HomeMy WebLinkAbout1.0 ApplicationSmall Temporary Employee Housing
Administrative Checklist
GENERAL INFORMATION — Submit 1 paper & 1 CD copy of the completed application to Planning Department Win 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: Encana K19CNE Pad
Section 19, T65, 92W Nabors M13 Rig
Tax Parcel Number for Parcel Containing Housing S ite: 2179-193-00-128
GPS and/or Lat-Long Coordinates of Housing Facility
Site (Often included in AP D): LAT: 39.511227, LONG: -107.713457 ELEV: 5667'
Zone District: Rural Lands
Maximum Number of Occupants at
Permitted Site (e.g. well pad): 8
Cumulative Amount of Time (in Days) The Facility Will
be at Location: Approximately +1- 87 Days
State or Federal Permitting Agency Overseeing Reclamation,
Restoration and Revegetation and Relevant P ermit Number: 05-045-20778
Date of Installation: 11-21-11
Date of Removal: est. 02-15-12
Name of Landowner: Encana Oil A Gas (USA) Inc.
Street Address:
370 17th Street, Ste 1700
Telephone:
720-876-3128
Email:
City:
Denver
State:
CO
Zip Code:
80202
Name of Operator's Com pliance
Officer: Renato Busch (Permitting / So. Rockies)
Street Address:
2717 County Road 215, Suite 100
Telephone:
(970) 285-2825
Email:
renata,busch@encana.com
City:
Parachute
State:
CO
Zip Code:
81635
Company 24 -Hour Emergency Contact: Phone Number.970-21O-8777E
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
or verified
is the Operator's
been received by
A copy of this completed Administrative Checklist and all associated submittals shall
the Garfield County Sheriffs Office and relevant Fire Protection District (if applicable)
following occupancy of the Small Facility. Additionally, the Garfield Count y Sheriff's
relevant Fire Protection District (if applicable) must be notified in writing (return receipt)
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.
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
Encana K19CNE Pad
Nabors M13 Rig
NOV 18 2011
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:
2500 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 distric is and the Garfield County Sheriffs 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
Sheriffs 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)
iii. 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 Sheriff's 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 (YIN)
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 docu ment.
Y
3
Nabors M13
Small Facilities ® K19CNE
Building Information (Per Unit)
Unit 1
Make: Teton Buildings LLC
Serial Number or Unit ID Number:
24096
Manufacture Year:
2010
Size of Unit (Square Feet):
780
Unit 2
Make:
Teton Building LLC
Serial Number or Unit ID N umber:
24113
Manufacture Year:
2011
Size of Unit (Square Feet):
416
Unit 3
Make:
Atco Structures (USA) Inc.
Serial Number or Unit ID Number:
21944
Manufacture Year:
2007
Size of Unit (Square Feet):
702
Unit 4
Make:
Teton Buildings LLC
Serial Number or Unit ID Number:
21486
Manufacture Year:
2010
Size of Unit (Square Feet):
780
Unit 5
Make:
Serial Number or Unit ID Number:
Manufacture Year:
Size of Unit (Square Feet):
ISDS Permit
ISDS Permit Number: Submitted with this STEN Administrative Checklist 5ER—P,qy
Signature of Operator's Comp e
Officer: ��::7e .--cs-c_
(By signing this form, l verify that all information provided in
the best of my knowledge)
Print Name: Renato Busch
this checklist is correct and accurate to
Title: Permittin• / South Rockies
4
Eligibility, Submittal and Performance Standards Certification
Section 7-808(D)(3) - Small Temporary Employee Housing Facilities (Small Facility(ies))
in Article VII — Standards, requires the that the following performance standards be met
with each facility:
Small Facilities, in the nature of Factory Built Nonresidential Structures [as defined under
C.R.S. 24-32-3302(a)] but NOT recreational vehicles [as defined under C.R.S. 42-1-102
(61), including truck, truck tractor, motor home or camper trailer], may be utilized for
housing of workers on projects related to commercial, industrial, mineral extraction or
highway operations, pursuant to the standards for Small Facilities contained in sub-
section (2), below. Such facilities are not subject to Garfield County building and fire
codes (building code, fire code). However, Small Facilities are subject to all pertinent
state (i.e. electrical permits), federal permits and relevant fire protection district(s) code
requirements.
