HomeMy WebLinkAboutApplication.pdfGARFIELD COUNTY Building and Planning Department 108 8 Ih Street, Suite 401 Glenwood Springs, Colorado 81601 Telephone: (970) 945-8212 Facsimile: (970) 384-3470 www.aarfield-countv.com
APR 27 2011 GARFit:LU COUNTY BUILDING & PLANNING 'srrH ~ Lf-II-Ct.'Mo Small Temporary Employee Housing Administrative Checklist GENERAL INFORMATION -Submit t paper & 1 CD copy of the
compleled applicalion 10 Planning Departmenl wlin 48 hours following occuDation (To be completed by the Small Facility Operator -e.g. welt pad operator) SectionfTownship/Range Location
of Housing Site: Sec 14-T6S-R94W Well Pad Number: RWF 22-14 Tax Parcel Number for Parcel Containing Housing Site: 2175-211-00-022 GPS andlor Lat-Long Coordinates of Housing Facility
Site (Often included in APD): Lat: 39.527491 Long:l07.856788 Maximum Number of Occupants at Zone District: Rural Pennitted Site (e.g. well pad): less than 8 Cumulative Amount of Time
(in Days) The Facility Will be at Location: 60days State or Federal Pennitting Agency Overseeing Reclamation, Restoration and Revegetation and Relevant Pennit Number: COGCC 20030107
Date of Installation: April 26, 2011 Date of Removal: June 26, 2011 Name of Landowner: Clough Sheep Company, LLC Street Address: PO Box 686 Telephone: (970)625-9024 Email: City: Rifle
State: CO Zip Code: 81650 ,,"arne of Operator's Compliance Officer: Williams Production RMT Company LLC Sandra J. Hotard Street Address: PO Box 370 City: Parachute Telephone: 970-285-9377
ext 2288 State: CO Email: Sandy.Hotard@willia ms.com Zip Code: 81635 Company 24-Hour Emergency Contact: Williams Production RMT Company LLC Phone Number: 970-285-9377 This Administrative
Checklist must be received by the Gcr1ieId County Planning Department within 48 hours following occupancy of the Small Facility. A copy of this completed Administrative Checklist and
all associated submittals shall the Garfield County Sheriffs Office and relevant Fire Protection District (if applicable) . Office and . following occupancy of the Small Facility. Additionally,
the Garfield County Sheriffsrecelpt) or venfied IS relevant Fire Protection District (if applicable) must be notified in writing (return the Operator's . email (return receipt) within
48 hours following removal of the Small Facility. It been receIved by be delivered to within 48 hours responsibility to confirm and obtain verification that the Administrative Checklist
has 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: 500BBL/21 ,000 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 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 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) 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 Sheriff's 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 (O){3) -All Requirements Applicant Planning Must be Satisfied
to be Eligible as a Small Facility Department Complies (YIN) Complies (YIN) 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 YES if well pad) in which reclamation and revegetation are secured with the permitting
agency (Permitted Site); and, 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, YES V 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 V highway
operation. YES 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. 3
Building Information (Per Unit) Unit 1 Make:ATCO Structures (USA) Inc Serial Number or Unit 10 Number: 354085432 Manufacture Year: 2008 Size of Unit (Square Feet): 14X56 Unit 2 Make:
AmeriTech Building System Serial Number or Unit 10 Number: 11-100619 Manufacture Year: 2008 Size of Unit (Square Feet): 14X56 Unit 3 Make: Serial Number or Unit 10 Number: Manufacture
Year: Size of Unit (Square Feet): Unit 4 Make: Serial Number or Unit 10 Number: Manufacture Year: Size of Unit (Square Feet): Unit 5 Make: Serial Number or Unit 10 Number: Manufacture
Year: Size of Unit (Square Feet): ISOS Permit ISOS Permit Number: SEPT-4-11-1~6 V Signature of Operator's cOl~~ ~ --. J\J ~ ;C;-.J-.. Officer: J -'" ( By signing this form, /verify that
all-lnformation provided in this checklist is correct and accurate to the best of my know/edge) Print Name: Sandra J. Hotard Title: Attorney-In-Fact 4
Eligibility, Submittal and Performance Standards Certification Section 7-808(0)(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 subsection (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 (0). 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 NonResidential 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 Department 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 Sheriff's 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 (SectionfTownship/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 logs/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). 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 (0) (3) of the Garfield County Unified Land Use
Resolution of 2008 shall be enforced in accordance with Article 12. Signature of Operator's Compliance Officer: P r i n t N a me: _..::S!..!a!!n.!!d~r~a~J.:.. .. !.H~o!..!t~a.!.r~d _
Title: Attorney -In-Fact Phone Number: 970-285-9377 ext 2288 Email: Sandy.Hotard@williams.comJohn.morris@williams.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 PE
Stamp See Date of Inspection See Summary Summary Print Name and Title: David Fox of Fox Engineering Solutions Signature See Form 8
Fox Engineering Solutions LLC 670 Canyon Creek Drive, Grand Junction, CO 81507 Ph: (970) 250-5505/Fax: (626) 784-0667 Email: coloradofox@bresnan.nef Inspection Report for: Prepare for:
location: RWF 22-14 Well Pad -Small Temporary Employee Housing Williams Production RMT Conducted By: SE 1/4 NW 1/4 of Section 14, T6S, R94W, 6th P.M. Garfield County David Fox, P.E.
