HomeMy WebLinkAbout1.0 ApplicationOLSSON
ASSOCIATES
December 8, 2010
Garfield County
Building & Planning Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
Subject: Small Temporary Employee Housing Permit Application — Well Pad
32A=24D
To Whom It May Concern:
Enclosed please find one (1) copy of the subject Small Temporary Employee Housing
Permit Application along with the required application fee. Petroleum Development Corp. (PDC)
is seeking permission to install temporary employee housing to support drilling operations on a
well pad in Garfield County.
As stated in the enclosed application, the need for the temporary employee housing at
this well pad is dictated by the remote location of PDC's operations and the hazards associated
with having employees routinely driving on the relatively primitive roads accessing these
operations. The installation of this housing will reduce the daily traffic to and from these well
pads and enhance the safety of PDC's operations. In addition, temporary employee housing is
needed for each drilling rig because long-term, affordable is housing is not readily available in
Garfield County.
If you or Garfield County staff have any questions regarding this application, please
contact me at 970-263-7800, ext. 2013.
Sincerely,
Mike Markus
Project Scientist
Olsson Associates
Enclosure — As Stated
826 211/2 Road TEL 970.263.7800
Grand Junction, CO 81505
FAX 970.263.7456 www.oaconsulting.com
SMALL TEMPORARY EMPLOYEE
HOUSING APPLICATION
WELL PAD 32A -24D
SUBMITTED TO:
GARFIELD COUNTY
PREPARED FOR
PETROLEUM DEVELOPMENT CORP.
DECEMBER 2010
OA PROJECT No. 010-0205
OLSSON
ASSOCIATES
GARFIELD COUNTY
Building and Planning Department
108 8th Street, Suite 401
Glenwood Springs, Colorado 81601
Telephone: (970) 945-8212 Facsimile: (970) 384-3470
www.garfield-countv.com
N- -10-604
�
Small Temporary Employee Housing
Administrative Checklist
GENERAL INFORMATION — Submit 1 paper & 1 CD copy of the completed application to Planning Department /in 48 hours following
occupation
(To be completed by the Small Facility Operator — e.g. well pad operator)
Section/Township/Range Location of Housing Site: Well Pad Number: 32A -24D
SWNE Sec24 TWP6S Rng97W
Tax Parcel Number for Parcel Containing Housing Site: 2411013 00001
GPS and/or Lat-Long Coordinates of Housing Facility
Site (Often included in APD): 39 50861468 N 10816829813 W
Zone District:
Resource Lands : Plateau
Maximum Number of Occupants at
Permitted Site (e.g. well pad): 8
Cumulative Amount of Time (in Days) The Facility Will 115 days
be at Location:
State or Federal Permitting Agency Overseeing Reclamation, COGCC, API 05 045 16214 00
Restoration and Revegetation and Relevant Permit Number:
Date of Installation: December 8, 2010
Date of Removal: April 1, 2011
Name of Landowner:
Puckett Land Company
Street Address:
5460 South Quebec St.
Telephone:
Email:
City:
Englewood
State:
CO
Zip Code:
80111
Name of Operator's Compliance
Officer: Steve Trippett
Street Address:
1775 Sherman St, Ste 3000
Telephone:
303-860-5800
Email:
strippett@petd.com
City:
Denver
State:
CO
Zip Code:
80203
Company 24 -Hour Emergency Contact: PDC 24HR Emergency Pager Phone Number:970-350-823°
This Administrative Checklist must be received by the Garfield County Planning Department
hours following occupancy of the Small Facility.
within 48
be delivered to
within 48 hours
Office and
receipt) or verified
is the Operator's
been received by
A copy of this completed Administrative Checklist and all associated submittals shall
the Garfield County Sheriff's Office and relevant Fire Protection District (if applicable)
following occupancy of the Small Facility. Additionally, the Garfield County Sheriff's
relevant Fire Protection District (if applicable) must be notified in writing (return
email (return receipt) within 48 hours following removal of the Small Facility. It
responsibility to confirm and obtain verification that the Administrative Checklist has
the Sheriff's Office and Fire Protection District.
