a=@ e 03■oo�_- o—.00� �§�� k/§� 2(0�et7d �,2 � To oi 2§ °.- E E a_ 0§ D) $$�fg §2t -mem x—®-■ 7o\�c©� a._�E >■@� 0.ec�V %eco>a�J 03 1-, & �o=- �t o2■Er■ ak �§§§ ck15 5Xk o,abE u- a--�2 §c9'C-■ c -0 0. 13. - #o -a« w20- £27,k§§e §228$ hHI 2' f E�2 11111! �2o c - R �,0 - ogo2A\ a=e>�@ 2Ra2%§£ �k/Ga ©e��o'� ©'o®E/(n 0PE2R2§ 3E,22w$ too I `kI'IDit 1K1v11, 01111 itaael tionl1 pU5Se4 �aI 2 Rao .r19•td Pt! erw 81 00 0 RF1ELG COt frY c0 1 0! 7 012 F�a�iie•00 Doe00 LYNIITED 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 es 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 casement 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 Attomcy-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. 1' UIIIlira i'lllitnli &l+ItIir Il10lh I' IIII4 E11111 R.aeptlonll• 6111004 02/2712012 12r121110 PM Joan Alberlee 2 or 2 Roo Feaii16.00 Dee Feate.00 GARF1ELD 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. WPX ' .y,+e., RO By. D. - • es Its:/ ice Pr • ident STATE OF OKLAHOMA ) ss. 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 tome 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, the} day of.a1°y; 2012. FekrwJ?f My Commission Expires: 2. Notary Public -23-Zoll After Recordation Please Return To: WPX Energy Rocky Mountian, LLC Attn: Land Dept. PO Box 370 Parachute, CO 81635 _11.4121, 1Q Yauatnr 7 Section 32 T.7S,R96W A,,, • NIIbI47 (.3—" \\ -�- _— % \\\ r/ 1 1 •\ 551gt� , Twill), \`. - -� • 1 \ \ GI- t o I 'Production Equip. • V a vlad `�"r i o 1411 ' 1 ; 5,ygr��-` / ► ,L I yw , \111#,‘I N. / /W t #6 \`+ Proposed SG�91+f-i,2T 1 // I NAk 57.11'\ \ \`I Et # . \ 160' \•. - C 7,5' .[^ 1 _ 11 1 1 \ \ ProposedAciess Road 1 • • `~ ' j‘.. • ! tdpa\ •`• \ / `p;en•, \ I Lssov� \Ei _Atone ` •ke M. 00 , • •., \• • RE PNT. in 1♦ Dayllghl Llne \ — `~. I 1 > \ N. ` , 1 ! Is •' `�`- NE#1 \ 1\ • • , • N. 0 BO GRAPHIC SCALE IN FEET 1 INCH . 80 FEET ♦ 15;c1- •"- N t ##8 C F4.1' 130'-,_, C43 \\ O0'1\ \ Edge of 1 j \• \, "�=PrvpasedPad I \\ •,.,• \ 1i \ ' ,\ ♦\ 1 • 1. Q . \ • \ v \ \. i .S1 W#58 F 10.3' m L \ ♦ \ \ \ i‘‘ \ \ • , \\ / \I 1 1 f 1 .` `�/--• 1 \\ 1 1 L 1 I \ St#4 I L L \ • F7.1r 1150''\ SW#5A• — • F10.41---, DyThl-lane • / 5010/S , REF- �NT. \ • ♦ \ ESTIMATED EARTHWORK QUANTITIES (cy) ITEM CUT FILL TOPSOIL EXCESS PAD 12,220 7600 4,390 230 PIT 4,310 4,310 TOTALS 16,530 7600 4,390 4,540 • 'NOTE: 1.) 10% Swell Factor Applied to Earthwork Cut Volume. 2.) Topsoil Volume Based on 12" Soil Depth. 3.) Tata! Disturbed Area = ±4.88 ac. • \ • • SE #3 C1.0' • \ • L _ 4. 136 FashThin1.Street Rifle, Colorado 81650 Ph. (970) 625-2720 Fax (970) 625-2773 IFF ' Survey Services, Inc. Revised: 7/6/15 Construction Plan Prepared for: SCALE: r- 80'�WPXENERGY WPX Energy Rocky Mountain, LLC DATE: 8/280 5 PLAT. 2 of 7 SO 23-32 Drill Pad - Plat 2 PROJECT: Vallee DFT: cs CONSTRUCTION LAYOUT Section 32 T7S.,R96W i.'"A "tafir &MA 5 "2.2., 1 --LN t\A 4 0 1000 2000 GRAPHIC SCALE IN FEET 1 INCH . 2000 FEET ACCESS DESCRIPTION: FROM THE 1-70 EXIST 72 ROUNDABOUT, PROCEED SOUTH TO SOUTHWESTERLY ALONG STATE HIGHWAY 6 ±3 0 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED RIGHT IN A NORTHERLY DIRECTION ±03 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A SOUTHWESTERLY DIRECTION ±1,2 MILES TO THE EXISTING SG 22-32 DRILL PAD, PROCEED ACROSS BOTTOM OF PAD TO THE LEFT IN A SOUTHWESTERLY DIRECTION 10.2 MILES TO THE SG 2342 DRILL PAD LOCATION, AS SHOWN HEREON Revised: 7/6/15 1,36 East Third Street Rtffe, Colorado 816S0 Ph. (970)6234720 fax (970) 625-2773 SCALE: 1- 2000' DATE: 6/ 26/ 15 PLAT 5 or 7 PEatEct: Valle DFT: es Construction Plan Prepared for: WPXENERGY WPX Energy Rocky Mountain, LLC SG 23-32 Drill Pad - Plat 5 ACCESS ROAD & TOPO MAP WPXENERGY WPX ENERGY ROCKY MOUNTAIN, LLC PO BOX 21358 TULSA, OK 74121-1358 COMPANY NUMBER: 3057 CHECK NUMBER: 3057300345 PAY DATE SUPPLIER NO. SUPPLIER NAME CHECK TOTAL Oct 29, 2015 527487 GARFIELD COUNTY BUILDING & PLANNING $75.00 Invoice Dale Invoice / Credit Memo Invoice Description Gross Discount Net OC 27.2015 Inv Nwn: 27-00T-2015 Inv Dere SO 2332 PAD OTWS PERMIT FEE 575.00 50.00 • 575.00 Supplier Support 1-866-581-4981 ,Pape ota)s'• $0.00 575.00 M- VERIFY THE AUTHENTICITY OF THIS MULTI -TONE SECURITY DOCUMENT. WPXENERGY WPX'ENER.O ROCKYMO JNTAIN, LLC PO'BOX 21'358 R� r TULSA,OK 74121-1358 Company Number: 3057 Seventy -Five Boilers And Zero Cents Pay To The Order Of GARFIELD COUNTY BUILDING & PLANNING ATTN: BROOKE WEINING 108 8TH ST, STE 401 GLENWOOD SPRINGS, CO 81601 US 00000000000000920850 CHECK BACKGROUND AREA CHANGES COLOR GRADUALLY FROM TOP TO BOTTOM. I • i• ' s •7.'te.,..�i.o.dqxv .ena enp, ' r•°-•,, a,,• y JPMnrganG18seba11N, N .. ? 70.2322179 ., s°.,'4 1 IChicago, IL • I. = r ` 1 Cheek `Number: 3057300345 Check Date: Oct 29, 2015 PAY (USD) 1 $75.00 II' 3O5730031 -e511' t:0?119232no: 000 9 2013 500 Authorized Slgnalero