Date Conducted: April 26, 2011 Garfield County Paragraph Article 7-808(0)(3) Land Use Resolution 2008 Reference Characteristic or Standard Description 3.a. Small Facilities, In the nature
of Factory Built Nonresidential Structures [as defined under CR.S. 24-32-3302(all bu t NOT recreational vehicles [as defined under CR.S. 42-1-102 (61), including truck, tru ck 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 th e standards
for Small Facilities contained in subsection (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. 3.a.(1) 3.a.(2) 3.a.(3) 1 2 The Small Facility
and any associated infra structure must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission (COGeq approved oil/gas
well pad) in which reclamation and revegetation are secured with the permitting agency (Permitted Site); and, 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. 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. Small Facility must comply with all applicable federal, state and local laws and regulation s. The Small Facility shall NOT contain recreational vehicles
as defined in Section 7-808 (0), Page 1 of 5 Inspection Comments Colorado Division of Housing certifications noted on Company trailer, Unit 10. 354085432 with FBNR Certification No.
19195 manufactured by AlCO Structures USA on 3-26-2008; and Driller's trailer, Unit ID. 11-100619 with FBNR Certification No. 20749 manufactured by Ameritch Building Systems, Inc. on
9-20-2008. All other aspects not subject to visual inspection and certification by third party Professional Engineer. Not subject to visual inspection and certification by third party
Professional Engineer. Not subject to visual inspection and certification by third party Professional Engineer. Not subject to visual inspection and certification by third party Professional
Engineer. Not subject to visual inspection and certification by third party Professional Engineer. No recreational vehicles observed on site.
RWF 22-14 Inspection Williams Production RMT 3 4 5 6 7 8 9 10 11 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. Each Small Facility shall be maintained in a dean, 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. At least one thirty (30) gallon (4 cubic
feet) wifdlife-proof refuse container shall be provided for each Factory Built Non-Residential Structure unit. Said container(s) must be durable, washable, nonabsorbent metal or plastic
with tight-fitting lids. 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. Outdoor food storage is prohibited. 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. Single-station carbon monoxide alarms shall be placed in each Factory Built Non-Residential Structure. 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
NonResidential Structure and placed in accordance with applicable fire protection district and/or Colorado Division of Housing codes. Domestic animals are prohibited at all Small Facilities.
Page 2 of 5 Fox Engineering Solutions LLC April 26, 2011 One potable water tanks of approximately 4000 gallons and one 4000-gallon sewage holding tank onsite. All tanks and piping located
above ground. No on-site disinfection systems installed. Site appeared to be maintained in clean, safe and sanitary condition, free of weeds and refuse. One wildlife-proof trash recepacle
with a capacity of approximately 20 cubic yards onsite. Individual refuse containers in each office/housing structure. Not subject to visual inspection and certification by third party
Professional Engineer. No outdoor food storage observed on-site. No active fire sprinkler systems observed in any of the factory built non-residential structures. Smoke detectors observed
in all factory built nonresidential structures. Colorado Division of Housing (CDH) compliance tags on all factory built nonresidential structures stating compliance with nonresidental
construction standards ofthe State of Colorado. Carbon monoxide detector located in all factory built non-residential structure (FBNR). Fire extinguishers observed in all structures.
No domestic animals observed on-site.
RWF 22-14 Inspection Williams Production RMT 12 13 14 15 16 17 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. 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 Deoartment within 24 hours of the occurrence. All required Access Permits shall
be obtained from the Garfield County Road and Bridge Department or the Colorado Department of Transportation. 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 hardcopy 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. 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. 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.