1
Fire Suppression Requirements (Per Performance Standard L)
"A water storage tank is required to provide water to the sprinkler system (if applicable) and initial
suppression activities. The size of the water tank shall be determined based on sprinkler
calculations and initial suppression demands. The relevant fire protection district shall be
responsible for determining the size of the water storage tank. If the Small Facility is not within a
fire protection district, the Operator shall provide at least 2500 gallons of water dedicated to initial
fire suppression which is accessible with a dry hydrant."
Required Size of water storage tank for sprinkler system and initial suppression activities:
2 , 5 0 0 gallons
A. Outline of Process. The Small Temporary Housing Facility(ies) Review process shall consist
of the following procedures as more fully outlined in Section 4-109 of Article IV of the Unified
Land Use Resolution of 2008.
1. Application to relevant protection districts and the Garfield County Sheriff's Office.
2. Application to the County
B. Review Process. Prior to submittal of any forms to the Planning Department, the applicant
shall submit all documents to the relevant fire protection district(s) and the Garfield County
Sheriff's Office. All forms shall be accurately completed, signed, dated and submitted to the
Garfield County Planning Department within 48 hours following occupation of the Small
Facility.
C. Submittal Requirements. The application submitted to the County shall contain the following
information:
i. A vicinity map indicating the section, township, and range of the subject lot and the
location of Small Facility within the subject lot and the Permitted Site; general relation
to surrounding public roads, private roads, adjacent utility systems, residential
development, other actively permitted Small, Minor and Major Facilities, natural
drainage courses and municipalities within one (1) mile of the proposed Small
Facility; north arrow and scale; GPS coordinates and current surface ownership of the
subject lot. The vicinity map shall be presented on a USGS 7.5 minute series
quadrangle at a scale of 1"=2000' or equivalent, with a topography depicted at a
minimum of 40' intervals.
ii. Surveyed layout of the proposed Small Facility within the surveyed boundaries of the
Permitted Site, including at a minimum: sewage and wastewater disposal, trash
receptacles, potable water storage, all other associated infrastructure and all other
equipment located within the Permitted Site. (See Section 4-502 (C )(3) for site plan
definition)
Hi. Identification of the private and public roadways accessing each Small Facility.
Roadways shall be marked as open, gated, and/or locked (include combinations).
Detailed directions, with mileage, shall be given from the nearest town within Garfield
County, nearest Garfield County Sheriffs Office dispatch location and responsible fire
district headquarters to each Small Facility, along each roadway.
iv. Name, address and phone number of surface owner of the subject lot.
v. Name, address and phone number, including a 24-hour emergency response
number of at least two persons responsible for Operator's emergency field
operations; contact numbers for local hospitals, emergency response, fire protection
2
districts, Garfield County Sheriffs Office, Life/Care Flight, and applicable regulatory
agencies; site safety/evacuation plan; and any other written response plan for
potential emergencies at the Permitted Site.
vi. Identification of the anticipated dates of installation and removal of the Small Facility.
The site plan shall include a notation of the total cumulative length of time (number of
days) that the Small Facility will be installed at the Permitted Site.
ELIGIBILITY
Requirement (Section 7-808 (D)(3) — All Requirements
Must be Satisfied to be Eligible as a Small Facility
Applicant
Planning
Department
Complies (Y/N)
Complies (Y/N)
The Small Facility and any associated infrastructure must
be completely contained within a state or federally
permitted parcel (such as a Colorado Oil and Gas
Conservation Commission (COGCC) approved oil/gas
well pad) in which reclamation and revegetation are
secured with the permitting agency (Permitted Site); and,
Y
The Small Facility is located at the Permitted Site for less
than a cumulative of one (1) year and at the end of the
utilization period, all structures, foundations and
associated infrastructure are completely removed; and,
Y
The Small Facility shall have an occupancy of eight (8) or
fewer people within a Permitted Site (e.g. well pad) who
are employees, contractors or sub-contractors of the
operator of the small facility and are needed for onsite
safety of the related commercial, industrial, extraction or
highway operation.