Small Facilities shall have all of the following basic characteristics:
A. 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,
B. 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,
C. The Small Facility shall have an occupancy of eight (8) or fewer people 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.
The Small Facility shall adhere to the following Standards: All required submittals (as
outlined in (2), above) shall be submitted to the Planning Department within 48 hours
following occupation of the Small Facility. Enforcement shall be in accordance with this
Resolution. The Small Facility shall demonstrate and certify compliance with the following
standards:
A. Small Facility must comply with all applicable federal, state and local laws and
regulations.
B. The Small Facility shall NOT contain recreational vehicles as defined in Section 7-
808 (D).
5
C. In no case shall unsafe water be used for drinking nor shall raw sewage or
contaminated water be discharged on the ground surface. The operator shall
conduct monthly tests (or quarterly if an on-site disinfection system is installed) and
maintain records of stored potable water samples specific for coli form bacteria.
Any tests indicating coli form contamination must be disclosed to the Garfield
County Board of Health or designee within 72 hours from the time the
contaminated water was tested.
D. Each Small Facility shall be maintained in a clean, safe and sanitary condition, free
of weeds and refuse. Any hazardous or noxious materials that must be stored at
the Small Facility for operational or security reasons must be managed in
accordance with all applicable federal, state and local laws and regulations.
E. At least one thirty (30) gallon (4 cubic feet) wildlife -proof refuse container shall be
provided for each Factory Built Non -Residential Structure unit. Said container(s)
must be durable, washable, non-absorbent metal or plastic with tight -fitting lids.
F. Refuse shall be disposed of weekly, at a minimum. Operators must keep
appropriate records, to be provided to the County or any interested third party upon
request, to demonstrate that refuse is collected in a timely fashion and disposed of
at a licensed facility.
G. Outdoor food storage is prohibited.
H. Factory Built Non -Residential Structures equipped by the manufacturer with a fire
sprinkler system, fire detection system, and/or alarm system shall be inspected,
tested, and maintained in accordance with the requirements of the relevant fire
protection district(s) and the Colorado Division of Housing.
I. Single -station carbon monoxide alarms shall be placed in each Factory Built Non -
Residential Structure.
J. One (1) or more approved fire extinguisher(s) of a type suitable for flammable
liquids, combustible materials and electrical fires (Class ABC), or dry chemical,
shall be located in each Factory Built Non -Residential Structure and placed in
accordance with applicable fire protection district and/or Colorado Division of
Housing codes.
K. Domestic animals are prohibited at all Small Facilities.
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 within each Permitted Site for a
Small Facility.
M. The operator shall document all emergency situations requiring action by any
government agency or fire protection district, in writing, and such documentation
shall be presented to the Planning Department within 24 hours of the occurrence.
N. All required Access Permits shall be obtained from the Garfield County Road and
Bridge Department or the Colorado Departm ent of Transportation.
6
O. The Garfield County Sheriff's Office and relevant fire protection district(s) shall be
notified and provided with all documentation as outlined in these regulations, within
48 hours following occupation of each Small Facility. In addition, the Garfield
County Sheriffs Office and relevant fire protection district(s) shall be notified either
by hard -copy or electronically within 48 hours following removal of all Small
Facilities. The Planning Department shall be copied on all such notification,
whether hard copy or electronic.
P. The Operator shall maintain records identifying workers, whether employees,
contractors or sub -contractors, and document the dates that each worker is housed
at the Small Facility. Such records shall be provided to the County or any additional
third party upon request.
Q. The Operator shall obtain a certification inspection conducted by a third -party
Professional Engineer Licensed in the State of Colorado. The certification shall
verify that at the time of inspection the identified Small Facility meets or exceeds
the standards set forth in Article 7.808 D. 2. of the Garfield County Land Use Code
of 2008, as amended. This certification shall be on forms provided by the Garfield
County Planning Department. The certification shall be provided to the Garfield
County Planning Department within 48 hours following occupation of the Small
Facility.