Page 3 of 5 Fox Engineering Solutions LLC April 26, 2011 One potable aboveground water tank of approximately 4000 gallons capacity on-site. Potable water demand is estimated to be 300
gallons/day gallons (4 individuals x 75 gpcd). Required fire suppression demand is 2500 gallons. Total potable and fire suppression volume required is estimated to be 4000 gallons. Water
supply appears adequate with 4000 gallons of storage with refills scheduled at 5-day intervals. Dry hydrant observed on water tank. Not subject to visual inspection and certification
by third party Professional Engineer. Not subject to visual inspection and certification by third party Professional Engineer. Not subject to visual inspection and certification by third
party Professional Engineer. Not subject to visual inspection and certification by third party Professional Engineer. This inspection was conducted by a third-party Professional Engineer
licensed in Colorado and certifies compliance only with applicable standards set forth in Article 7.808 D. 3. ofthe Garfield County Land Use Code of 2008, as amended, that are subject
to visual inspection.
RWF 22-14 Inspection Williams Production RMT 18 19(a) 19(a)(1) 19(a)(2) 19(b) The Operator shall accurately complete all required forms provided by the Garfield County Planning Department
identifying he 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. 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: Demonstrate that year-round vehicular access is available
and maintained for safe and regular access for sewage hauling vehicles. Maintain all sewage disposal records including but not limited to trip logs/reports and landfitl receipts as public
records, available to the County and/or any other interested third party upon request. Individual Sewage Disposal System (ISDS): If an ISDS is Facility (eight or less individuals) and
shall otherwise be permitted and operated in accordance with the Garfield County [SDS regulations as contained in BOCC Resolution Number 1994H-136. proposed, then it shall be designed,
installed and operated to accommodate the maximum number of persons who will inhabit the Small 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. Page 4 of 5 Fox Engineering Solutions LLC April 26, 2011 Not subject to visual inspection
and certification by third party Professional Engineer. One aboveground sewage holding tank with 4000-gallon capacity on-site. Sewage flows estimated to be 300 gallons/day (4 individuals
x 75 gpcd). Sewage holding tanks need to be emptied approximately every 13.3 days (4000 gallons /300 gallons per day). Wastewater vault equipped with overflow alarm device. Not subject
to visual inspection and certification by third party Professional Engineer. Not subject to visual inspection and certification by third party Professional Engineer. Not subject to visual
inspection and certification by third party Professional Engineer.
RWF 22-14 Inspection Williams Production RMT Fox Engineering Solutions LLC April 26, 2011 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, subject to and limited to visual inspections items as identified above; set forth in Article 7-808 (D) (3) of the Unified Land Use Resolution
of 2008, for Garfield County, Colorado. PE Certification Number: No. 25420 (Colorado PE Stamp Date of Inspection: April 26, 2011 Print Name and Title: ~avid..! ' Fox, pri,n~Engineer
. ~f{rO(l Signature: Page 5 of 5
GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT PAYMENT AGREEMENT FORM (Shall be submitted with application) GARFIELD COUNTY (hereinafter COUNTY) and Clough Sheep Company, LLC __ _
___ Property Owner (hereinafter OWNER) agree as follows: 1. OWNER has submitted to COUNTY an application for _____________ RWF 22·14 pad location STEH &ISDS (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) ~~~<tlk 4-210-1/Date Sandra J . Hotard Print Name Williams Production RMT Company LLC Mailing Address: PO Box 370,
Parachute, CO 81635 Page 4
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)'ll 1.1 w ¢,. 150' """""'"" ..... ~.y.. ~ '. 1.0"· F •• ,. B . '/' JB C 5,0: . "",""",!! .. ~'=-~ 1." --,' '21-1': E 41.12 '1 ,/.::.,' '.j' . I. /. ~ ,I • 1/~1.· .......... /1< i' ....
. jK/t .-\ ~ ... /,........... .., /' il·~lil •. /'" " .... '''--.: j)( ~,L-\ .. tl~~~~O /of; t ~. i.t IT '\ ... J' is I( J )( II ... j . . ..'.!:l ~. : /1 .' ..t -i It {6". ~I. . .