Temporary employee housing facilities that do not have
the three characteristics listed above, or consist wholly or
in part of Recreational Vehicles as defined above, are
subject to the administrative permit requirements or the
Major Impact Permit process, standards and
requirements contained in this document.
y
3
Unit 1
Make: ATCO
Serial Number or Unit ID Number:
20565
Manufacture Year: 2006
Size of Unit (Square Feet):
14 x 48 (672 sq. ft.)
Unit 2
Make: ATCO
Serial Number or Unit ID Number:
21524
Manufacture Year: 2007
Size of Unit (Square Feet):
13 x 54 (702 sq. ft.)
Unit 3
Make: ATCO
Serial Number or Unit ID Number:
21526
Manufacture Year: 2007
Size of Unit (Square Feet):
13 x 54 (702 sq. ft.)
Unit 4
Make:
Serial Number or Unit ID Number:
23592
Manufacture Year: 2010
Size of Unit (Square Feet):
Unit 5
Make: ATCO
Serial Number or Unit ID Number:
19041
Manufacture Year: 2008
Size of Unit (Square Feet):
13 x 54 (702 sq. ft.)
ISDS Permit
ISDS Permit Number: if py _12_10_ /k6 —)
Signature of Operator's Compliance
Officer:
(By signing this form, t verify that all information provided in
the best of my knowledge)
Print Name:
this checklist is correct and accurate to
Title:
4
Building Information (Per Unit)
Unit t 6
Make:
/1tcri +Cc_h
Serial Number or Unit ID Number:
.z d S 27
Size of Unit (Square Feet):
Manufacture Year: 2o
Unit 2
Make:
Serial Number or Unit ID Number:
Manufacture Year:
Size of Unit (Square Feet):
Unit 3
Make:
Serial Number or Unit ID Number:
Manufacture Year:
Size of Unit (Square Feet):
Unit 4
Make:
Serial Number or Unit ID Number:
Manufacture Year:
Size of Unit (Square Feet):
Unit 5
Make:
Serial Number or Unit ID Number:
Manufacture Year:
Size of Unit (Square Feet):
ISDS Permit
ISDS Permit Number: L.Ee"% /2— /61— l x-67
Signature of Operator's Comply
Officer: StA-.�74
(By signing this fond, l verify that a 1 information provided in
the best of my knowledge)
Print Name: Steve Trippett
this checklist is correct and accurate to
Title: Asset Mana• er
4
Facility (eight or less individuals) and shall otherwise be permitted and
operated in accordance with the Garfield County ISDS regulations as
contained in BOCC Resolution Number 1994H-136.
I hereby attest that I am the designated Compliance Officer for the aforementioned
Small Temporary Employee Housing Facility(ies). I attest that I have read and
understand the standards to which the Facility(ies) shall be installed and
operated. I attest that the Facility(ies) will be constructed and maintained in
accordance with all applicable Garfield County, State of Colorado and Federal
regulations and standards. In addition, I attest that I have read and understand the
enforcement provisions as described in Article 12 of the Garfield County Unified
Land Use Resolution of 2008. Further, I understand that non-compliance with any
of the provisions as outlined in Article 7-808 (D) (3) of the Garfield County Unified
Land Use Resolution of 2008 shall be enforced in accordance with Article 12.
4---� Signature of Operator's Compliance Officer:
Print Name:
Steve Trippett
Title: Asset Manager
Phone Number: 303-860-5800
Email: strippett@petd.com
I hereby attest that I am a Licensed Professional Engineer in the State of
Colorado. I attest that I have conducted a visual inspection of the Small Facility
identified in this Administrative Checklist, as installed, and, based on information
from that inspection I certify that the Small Facility complies with the standards
set forth in Article 7-808 (D) (3) of the Unified Land Use Resolution of 2008.
PE Certification Number
Date of Inspection
Print Name of d Title
D40-/ ,
Signature
8
1
owl ev.