R. The Operator shall accurately complete all required forms provided by the Garfield
County Planning Department identifying the location of the facility
(Section/Township/Range, relevant Tax Parcel Number, and GPS coordinates or
Latitude/Longitude coordinates); relevant zone district; maximum number of
occupants; cumulative amount of time (in days) that the Small Facility will be at the
specified location; identification of the State or Federal permitting agency
overseeing reclamation, rehabilitation and revegetation of the Permitted Site and
relevant permit number; date of installation; date of removal; name and contact
information of the landowner; name and contact information of the Operator's
Compliance Officer; 24-hour emergency contact information for the Operator;
building information (make, manufacture year, serial number, size (square feet));
signature and contact information of the Operator's Compliance Officer.
S. Wastewater Disposal:
1) Vault System: All vault systems shall be designed and installed to
accommodate the maximum number of persons (eight or less
individuals), who will inhabit the Small Facility. In addition, all vault
systems shall be equipped with an overflow alarm device. Vault
systems shall be designed to accommodate a minimum of 75 gallons
of wastewater per person per day. If a vault system is proposed or has
been approved, the Operator must:
a. Demonstrate that year-round vehicular access is available and
maintained for safe and regular access for sewage hauling vehicles.
b. Maintain all sewage disposal records including but not limited to trip
Togs/reports and landfill receipts as public records, available to the County
and/or any other interested third party upon request.
c. (b) Individual Sewage Disposal System (ISDS): If an ISDS is
proposed, then it shall be designed, installed and operated to
accommodate the maximum number of persons who will inhabit the Small
7
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). 1 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 alt 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 ac ordance with Article 12.
Signature of Operator's Compliance Officer: _
Print Name: Robin Richardson / Renata Bunch
Title:
Piceance Safety
/ Permit Coordinator
Phone Number: (970) 285-2./29
/ (9']O) 285-2825
Email; robin.riciiardsoivencana.com / renata.busch�encana.com
I hereby attest that 1 am a Licensed Professional Engineer in the State of
Colorado. 1 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
42408
Date of Inspection
11-19-2011
Print Name and Title
Paul Hawkes, PE
Signature
PE Stamp
0�� 4 L/c
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1113(3,,,1,-11-19711.-`��
yeti �r
GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT
PAYMENT AGREEMENT FORM
(Shall be submitted with application)
GARFIELD COUNTY (hereinafter COUNTY) and Encana Oil & Gas (USA) Inc.
Property Owner (hereinafter OWNER) agree as follows:
1. OWNER has submitted to COUNTY an application for K19CNE Well Pad Small Temporary
Employee Housing (STEN) Admin.Checklist, Septic Permit (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)
Signat re Date
Renata Busch - Permitting/South Rockies
Print Name
Mailing Address:
Encana Oil & Gas (USA) Inc.
2717 County Road 215, Suite 100
Parachute, CO 81635
Page 4
1111 lel P:i114.1.1 J 11111
Reccptiontt: 801714
04122/2011 04 26:38 PM Jean Plberico
1 of 1 Pee Fee:$11 00 Dot Fee 0.00 GAPF1EL0 COUNTY CO
STATEMENT OF AUTHORITY
Pursuant to C.R.S. §38-30-172, the undersigned executes
this Statement of Authori ty on behal t ot Encana Oil & Gas (USA) Inc.
a corporation (corporation, limited liability
company, general partnership, registered limited liability
partnership, registered li.mi.Led 1idbiliLy 1.i.iniLed iiaELner111ip,
limited partnership association, government agency, trust or
other) , an entity other than an individual, capable of holding
title to real property (the "Entity"), and states as follows;
The name of the Entity is Encana Oil & Gas (USA) Inc.
and is formed under Lhe laws of of the State of Delaware
The ma i 1. i.ng address for the Entity is 370 17th Street, Suite 1700
The name and/or position of rhe person authorized to
execute instruments conveying, encumbering, or otherwise
affecting title to real property on behalf of the Entity is
Renata Busch, Jason Eckman, Mike Herndon, and Brett Crabb
The limitations upon the authority of the person named
above or holding the position described above to bind the Entity
are as fol lows : sign permit applications and permits issued by Garfield County
(if no limitations, insert "None")
Other matters concerning the manner in which the Entity
dealta with any inLer.c:3t in real property are:
(if no/other matter, lcave this section blank)
EXECUT D this /T day ot April
signature: 1
Name (typed or printed: Darrin J. Henke
Title (if a;iy) Vice -President
STATE OF Colorado
COUNTY OL'
Denver
, 201
)
)ss.