:Ji " . . ~I . . .0FlAR~ PI~ A EQUIPMENT .... EA g (10' X 10') I I. f 3 ... ' . . .. F /1.7' .5E COR ~ L f.1 .' SW cOR ..... • .q:~ .' F •. 0. : NOTE: 1'1 C ~ .''''''-. _ '. . '150 60:
CC USE EXCESS PIT MATERIAl. . .,' '--, BP/SB'---:: '-. -r . ...;....:....... -. -to-TO CONSTRUCT PAD I I ~EGEHD: . BP /SS i ) BP -BRUSH PILE/IJAARitl<" . . . • • • I I . sa _ STRAW BALE
B ..... IER "'{otT. <. &'Ms II . [l:B::I~. CeNTAlNWENT BERW ...................................... . f!!i TOTAl. DI~~.::: .. ~~:.~ .. ~:~:;,C:..................................... -I
I~~:MA:~~ DI~ITLlQU~~;SnOEILs E(XYCDESS)S //d /' ". PAD '0850 8050 4050 -1250 ~e-1'~UC,./, .... .... ". . PIT 20185 & &I~.! COl.Q ~ t CON~T~UCTJON &U~VE'r'&, INC. OTAL~ 31035 8050 4050
18935 i 1,\' cZIcZ112 &UN~J&E el.vo. REVISED: 7/3/07 e~S'!:e-&11. T, CO 816S2 UJJI.I.IAM& PROOUCTION, ~MT (~'cZI.>e'6-S'S3 I SCALE: l' = 80' I SHEET: b. --' '0' ~/I \ . /' 20185 2 of
9
ACCESS: FL.AT #& TOPO & ACCESS FROM ll-IE 1-70 WEST RIFLE EXIT PROCEED ALONG STATE HIGHWAY 6 IN A NORll-IEASTERLY DIRECTION ±500 FEET TO AN INTERSECTION \11TH A DlRT/GRAV£L ROAD ON THE
LEFT, PROCEED LEFT IN A NORTHWESTERLY DIRECTION ±0.2 MILES TO A 4-WAY INTIERSECTlON, PROCEED LEFT IN A GENERAL SOUTHWESTERLY DIRECTION ±0.6 MILES TO AN INTIERSECTION WITH A DIRT /GRAV£L
ROAD AND THE BEGINNING OF A PROPOSED FlAGGED ACCESS CENTERLINE ON 'THE RIGHT, PROCEED RIGHT IN A GENERAL NORTHERLY DlRCTlQN ±0.9 MILES TO THE PROPOSED RWF *22-14 WELL SITIE, BEING 'THE
LOCATION. CON6TRUCTION 6URYE'T'6, INC. REVISED: 5/23/07 (z)(z)12 euN~le.e eL.vo. ~I~ T, CO 616&2 <S1(Z»)816-S1S3 WILL.IAM~ !=~OOUCTIO'" ~MT SCALE: 1· = 2000' SHEET 5 OF 9
Bonuales. Gia From: Sent: To: Cc: Subject: Attachments: Bonuales, Gia Tuesday, April 26, 2011 2:27 PM 'jsears@garcosheriff.com' ; 'Jena Thompson' Reed, Gary RWF 22-14 Rig Move On Notification
RWF 22-14 Sheriff Letter & Map dated 4-26-11 .pdf I am notifying you on the attached pad location we wi ll be commencing drilling operations in the next few days and these operations
wi ll continue for approximately 60 days. At which time I will notify you of the removal of the Employee housing. This notification is per the GARCO Regulations for our pad located in
Sec 14-T6S-R94W. Attached please find a map with directions to the pad, a pad layout and emergency contact information. Should you have any questions please let me know. 610 Bonuolc
!;\ Land Data Tech Associate Williams Production RMT Company LLC 1058 County Road 215/PO Box 370 Parachute, Co 81635 970.263.2746-0ffice 970.216.8537-Cell 970.285-2047-Fax gia.bonuales@williams.com
1
Garfield County Sheriff's Office Emergency Operations Attn: Jim Sears 108 8th Street Glenwood Springs, CO 81601 Ph: 970-945-0453 RE: Emergency Response Notification Drilling (RWF 22-14)
Dear Jim: r1~r1/',rI"I·~amS . !f~ Williams Production RMT Company LLC 1058 CR #215 PO. Box 370 Par;lchule, CO 81635-0370 970/285-9377 970/285-9573 fax This letter is to inform The Garfield
County Sheriffs Department that Williams Production RMT Company LLC will soon commence drilling operations on the above mentioned drilling location. Williams will provide rig site housing
accommodations for the duration of the drilling operation approximately 60 days. In accordance with Garfield County Planning and Zoning Regulations, the attached documentation provides
emergency response infonnation and driving directions for the Williams RWF 22-14 Pad. Should you have any further questions or concerns regarding this notification, feel free to contact
me at (970)683-2288. Sandra J. Hotard Attorney-In-Fact
Bonuales. Gia From: Sent: To: Cc: Subject: Attachments: Bonuales, Gia Tuesday, April 26, 2011 2:26 PM 'Kevin Whelan' ; 'Jena Thompson' Reed, Gary RWF 22-14 Rig Move On Notification RWF
22-14 RFPD Letter & Map dated 4-26-11.pdf I am notifying you on the attached pad location we will be commencing drilling operations in the next few days and these operations will continue
for approximately 60 days. At which time I wi ll notify you of the removal of the Employee housing. This notification is per the GARCO Regulations for our pad located in Sec 14-T6S-R94W.