HIS INSIGNIA IS THE:PROPERT ,
STATE OF COLORAD
DIVISION OF HOUSING
TNI5 NONRE610E7/TIA L STRUCTURE COMPLIES WITH ENE FACIQAT LAM
NONRESIDENTIAL CONSTRUCTION STAMOARBS Of TNI{ STATE OF eCLORAOO
MANUFACTURERIIII NAM ! _
PLAN APPROVACO. UN'tT DE
A
DAT[ DLHLT
CD TIi1CATIWH R6. FINN
MANUFACTURER CERTIFIES THE FOLLOWING:
HOOF DI$ Q$ LOAD
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THIS INSIGNIA IS THE PROPERTY OF TtGE
STATE OF COLORADO
DIVISION OF HOUSING
THIS NO writes:minim. ern UOTURE COMFLIES WI7N THE 7RCTORT BUILT
ONREJIOENTEAL OC•NSTRUCTION BTANOAAOE CIF THE STATE OF COLORAOS
YARIIEACTURBNEJ'
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MANUFACTURER CERTIFIES THE FOLLOWING:
ROOT MEM LOAD
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ISIS RATERS COLAS
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THLS INSIGNIA is Alipbriv OF'THE
STATE OF COLORAD
DIVISION OF MOUSING
THIS NONRESIDENTIAL STRUCTURE common WITH THE FACTO DyILT
NONRESIDENTIAL tONSTRUCTION STANDARDS Of TINE STATE OF COLORADO
YADIUF,ACTURtTAISY
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PLAN A11WVAL$0. - UNIT EDI,EDI,`STT r T 1 _
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MANUFACTURER CERTIFIES THE FOLLOWING:
Roo! DECO LOAD
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STATE OF COLORADO
DIVISION OF HOUSING
THIS NO 141WHDEMTI*L tTAUrfa9CCOUPLI Et WTN INN FACTORS
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Ftlt! IATN* tit UA W% W111.31
Md. RATN{D moon
FIR4 scamp TiR ANO:+'. 1.
THIG INSIGNIA IS THE PROPERTY OF THE
STATE QF COLORADO
DIVISION OF HOUSING
THIS NUNFESIDEINTI A L STPUCTUFE COMPLIES WITH THE FAC TCIRY BUILT
NON FlESIDENTIAL COriSTRIJCTION STANDARDS OF THE STATE QF CI:MCRACO
MATIUFACTUREROT NAME111
t y
PLAN APPROVAL
DATE BUILT -
LIfLLIT IDN
CFNITIFNCAT1ON Mb. FRNR
MANUFACTURER CEFITiWJES THE FOLLOW1NG: •
ROOF DESIGN LOAD
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FLOOR D($ION
OCCUPANCY
FIRE AXIOM EXTERIOR WALLS
FIRE RATING CEM. p G
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11.4111.1100M0110L1941 22
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THIS INSIGNIA IS THE PROPERTY OF THE
STATE OF COLORADO
DIVISION OF HOUSING
THIS NONRESIDENTIAL STRUCTURE COMPLIES WITH TNM FACTORY aim T
NONfi[7IDENTIAL uUNSTRUCTIOiI STANDARDS OF THE STATE OF CDLaPADQ
MAP WFACTUREfilsr MANI
KAM APPROYA
DOTE BUILT
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CCRTIPIOATFON NO. TOM
20529
MANUFACTURER CERTIFIES THE FOLLOWING:
NOOK DUMB LOAD ps,
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mamma ttXTMUOR WALLA NR
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Facility (eight or less individuals) and shall otherwise be permitted and
operated in accordance with the Garfield County ISDS regulations as
contained in BOCC Resolution Number 199411-136.