}
The foregoing instrument was acknowledged before me hits /1/ day of
April , iu 11 by Darrin J. Menke , on behalt ot
Encana Oil & Gas (USA) Inc. , a Delaware Corporation
Witness my hand and official seal_
My commission expires: Li? Ala/4 40./
(Notary Public)
1sg r 1. .
05/09
KHEMARAT SUTHIWAN
Notary Public
State of Colorado
?eV°.
Waste
Water* -
Tank
Power ---"-
Unit
Fresh
Water --+-E2220
Tank
ater +-
Tank
428.
9AS/S F BEARINGS NOTE:
Basis of Bearings is the West line of the SW
1/4 of Section 19, T6S, R92W, 6th P.M, which is
taken from Global Positioning Satellite
observations to bear NO0'58 54 "W
a measured distance of 2598.39' (The
Southwest Corner of Said Section Being a 1981
Cap LS 15846 and the West 1/4 Corner of Said
Section Being a Set Stone).
589'36'17"E 131.60'
Rig Trench
1
Mud Traiier
�--60'x13' 21486
urj66Gape��
Tool Pusher Trailer
54'x13' 21944
Meeting Trailer
Unit 32'x13' 24113
Company Mon Trailer
"`f Unit 60'x13' 24096
®— Unit Storage
GE
R0
Changing Troller
38'x8'
Well Pad
(K19CNE)
l9
n
Portable
Toilet
Edge of
Well Pad
Dempster
z
r41'47"E nog'
508'23'09"E 29.12'
S07'54'44'W 22.94'
521'38'37"E 40.36'
504'03'39"E 3317'
332'56'56"W 28.93'
55935'25'W 13.73'
S08'04'23'W 41.62'
S2226'56'W 14.27'
S13O1'06"E 30.28'
509'38'03W 28.85'
558.04'17"W 24.79'
66 35'4('W 33.37'
S41'O1'28"W 19.02'
530'45'31"E 14.24'
51826'46"E 33.82'
S38'42'04'E 55.77'
508'08'08'E 24.18'
51329'43"W 23.82'
S39 49'26"W
45.92'
S5144'52'W 51.48'
S51'44'S2"W 55.77'
Boundary of Existing
Disturbance
O
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ENCANA OIL & GAS (USA) INC
TEMPORARY EMPLOYEE HOUSING LAYOUT
WELL PAD (K19CNE)
Section 19, T6S, R92W, 6th P.M.
0
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0
O
HORIZONTAL SCALE
DIRECTIONS TQ S/TF•
From Rifle Grand River Medical Center turn Right
onto Airport Rd On Airport Rd, travel past the
CMC Campus and past the West Mamm Road 1-1.5
miles to Hunter Rood Access. Turn Right (South)
onto Hunter Road Travel d-1 Mile, Turn Left (East).
Travel 1-1/3 Mile to K19CNE Location. No Guard
Gates.
,5vemrs QJHVfeSH/P.'
Encan Oil & Gas (USA) Inc.
370 17th Street, Ste 1700
Denver, CO 80202
INSTAL/ 9170N DAZES
Installation Date: 11-21-11
Removal Date: 02-15-12
Cumulative length of time is
Approximately ±87 days
EMERGENCY CONTACTS:.
