HomeMy WebLinkAboutApplicationGørfield County ONSITE WASTEWATER
TREATMENT SYSTEM
(owrs)
PERMIT APPLICATION
Community Development Department
108 8th Street, Su¡te 401
Glenwood Springs, CO 81601
l97Ol94s-82t2
www.sarf¡eld-countv.com
TYPE OF CONSTRUCTION
X New lnstallation I Alteration f¡ Repair
WASTE TYPE
X Dwelling E Transient Use E Comm/lndustrial E Non-Domestic
E Other Describe
INVOTVED PARTIES
Property Owner:Cloush Sheep nv. LLC Phone:
Mailing Address: PO Box 686 Rifle, CO, 81650-0686
Contractor:TEP Rockv Mountain LLC Phone: (9701285-9377
Mailing Address PO Box 370. Parachute. CO 81,635
Engineer:Fox Engineerine Solutions, lnc.Phone : l97Ol 250-55Oc
Mailing Address:670 Canvon Creek Drive,Grand Junction. CO 81507
PROJECT NAME AND TOCATION
Job Address: NR 23-3 Pad
Assessor's Parcel Number: 217503200011 Sub Lot Block
Building or Service Type: Small Temporarv Emplovee Housine #Bedrooms: 4 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 E SepticTank t Aeration Plant X Vault El vault Prlvy tr Compost¡ng Toilet
E Recycling, Potable Use E Recycling E P¡tPr¡w E lncinerationToilet
D chemical To¡let X other Hauled bv Civeo to Garfield and Mesa CounW Landfills
Ground Conditions Depth to 1st Ground water table NA Percent Ground Slope NA
Final Disposalby E Absorption trench, Bed or Plt E Underground Dispersal E Above Ground Dispersal
E Evapotranspiration E Wastewater Pond E Sand Filter
X Other Hauled bv Civeo to Garfield and Mesa Countv Landfllls
Water Source & Type tl Well D spring E stream or Creek I cistern
X Community Water System Name Cltv of Rifle & Ute Water-Haulpd hv Civpo
Effluent Will Effluent be discharged directly ¡nto waters of the State? EI Yes X No
CERTIFICATION
Âpplicant acknowlcdges 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 subjectto 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 evaluatlng the same for purposes of issuing the. permit applied for herein. I
fuither 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
have provided the requi n which is correct and accurate to the best of my knowledge.
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Owner and Sign Date
OFFICIAL IJSE ONTY
Specia I Cond itions:
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6Permil Fee:.775 perk Fee: ùÀ$tl611¡9 -I*^'l
"wü*Building Permit
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Septic Permit:
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lssue Date:
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DATE
BLDG DIV:
APPROVAI
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-Êeëeotion$: 8?9861øl¡latzølO Ø2:18:46 Pl'l Jeen Êìberico1 0f 2 Rec Fee:$16.@Ø Doc Fee,Ø.ØØ GÊRFIELD CoUNTY C0
POìWER OF ATTORNEY
KNOV¡ALL PERSONS BY TITESE PRESENTS:
THAT TEP ROCKY MOUNTAIN LLC, a Delaware limited liability company, hereby nominates,
constitutes, and appoints Bryan S.Ilotard, âs its true and lawful Attorney-in-Fact to execute and deliver
in the name and on behalf of TEP ROCKY MOUNTA,IN LLC ("Principal") any of the following
designated instruments or documents in connection with the Principal's operations in exploring for and
producing oil, gas, or other minerals from lands, or interests in lands, owned, held, or claimed by the
United States, any strate or polilical subdivision thereof, any person, corporation, parfirership or other legal
entity:
A. (1) Applications for permits or leases; (2) consents, stipulations, or.agreements in connection with
the issuance of permits or leases; (3) acceptances of leases, subleases, or permits; (4) acceptances of all
instruments transferring leases, offers to lease, permits, applications for permits, or subleases? or ân interest
in any ofthese (includirg assignments of working or royalty interests) to Principal.
B. Applications for extcnsions or renewals of leases and permits
C. (1) Prospecting, seismic, or exploration permits; (2) instruments in connection with the acquisition
or maintenance of prospecting seismic, or exploration permits.