I hereby attest that 1 am the designated Compliance Officer for the aforementioned
Small Temporary Employee Housing Facllity(ies). I attest that I have read and
understand the standards to which the Facility(les) shall be installed and
operated. I attest that the Facillty(ies) will be constructed and maintained In
accordance with all applicable Garfield County, State of Colorado and Federal
regulations and standards. In addition, I attest that 1 have read and understand the
enforcement provisions as described In Article 12 of the Garfield County Unified
Land Use Resolution of 2008. further, I understand that non-compliance with any
of the provisions as outlined In Article 7-808 (D) (3) of the Garfield County Unified
Land Use Resolution of 2008 shall be enforced hi accordance with Article 12.
Signature of Operator's Compliance Officer:
Print Name: Steve Trippett
1
Title: Asset Manager
Phone Number: 303-860-5800
Email:
strippett@petd.com
I hereby attest that I am a Licensed Professional Engineer In the State of
Colorado. I attest that I have conducted a visual inspection of the Small Facility
identified in this Administrative Checklist, as installed, and, based on information
from that Inspection I certify that the Small Facility complies with the standards
set forth in Article 7-808 (D) (3) of the Unified Land Use Resolution of 2008.
PE Certification Number
Date of Inspection
Print Name afid Title
Signature
I
PE Stamp
8
GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT
PAYMENT AGREEMENT FORM
(Shall be submitted with application)
GARFIELD COUNTY (hereinafter COUNTY) and Petroleum Development Corp.
Property Owner (hereinafter OWNER) agree as follows:
1. OWNER has submitted to COUNTY an application for small Temporary
Employee Housing Facility (hereinafter, THE PROJECT).
2. OWNER understands and agrees that Garfield County Resolution No. 98-09, as
amended, establishes a fee schedule for each type of subdivision or land use review
applications, and the guidelines for the administration of the fee structure.
3. OWNER and COUNTY agree that because of the size, nature or scope of the
proposed project, it is not possible at this time to ascertain the full extent of the costs
involved in processing the application. OWNER agrees to make payment of the Base Fee,
established for the PROJECT, and to thereafter permit additional costs to be billed to
OWNER. OWNER agrees to make additional payments upon notification by the COUNTY
when they are necessary as costs are incurred.
4. The Base Fee shall be in addition to and exclusive of any cost for publication or
cost of consulting service determined necessary by the Board of County Commissioners for
the consideration of an application or additional COUNTY staff time or expense not covered
by the Base Fee. If actual recorded costs exceed the initial Base Fee, OWNER shall pay
additional billings to COUNTY to reimburse the COUNTY for the processing of the
PROJECT mentioned above. OWNER acknowledges that all billing shall be paid prior to
the final consideration by the COUNTY of any land use permit, zoning amendment, or
subdivision plan.
PROPERTY OWNER (OR AUTHORIZED REPRESENTATIVE)
/2/2/7-0/0
Signature Date
Steve Trippett
Print Name
Mailing Address:
1775 Sherman St, Ste 3000
Denver, CO 80203
Page 4
I01
Petroleum Development Corporation
February 1, 2010
Garfield County Building 04 Planning Department
108 = 8" Street, Suite 401
°Leawood Springs, CQ 81601
Re: Principal Agent and Authority to Sign
Ladies and Gantietnen;
This letter shall serve as formal notice that Petroleum Development Corporation (hereafter
"PDC"), as Operator, hereby directs and designates Steven W. T rippett, Asset Director Central,
DS a representative and principal agent of PDC, authorized to sign and submit all permit
npplications to Garfield County, Colorado on behalf of PDC, Furthermore, Steven W Trippett is
authorized to accept and bo served With all notices From C;3nrtield County regarding any
applicable permit applications and permits,
Sincerely,
Petroleum Development Corporntlou
/7a1"1
MOIL Schaff
(VINE President l-,alld
p
URI OL;EPoRt OFFICE:
Petroleum Development Corporation
0.20 Genesis 6ouloverd a PA Cox 26
Orlegeport, Wept Virginia 20330
(304) 042-3607
CORPORATE OFFICE:
I'otrolaum Development ODe rotlan
2770 Sheraton Street Suite 3000
Denver, Colorado 60203
(2O3) 860-6000
EVANS OFFICE:
Petroleum navelopment Cerparatlen
3001 Demon Avenue
Moe, Colorado 60020
(170) 600,0272
(�; ?�� �I(i .IS I 'II II
1 and Company
September 1, 2010
Garfield County
Building and Planning Department
108 81h Street, Suite 401
Glenwood Springs, CO 81601
Re: Limited Review Process
Minor Temporary Housing Permit
Garfield County, Colorado
To Whom It May Concern:
This letter is to inform concerned parties that Puckett land Company ("Puckett") has authorized PDC
Energy ("PDC") to pursue a Minor Temporary Housing Permit at a site location in Section 24 of Township