Safety On -Cal/ 970-210-8755
Environmental On -Call 970-319-9173
Encana Gas Control 970-285-2615
Garfield County Emergency Dispatch 970-625-8095
Mesa County Emergency Dispatch 970-242-6707
Grand River Medical Center (ER) 970-625-1510
St. Mary's Hospital (Grand Junction) 970-244-2275
Care Flight (Stationed at St. Marys) 800-352-4923
Colorado Road Conditions 877-315-7623
Poison Control 800-332-3075
Amb/Fire/Police-Land Line 911
Production
David Griso
W 970-285-2601
C 970-250-9660
Gerald Papez
C 970-260-8966
Shane Vaughn
C 970-210-4023
Ross Deters
W 970-285-2725
C 970-309-8580
Scott Parker
W 970-285-2787
C 970-379-9798
Dewey Neely
W 970-285-2632
C 970-250-9462
Drilling and completion's
John Grubich
W 970-285-2631
C 970-379-6755
Mark Balderston -Frac
W 970-285-2692
C 970-629-5846
Kirby Burchett-WrkOvr
C 970-250-1179
0 970-285-2664
Plant/Pipeline
Gas Control
(Parachute)
W 970-285-2615
T 800-791-7691
C 970-501-7519
Brad Ankrum
W 970-285-2630
C 435-260-1673
Rocky Erb
O 970-285-2639
C 970-210-8571
Floyd Avery
C 970-319-0357
O 970-285-2679
Greg Cohn
C 970-319-7506
O 970-285-2859
CERTIFICATE ,,,-4:7,60 REG..0),-iili
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THIS IS TO CERTIFY THAT THE ABOVE PL111441,61:PINR /" .tc rl7
FROM FIELD NOTES OF ACTUAL SURVEYS-tME OR 1E�jn ,i
MY DIRECT SUPERVISION AND THAT THE5 h' RE TRUE AN •Cl i
CORRECT TO THE BEST OF MY KNOWLEE J 0 E --1• i
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SURVEYED BY: C.D.S.
DATE SURVEYED: 11-21-11
DRAWN BY: L.C.S.
DATE DRAWN: 11-21-1
SCALE: 1" = 100'
Tri State (435) 781-2501
Land Surveying, Inc.
1 180 NORTH VERNAL AVE. VERNAL, UTAH 84078
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ENCANA OIL & GAS (USA) INC
SEPTIC & FRESH WATER SITE PLAN
WELL PAD (K19CNE)
Section 19. T6S. R.92W. 6th P.M.
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100 070'++ 0 004L AVE. VER,NA'_, 40 MON
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2
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ENCANA_
Mena Orl d Gas ANSA Inc.
170 exit at the Debeque Revised 11-3-2010
SOUTH PICEANCE
DRILLING RIG GROUP
Site Safety Response Plan
Date: 11.02.2011 Consultant(s): Vladimir Kochetov / Charlie Brown
Rig: Nabors M13 Pad K19CNE T6S R93W 6th PM
Nearest town: Rifle Distance to nearest town: 2.5 miles
GPS coordinates: Lat 39.511319 N Long 107.713796 W ELEVATION: 5323' (Section 19, T6S, R93W, 6th P.M.)
Site Emergency Directions: From Rifle Grand River Medical Center turn right onto Airport Rd.
On Aireort Rd, travel past the CMC campus and past the West Mamm Road -1.5 miles to the Hunter Road access.
Turn right (south) onto Hunter Road and travel -1 mile, turn left (east). Travel -1/3 mile to K19CNE location.
No Guard Gates. Use Garfield County Dispatch 970-625-8095
API#: 05-045-13512-00
Muster Location: Location Entrance
Rig phone: 303-353-5354
Safe place for Care Flight to land: Grand River Medical Center -3 miles. Transport by ambulance to hospital & air flight.
Secondary Escape: Safely exit the location, avoid hazards and meet as a group at designated muster location
In case of an emergency (Injury, Accident, Fire, Gas Release, or Spill):
- - Make the 911 emergency call immediately if the situation requires (Call the county dispatch.)
County Dispatch will fulfill 911 duties: Fire, AmbulancelFlight for Life, and Sheriff.
- - All personnel on location meet at designated meeting place (MUSTER POINT.) Determine that all personel are accounted
for, using the daily log in sheet.
-- If safe to do so, perform rescue operations and administer 1st aid.
- - If injured person can be safely moved, transport to the nearest hospital. If not, meet and guide the
Ambulance/Care Flight to the pre -planned meeting place and direct thern to the accident site.
-- Assign a designated communication person for phone communication and incident documentation.
- - If safe to do so, control the release and contain the spill.
-- Evacuate the location and surrounding area as needed.
- - Document all information, ie: time of incident, time of reporting, time of response, time any changes occurred
w/ incident, description of incident, names of personel involved, witnessess, estimated spill volumes, etc.