Attached please find a map with directions to the pad, a pad layout and emergency contact information. Should you have any questions please let me know. Gia ,13onu '\I<'~ Land Data Tech
Associate Williams Production RMT Company LLC 1058 County Road 215/PO Box 370 Parachute, Co 81635 970.263.2746-0ffice 970.216.8537-Cell 970.285-2047-Fax 2ia.bonuales@wjlliams.com 1
Rifle Fire Protection District Attn: Kevin Whelan 1850 Railroad Ave Rifle, CO 81650 Ph: 970-625-1243 RE: Emergency Response Notification Drilling Pad (RWF 22-14) Dear Kevin: Williams
Production RMT Company LLC 1058 Cit #215 P.O. Box 370 P:mlchure. CO 8163)-0370 970128S-9377 97011HS-9S73 r:u: This letter is to inform The Rifle Fire Protection District that Williams
Production RMT Company will soon commence drilling operations on the above mentioned drilling location. Williams will provide rig site housing accommodations for the duration of the
drilling operation approximately 60 days. In accordance with Garfield County Planning and Zoning Regulations, the attached documentation provides emergency response information and driving
directions for the Williams RWF 22-14 pad. Should you have any further questions or concerns regarding this notification, feel free to contact me at (970)683-2288. Sincerely, Sandra
1. Hotard Attorney-In-Fact
Williams Production RMT RWF 22-14 Well Pad Directions to S ite ' ~~ ""'11 -,;:;",; ->:",. ~L ",-:: .. ;:,:~.;:--' '"~. ~ . v I j C_OCSc.v.E""FU7 'NO"1«JI!~~CT s-.._t· T &$./1 .'" IV
_-J..~~::::.;:-==-:<-::,:, --;.--= -"--:-+-"-.,.; /"\ \ \ { ............ ----.,,~, I 'I-\ " .......... \ \ 'I \ '(' ,-f01.._......_.. ;1 '\ .... , J Y-.: < I . ~ ...... -\ \ /---------./\
\ c_ > 'I--~~=-------------------~~ I] Ori~ i "9 Elluipme'" Area -< -WilIiaml RepresenlB!ive OmcelHousing (2-bdrrn .' 40(01)8110n Abovegro...-.d PotableW • ." Clsrem .... ,In Ory Fire
Hv<bl'll 400o.g."cn Above-ground WaSlew"", Vault with Hign Water .. ~ ir br:~~I';'''' 'i ( l.bQom ) , , I'-~b,'':': .. ; ~ y. '-.. ~" ... .. ~ i . ....-------:. <:-~~~~.-~ J Ii x -Y-=--'-'-"""'.~w.'J
"n emergenCY Contact I !Sf' Main OffICe: ~TIl-28S·93n answer.,.;! 24 Hours Robin Brown-W ~ l iams Drllii"9 Q7C-J09.~1O Cell Scon 8<1dy-Win .. ",. Drilling Sup.071l-27G-11187 Cell Kevin
McOermoll-W~~.ms Sarety·97o-JO~1 HI5 C~I Marl< M<.mby. SpiU eonc",dcr 1170-260-15115 C~I -!..,.-.=-y RWF :}2./4 /)"." Ibd · ,*" ~ DI?!U. RIG U. 'tOVT Will~m~, ~ ""'" The weli pad site
is located In the SE 1/4 NW 1/4 of Section 14. T6S . R94W. 6th P.M. (NAD83 N39.5274° Wl07.8567") The site will temporarily office and house up to a muimum of four Individuals durln9
natural gas drilling actlll~les and Is expected to be completed in one year or less. The individuals will occupy three indillidual trailer officeslhouses located on the well pad. All
office/houses have Colorado Division of HOUSing compliance tags . One aboveground sewage holding tank with 40Q0.gallon capacity on-site . Sewage flows estimated to be 300 gallons/day
(4 individuals )< 15 gpcd) . Sewage holding tank needs to be emptied ilpproximately ellery 13.3 days (4000 gallons /300 gilUons per day). Wastewater vault equipped with overflow alarm
dellice. Williams utilizes the services of a licensed contractor to remOlle and haul the wastewater to a State cerHfied treatment/disposal facitity . One potable aboveground water tank
of approximately 4000 gallons capacity on-site. Potable water demand is estimated to be 300 gallons/day (4 individuals _ 15 gpcd). ReqUired minimum fire suppression demand is 2500 gallons.