6 South, Range 97 West.
Should there be any questions regarding PDC's capacity, please call me at (303) 763-1000.
Sincerely,
PUCKFTT LANF) COMPANY
By: Zir'
l"itle:
Date: 4 oiof0
I, I
DRIVING DIRECTIONS
PETROLEUM DEVELOPMENT CORP.
TEMPORARY HOUSING SITE PLAN FOR
PUCKETT #32A -24D, #32B -24D, #32C -24D, #32D -24D,
#42B -24D, #42C -24D, #42D -24D & #43A -24D
SECTION 24, T6S, R97W, 6th P.M.
SW 1/4 NE 1/4
FROM THE TOWN OF PARACHUTE, COLORADO, TAKE PARACHUTE AVE.
TO THE NORTHWEST, PROCEED ALONG THIS ROAD APPROXIMATELY 0,4
MILES TO THE JUNCTION OF THIS ROAD AND COUNTY ROAD #215.
PROCEED IN A NORTHWESTERLY, THEN NORTHERLY DIRECTION ALONG
COUNTY ROAD #215 APPROXIMATELY 7.1 MILES TO THE JUNCTION OF THIS
ROAD AND AN EXISTING ROAD TO THE WEST. THIS ENDS THE USE OF
PUBLIC
ROADS FOR THE REMAINDER OF THE ROUTE TO THE LOCATION.
TURN LEFT ONTO THIS ROAD AND PROCEED IN A WESTERLY, THEN
NORTHERLY DIRECTION APPROXIMATELY 0.3 MILES TO THE JUNCTION
OF THIS ROAD AND AN EXISTING ROAD TO THE WEST.
TURN LEFT ONTO THIS ROAD AND PROCEED IN A WESTERLY, THEN
NORTHWESTERLY, THEN SOUTHWESTERLY, THE WESTERLY, THEN
SOUTHERLY, THEN EASTERLY, THEN SOUTHERLY, THEN SOUTHEASTERLY,
THEN NORTHWESTERLY, THEN WESTERLY DIRECTION APPROXIMATELY
6.2 MILES TO THE JUNCTION OF THIS ROAD AND AN EXISTING ROAD TO
THE SOUTHWEST.
TURN LEFT ONTO THIS ROAD AND PROCEED IN A SOUTHWESTERLY
DIRECTION APPROXIMATELY 1.1 MILES TO THE JUNCTION OF THIS
ROAD AND AN EXISTING ROAD TO THE SOUTH.
TURN LEFT ONTO THIS ROAD AND PROCEED IN A SOUTHERLY, THEN
SOUTHWESTERLY DIRECTION APPROXIMATELY 0.2 MILES TO THE
JUNCTION OF THIS ROAD AND AN EXISTING ROAD TO THE SOUTHEAST.
TURN LEFT ONTO THIS ROAD AND PROCEED IN A SOUTHEASTERLY,
THEN NORTHEASTERLY, THEN SOUTHEASTERLY DIRECTION
APPROXIMATELY 0.4 MILES TO THE JUNCTION OF THIS ROAD AND AN
EXISTING ROAD TO THE SOUTH.
TURN RIGHT AND PROCEED IN A SOUTHERLY DIRECTION APPROXIMATELY
290' TO THE WELL LOCATION
TOTAL DISTANCE FROM PARACHUTE COLORADO TO THE WELL
LOCATION IS APPROXIMATELY 15.7 MILES.