- - Inform EnCana Drilling Supervision and EHS as soon as possible for all incidents.
South Piceance Drilling Supervision:
- - Notify appropriate Emergency Response Agencys
- - Keep phone open for communications wl Emergency Responders and the scene of the incident.
- - Notify appropriate Company Groups and Managers.
Matt Abell 720-468-2618
John Grubich 970-379-6735
Amy Hughes 303-517-0469
Safety On -Call 970-210-8755
Environmental On -Call 970-319-9173
Gas Control 970-285-2615
Garfield County Emergency Dispatch 970-625-8095
Mesa County Emergency Dispatch 970-242-6707
Grand River Medical Center (ER) (Rifle) 970-625-1510
St. Mary's Hospital (Grand Junction) 970-244-2273
Care Flight (same as St. Mary's) 800-332-4923
CO Rd Conditions/State Patrol (1+) 877-315-7623
Poison Control (1+) 800-332-3073
I•
Wet Rifle •'
Exit 87
f)1iir.14 -.
Gaitleld County
An part
1-0.3 mi.
. •
24
•
•
?.i rj' f1�• . k
'�
it
Existing Location (-
Well pad (K19CNE) I
_ \ V4
) /
1-0.2 mi
1
- - X25
c1;-.
r
30
\ ti -
9.! x
J
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is
25 •
15864
EnCana Oil & Gas Inc.
Well Pad (K19CNE) Expansion
SEC. 19, T6S, R92W, 6th P.M.
5827
•
.i�,ds47er9
(435) 781-2501
180 North Vernal Ave. Vernal, Ulah 84078
SCALE: 1" = 2,000'
DRAWN BY: JAS
DATE: 02-24-2011
i
TDFC]GRAP1-11C MAP
., B"
SHEET
10
0E11
1 j
encana.. SRBU: South Piceance- EMERGENCY NOTIFICATION CHART
iatural gas
miliptiDENT COMMANDER
(most senior employee or company represetltaive on site - appointed 01- delegate)
PRODUCTION!
CONSTRUCTION
FACILITIES/PIPELINE
DRILLING & COMPLETIONS
David Grisso
Poison Control (800) 332-3073
Garfield County
W 970-285-2601
Brad Ankrum
Mesa County
C 970-250-9663
W 970-285-2630
Colorado State Patna'
(970) 824-6501
C 435-260-1673
Hospital (Rifle)
Gerald Papex
Care Flight (5t Mary's) (800) 332-4923
LOSS CONTROL
& INSURANCE
CORPORATE
C 970-260-8963
Gas Control
John Grublch
Tim Blackwood
W720-876-5537
C 303-5123329
W970-285-2615
W970-285-2631
Shane Vaughn
C 97 03 01-1 31 9
C 970-379-6735
C 970-210.4023
Rocky Erb
Mark Balderston
Ross Deters
0 970.285-2639
W970-285-2692
W 970-285-2725
C 970-210-8571
0 9706295845
C 970-309-8583
Floyd Alvey
Kirby Burchett
Scott Parker
C 970319-0357
C 970-250-1179
W970-285-2787
0 970-285-2679
0 970-285-2664
C 970-379-9793
Greg Cohn
Dewey Neely
0 970319-7506
W 970-285-2632
0 970-285-2859
C 970-250-94@
•
EMERGENCY MANAGER
and/ or Deputy Emergency Manager
PRODUCTION
PIPELINE( CONSTRUCTION
DRILLING & COMPLETIONS
Tina Johnson
W 720-876-5083
C 303-249-6370
Jim Walcutt
W720-876-3726
C 303-204-5025
Jesse Wood
W 720-876-5064
C 303E-355559
C 303-621-2433
Matt Abell
W 720-876-3839
C 720-468-2618
Tina Johnson
W720-676-5083
C 303-249-6370
Jim Walcutt
W720-876-3726
C 303-204-5025
4
�ACh as ma_ SUPPORT TEAM
1hl par support such as manpower, equipment services, supplies, etc)
IOW
ENVIRONMENT OFFICER
inimaiiii„ IL