D. Instruments withdrawing applications for leases or perrnits.
E. (l) Requests for rights-oÈway and surface use permits; (2) acceptance of grants of rights-of-way
and surface use permits, including any stipulation or condition in the grants; (3) any statements that may be
required in connection with applications for rights-of-way and surface use permits.
F. Requests for extension oftime in which to drill wells.
Principal agrees to be bound by all representations the Attorney-in-Fact may make in any instrument or
document he or she is authorized to execute and deliver under this Power of Attomey. Principal hereby
waives any defenses available to ¡t to contest, negate, or disaffirm the actions of its Attorney-in-Fact under
this Power of Attomey.
This Power of Attorney is cffective July 1, 2016, and shall continue in fult force and effect until revoked in
writing, and has the same force and effect as if the Principal granted separate special authority to the
named Attorney-in-Fact to execute and deliver each such insFument or dooument separately for each and
every such insfument or document so executed and delivered.
EXECUTED by Príncipal on this 13ù day of July, 2016.
Terra Energr Partnerc LLC as sole member of
TEPRocl¡ry Mountain LLC
AGREED TO A¡ID ACCEPTED
BY:
BY S. Lmd s
$OruF#RffiHÐ
üÐFY
2-
ITS: President and CEO Attorney-in-Fact
ACKNOWLEDGEMENT
State ofTexas
CountyofHanis
(lt{otary Seal)
This instrument was acknowledged before me on I ,, /3 .2016 by Michael S. Land, known to
me to be the President and CEO of Terra Energy Partnefs LLC, u Delaware corporation, on behalf of the
corporation.
TIFTÀNY CEEETI POTTOCK
Nolory Public, Slole of lexos
My Commission Expires
April 2ô, 2019
NR 23-3 PadVault System DescriptionThe site will temporarily office and house up to a maximum of eightindividuals during natural gas drilling activities and is expected to becompleted in one year or less. The individuals will occupy up to fourindividual units located on the well pad. Officeihouses have ColoradoDivision of Housing compliance tags.,d*ÈiúFour above ground sewage holding tanks with 1500-gallon (6000-gallon total) capacity on-site.The Vault System is displayed in the pictures. Sewage flow is estimated to be 600 gallons perday (8 individuals x 75 gpcd). Sewage holding tanks need to be emptied approximately ever¡'10 days (6000 gallons/ 600 gallons per day). Wastewater vault is equipped with overflow alarmdevice. Terra Energy Partners utilizes the services of a licensed contractor to remove and haulthe wastewater to a state certified treatment/disposal facility.Two aboveground potable water tanks of approximately 3360 gallon capacity each on-site."Potable Water Only" signs will be posted on tanks. Potable water demand is estimated to be600 gallons per day (8 individuals x 75 gpcd). Required minimum fire suppression demand is2500 gallons.Road access to the site is maintained year round through the services of aprivate road maintenance andconstruction contractor.
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GRAPHIC SCALE IN FEET
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REVTSED: 1/3O/18
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Section 3
T,65,,R94W
1000 2000
GRAPHIC SCALE IN FEET
I INCH = 2000 FEET
ACCESS DESCRIPTION:
FROM INTERSTATE 70 EXIT 87, PROCEED NORTHERLY AND EASTERLY ALONG STATE HIGHWAY 6 tO.1 MILES TO AN
INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A NORTHERLY DIRECTION 10.2 MILES TO THE INTERSECTION
wtTH couNTy ROAD 't98 (SWALLOW ROAD), PROCEED LEFT lN A WESTERLY DIRECTION r0.1 MILES TO AN INTERSECTION WITH
A DIRT/GRAVEL ROAD,
AS SHOWN HEREON.
PROCEED RIGHT IN A NORTHERLY DIRECTION T4..1 MILES TO THE EXISTING NR 23-3 DRILL PAD LOCATION,
TEP Rocky Mountain LLC
ons n
TË
an repare for:
NR 23-3 Dnll Pad - Plat 5
ACCESS ROAD & TOPO ]I,TAP
625-2773Fqx
SCALE:
DATE:
PLAT:
PROJECT:
DFT:
7
TEP