SURFACE OWNERSHIP
PUCKETT LAND COMPANY
5460 SOUTH QUEBEC STREET
Englewood, CO 80111
INSTALLATION & REMOVAL DATES
Installation Date, December 1, 2010
Removal Date, April 1, 2011
Duration on Site, 122 Days
24 HOUR RESPONSE
CONTACT INFORAMTION
1. PDC 24 Hour Emergency Pager
(970) 350-8230
2. PDC Drilling Manager
(303) 860-5800
3. Garfield County Dispatch
(970) 625-8095
4. St. Mary's CareFlight Helicopter
(970) 332-4923
5. Poison Control Hotline
(800) 222-1222
6. CHEMTREC
(800) 424-9300
NOTE:
GARFIELD COUNTY REQUIRES 20'
SPACING BETWEEN SKID HOUSES.
Wirerope
100'
T
BOP'S
Elevators
0
xN
--0
2
0
0
N
—
0
0
U
VICINITY MAP
SCALE: 1"=2000'
0
SCALE
DATE: 12-06-10
DRAWN BY: C.H.
Directional Tub
Directional Tub
DC Tub
C) #32B -24D
0 #32C -24D
#32A -24D
in A
o #32D -24D
0 #43
Ing
0 #42
-O #42C -24D
n A
1 C
C) #42B -24D a°
#2 Pump'
Boiler
0E
0
E
0
0
E
0
0
Q Mud Tank
Q Mud Tank
0
0
N
0
E
0
0
BP Tub
00
0I
0
Anchor
(7:41)
LW
0
DP Tub
Company Man
Water Vault n
Directional Driller
Sewer Vault
Mud Logger
Water Vault 1
0
N)
N
125'
,D
Do
Dry Mud
Storage
Additives
0000
[7'11m
LW
0�
00
IBit House
Tool Pusher
•• 42- .0 c'\STE' • eA. `
• ,
•i
i
TF OF •CO.pc �o
•••••...••.•••
Proposed
Access Road
Sewer Vault n
0
E
0
0
t
0
Air
Water Vault n
in
r
N
Future Rig Hand Camp'/
Water Vault n
Sewer Vault n
Change Out
(No Living Quarters
Water Vault n /
J
UINTAH ENGINEERING & LAND SURVEYING
85 So. 200 East * Vernal, Utah 84078 * (435) 789-1017
Project Address
Garfield County
Building & Planning Department
108 8th Street Suite 401
Glenwood Springs, CO 81601 -
Phone: (970)945-8212 Fax: (970)384-3470
Parcel No.
Ala SEPT -12-10-1867
Pe it Type: Septic Permit
Work Classification: New
Permit Status: Active r'
Subdivision
Issue Date: 12/7/2010
Section
Expires: 12/07/2011
Township
Range
DEBEQUE, CO
241101300001
Owner Information
Address
Phone
Cell
Puckett Land Company
5460 Quebec ST
Greenwood Village CO 80111
303-773-1094
Contractor(s)
Phone
Primary Contractor
Petroleum Development Corporation (303)860-5800
Yes
Proposed Construction / Details
TEH for well pad: Puckett 32A -24D
FEES DUE
Fee
Amount
Septic Fee - New $73.00
Total: $73.00
Valuation:
Total Sq Feet:
$ 0.00
0
FEES PAID
Inv Total Paytype Amt Paid Amt Due
Inv # SEPT -12-10-20731
$ 73.00 Credit Card
$73.00
$ 0.00
Required Inspections:
For Inspections call : 1(888)868-5306
Inspection
IVR
See Permit Record
Building Department
Copy
Tuesday, December 7, 2010
2
Puckett 32A -24D
GARFIELD COUNTY SEPTIC PERMIT APPLICATION
108 8'f Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
WV w.onrtirld-cuu •.cnm
I
Parcel No: (this information Is available al the assessors office 970.945.9134)
24110 1300001
2
Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
App. 8.6 miles NW of Town of Parachute, 7 Section 24, T6S, R97W, 6th P.M.