EMERGENCY CONTACTS
Fire, Sheriff, Hospital:
911
Poison Control (800) 332-3073
Garfield County
(970) 625-8095
Area RoadNLbather (877) 315-7623
Mesa County
(970) 242-6707
Federal Aviation Administration (FAA)
Colorado State Patna'
(970) 824-6501
(817) 222-5(616
Hospital (Rifle)
(970) 625-1510
Care Flight (5t Mary's) (800) 332-4923
HAZMAT
CONTRACTORS
Colaradi State
Patrol
970-824-6501
South Rockies Business Unit
Vice President
Darrin Henke
W 720-876-5157
C 303-819-7316
Level 1
Level 2
111 Level 3
EXECUTIVE
MANAGEMENT
EHS USA Div€sten
Vice President
Byron Gale
W (720) 876-3626
C (303) 819-7318
USA DIVISION PRESIDENT
Jeff WoJahn
CORPORATE PRESIDENT &
CHIEF EXECUTIVE OFFICER
Randy Eresman
Date Reviewed: 2011 Date Revised. 11112011
IMIIIMMIP
SAFETY OFFICER
Mat
IOW
ENVIRONMENT OFFICER
inimaiiii„ IL
Safety On Call
970-210-8755
Brad Mallory
W 970-285-2699
C 970-303-1193
Shaun Plnnt
W 970-285-2889
C 970- 987-8178
SECURITY
USA DIVISION
Environmental On Call
970-319-9173
Kathy Friesen
W970-285-2665
C 970-319-2270
Brett Middleton
W970-285-2739
C 970-987-4650
Kathy Vertix
W 970-285-2626
C 970-456.6406
REGULATORY
EHS
Margie Bowman
W 720-876-5456
C303 -218-3020R
OFFICER
EH&S South Rockies
Brant GImmeson
W 720-8765030
C 306$19-7323
Jason Oates
W 720 8763228
{ )
C (720) 785-4806
Safety SRBU
Danny Knutson
W720-876-3513
C 970-309-7510
Denver RP
Incident
Command Center
618 Floor
Roorn # 665
AGENCY CONTACTS
BLM (Grand Junction)
BLM (Silt)
COGCC (Denver)
COGCC (Rifle)
CDPHE
National Response Or
Federal OSHA
CO One -Call
Pipeline Quick Reference
PUC (8-5 M -F)
After Hours Pager
970-244-3050
970-876-9000
888-235-1101
970.625-2497
877-518-5608
800-424-8802
800-321-6742
600-922-1987
811
303-894-2854
303-826-1313
EMERGENCY MANAGEMENTT `
COMMUNITY
& PUBLIC
RELATIONS
HUMAN
RESOURCES
SECURITY
USA DIVISION
LAND
REGULATORY
Doug Hock
W720.876-5096
C 303-328-7048
Margie Bowman
W 720-876-5456
C303 -218-3020R
John Lipka
W (720) 876-3748
C {303) 807-8974
(303) 5670928
Helen Capps
W720-876-3644
C 303-886-1980
Jason Oates
W 720 8763228
{ )
C (720) 785-4806
INFORMATION
TECHNOLOGY
LEGAL
FINANCE
LOSS CONTROL
& INSURANCE
CORPORATE
AXIOM
Don Ross
W720-876-5261
C 303-807-8719
Mary Viviano
W720-876-5020
C 720-272.6800
Tim Blackwood
W720-876-5537
C 303-5123329
David Platt
W (403) 645-7514
C (403) 606-2877
(877) 502-9466
Corporate HQ — Calgary — Security Desk
On C 0 24 Hours
(403 645-7777
GES Coordinates -Parachute Field Office
Degree N: 039' 28' 29"
Degree W. 108" 05' 16'
UNCONTROLLED DOCUMENT IF PRINTED
Cisco Meeting Place Express
Toll Free: 1-877345-2224
Long Distance: 1403-845-2224
Meeting ID to start the meeting 1424210134
Password 101314
To Join the meeting 242101a6
Password 10131#
Project Address
Garfield County
Building & Planning Departr , It
108 Bth Street Suite 401
Glenwood Springs, CO 81601 -
Phone: (970)945-8212 Fax: (970)384-3470
Parcel No.
nit NO. SEPT -11-11-2294
Permit Type: Septic Permit
Work Classification: New
Permit Status: Active
Issue Date: 11/29/2011
Expires: 11/28/2012
Subdivision
Section Township Range
K19CNE/Nabors M13
SILT, CO 81652-
217919300128
Owner Information
Address
Phone
CeII
EnCana Oil and Gas
370 17th ST
Denver CO 80202
720-876-3513
Contractor(s)
Phone
Primary Contractor
Proposed Construction 1 Details
Small TEH for K19CNEI Nabors M13
FEES DUE
Fee
Septic Fee - New
Total:
Amount
$73.00
$73.00
Valuation:
Total Sq Feet:
$000
0
FEES PAID
Inv Total Paytype Amt Paid Amt Due
Inv # SEPT -11-11-21549
$ 73.00 Check # 756499
$73.00
$ 0.00
Required Inspections:
For Inspections call : 1(888)868-5306
Inspection
IVR
See Permit Record
Building Department
Copy
Tuesday, November 29, 2011 2
GARFIEL,D COUNTY SEPTIC PERMIT APPLICATION
108 8`r' Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
www.garfield-coiinty.com
Encana Pad K19CNE
Nabors Rig M13
Submitted w/Small Temporary
Employee Housing
STAFF USE ONLY
Permit Fee:
1-3
P 1Cg )V 1 I Ills irnfcumgtior,s available at the assessors office 970-945-9134)
2
Total fees:
Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
Section 19, T6S, R92W / directions provided with Site Plan
3
Septic
Lot Size: Lot No: Block No: Subbd./ Exemption:
n/a 00
4
Owner: (property owner)
Encana Oil & Gas (USA) Inc.
Mailing Address
370 17th St., Suite 1700
Ph:
720-876-3128
Alt Ph:
5
%
.. Z 7 //
Contractor:
EnCana Oil & Gas (USA) Inc
Mailing Address
2717 CR215, Parachute, CO
Ph:
970-285-2600
Alt Ph:
970-285-2825
6
Engineer:
TriState Land Surveying, Inc.
MailingAddress
180-N. Vernal Ave, Vernal, UT
Ph:
435-781-2501
Alt Ph:
7
PERMIT REQUEST FOR: (X) New Installation ( ) Alteration ( ) Repair
8
WASTE TYPE: ( )Dwelling (X)Transient Use ( )Commercial or industrial ( )Non- Domestic wastes
( )Other - Describe
9
BUILDING OR SERVICE TYPE: Factory Built Non-residential
Number of bedrooms 1 Garbage Grinder ( )Yes ( )No
10
SOURCE & TYPE OF WATER SUPPLY: ( }WELL ( }SPRING ( )STREAM OR CREEK ( )CISTERN
if supplied by COMMUNITY WATER, give name of supplier: Vault & haul system - water received from CDPHE certified water hauler
11
DISTANCE TO NEAREST COMMUNITY SEWER SYSTEM:
Was an effort made to connect to the Community System?
YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN
12
GROUND CONDITIONS:
Depth to 151 Ground Water Table Percent Ground Slope
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 (4Other-Describe
Dispersal ()Above Ground Dispersal ( }Evapotranspiration ( )Sand filter
water hauled to municipality
15
Will effluent be discharged directly into waters of the stale? ( )YES (X)NO
16
PERCOLATION TEST RESULT: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test)
Minutes per inch in hole No.l Minutes per inch in hole
No.3
No._
Minutes per inch in hole No.2 Minutes per inch in hole
Name, address & telephone of RPE who made soil
Name, address & telephone of RPE responsible
absorption test:
for design of the system:
17
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 resullnthe_denial of the ap 'cation or revocation of any permit granted based upon said application
and legal action for perjury as prove -by-law
OWNERS SIGNATURE Renata Bssch / Permitting, South Rockies DATE 11/22/2011
STAFF USE ONLY
Permit Fee:
1-3
Perk Fee:
E n U
Total fees:
3 _
Building Permit N:
,.
Septic
Permit #:
Ep -1-
aaq1-1
Issue Date:
//-0W- 01 /
Bui
ling & P ng De
:
%
.. Z 7 //
APPRO•AL
DATE