3
Lot Size: Lot No: BIodt?No: Subd./ Exemption:
Acres N/A N/A N/A
4
Owner: (property goner)
Puckett Land Company
Mailing Address
2460 S Quebec St, suite 250
Greenwood Village, CO 80111
Ph:
Alt Ph:
5
Contractor:
Petroleum Development Corporation
Mailing Address 1775 Sherean Street, Ste 3000
Denver, CO B0203
Ph:
1303) 860-5800
Alt Ph:
6
Engineer: N/A
Mailing Address
Ph:
Alt Ph:
7
PERMIT REQUEST FOR: (x) New Installation ( ) Alteration ( ) Repair
8
WASTE TYPE: ( )Dwelling ( )Transient Use (?)Commercial or industrial ( )Non- Domestic wastes
( )Other - Describe
9
BUILDING OR SERVICE TYPE: sewage vaults associated with ternporary employee
housing - -Prei 41—
Garbage Grinder ( )Yes (X)No
Number of bedrooms N/A
10
SOURCE & TYPE OF WATER SUPPLY: ( )WELL ( }SPRING ( )STREAM OR CREEK (X)CISTERN
If supplied by COMMUNITY WATER, give name of supplier: Water hauled to location by Artesian Water Service
I1
DISTANCE TO NEAREST COMMUNITY SEWER
Was an effort made to connect to the Community System?
SYSTEM: Town of Parachute - app. 8.6 miles to the South East
No - di stance too g reat
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS:
Depth to 1°' Ground Water Table app . so feet Percent Ground Slope < 1 o t
13
TYPE OF INDIVIDUAL SEWAGE DISPOSAL SYSTEM (ISDS) PROPOSED:
( )Septic Tank ( )Aeration Plant (X)Vault ( )Vault Privy ( )Composting Toilet
( )Recycling, Potable Use ( )Recycling, other use ( )Pit Privy ( )Incineration Toilet ( )Chemical Toilet
( )Other- Describe
14
FINAL DISPOSAL BY:
( )Absorption trench, Bed or Pit ( )Underground
( )Wastewater pond (X)Other-Describe
Dispersal ( )Above Ground Dispersal ( )Evapotranspiration ( )Sand filter
South Canyon or W. Garfield Landfill or other permitted facility
15
Will effluent be discharged directly into waters of the state? ( )YES (X)NO
16
PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes N/A per inch In hole No.1 Minutes N/A per inch in hole
No.3
No._
Minutes N/A per inch in hole No.2 Minutes N/A per inch in hole
Name, address & telephone of RPE who made
Name, address & telephone of RPE responsible
soil absorption test: N/A
for design of the system: N/A
17
--->
Applicant acknowledges that the completeness of
the local health department to be made and furnished
issuance of the permit is subject to such terns and
reports submitted herewith and required to be submitted
and are designed to be relied on by the local department
understand that any falsification or misrepresentation
and legal action for perjury as provided by law.
the application is conditional upon such further mandatory
by the applicant or by the local health department
conditions as deemed necessary to insure compliance
by the applicant are or will be represented to
of health in evaluating the same for purposes
may result in the denial of the application or revocation
and additional test and
for purposed of the evaluation
with rules and regulations
be true and correct to the best
of issuing the permit applied
of any permit granted
�z/2/Zo/r,
reports as may be required by
of the application; and the
made, information and
of my knowledge and belief
for herein. I further
based upon said application
OWNERS SIGNATURE DATE
SP 1 a•-Cr-�O
vl�uj Z-1-3
STAFF USE ONLY
Permit Fee:
F3
Perk Fee:
rnsitiF -E
Total fees:
73 •
Building Permit 11:
Septic Permit #:
SP1- - .. -) o -1 E & R--
Issue Date:
G4)7-9,010
Bui 'ng &'i ing DLpt:
/2` 7 - l . 114 6142.41
AI'11ROVA - DATE