Total potable and flre suppress ion volume required Is estimated to be 4000 gallons. Water supply appears adequate with 4000 gallons of storage with refills scheduled at 5-day Interval
s. Dry hydrants observed on water tank. Road access to the site is maintained year.round through the servfces of private road maintenance and construction contractors. Factory-Built
Nonresidential Structures (Office/Housing) halle a minimum separat!on distance of 28n. Base mapping by Bookcliff Survey Services. Inc. Site featureS including housing trailers. waler
and wastewater tanks , portable toilets and dumpster surveyed with Trimble Geo-XT' GPS equipment. Please note that this is a construction site and that the locations of drill equipment
and other items are sublect to relocation. RWF 22·14 Site Plan Garfield County. Colorado Small Temporary Employee Housing and SeptiC Permit Application Applicant Williams ProductiOn
RMT D31e; #,pril26. 2011 Ched<ed: [IF Fox Engineering Solutions LLC 670 Canyon Creek Drive. Gtand Jundion. CO 81S07 Ph: (1170)250-5505 1 F .. : (1126)784-0667 Emoit: CQk>radofo~@bresn.n.
n"t Vers;on: 001 ~
Apri l 5th, 20 11 Mr. Fred Jarman, Director Gartield County Building and Planning Department 108 8'" Street, 4'" Floor Glenwood Springs, CO 8160 I RE: RWF 22-14, NR 23 -3 Drilling Pad
Locations, Garfield County, Colorado Dear Mr. Jarman: This letter authorizes Williams Production RMT Company LLC to represent me in the submittal and processing of the required Garfield
County Small Temporary Employee Housing (STEH) and Individual Sewage Disposal System <ISDS) permits on the above drilling pad locations. Sincerely, Clough Sheep Company,
STATEMENT OF AUTHORITY CONfORMED COpy I. This Statement of Authority relates to an entity named CLOUGH SHEEP COMPANY, LLC 2. The type of entity is a limited liability company. 3. The
entity is formed under the laws of Colorado. 4. The mailing address for the entity is P.O. Box 686, Rifle, Colorado 81650. 5. The name of each person authorized to act on behalf of the
Company with respect to real estate matters is David Ryan McKenzie, Manager. 6. This Statement of Authority is executed on behalf of the entity pursuant to the provisions of Section
38-30-172, C.R.S. Executed this --2 day Of---l-A¥'.t::.~~ ___ ., 2011. .4 /' "'//--=~-:;;;~f" //.. /" /~ STATE OF COLORADO ) ) SS. COUNTY OF GARFIELD ) The foregoing instrument was acknowledged
before me this?.tt1 day orJJ-;f!~·_r_,__'! ____. . , 2011, by David Ryan McKenzie, Manager of Clough Sheep Company, LLC. ' , 0;; i'--(>' .,-~ .......I. /~· Wi~e~Y;1!lim~ ,apd official
seal. ~J...c~sjn}jpires:!1rfi I~ )011( ~~ _ \o.·,~ ".c > ""\" ", l .' . ~ :-eN: -t ~,----' 7M~·'7''';ifL.--'+-------------)-: '" •••••••• ;\~ IOU C ") ,f,,,. AFTER RECORDATION PLEASE
RETURN TO WILLIAMS PRODUCTION CO RMT LLC ATTN: LAND DEPT. 1058 COUNTY RD 215 PARACHUTE, CO 81635
Im~'.b n'MPi,Wv.r~~ IrHtl"fi\r:Iot!\:Wllf.I~~ ~1IJ.1II1111 ReeepU onlt: 795365 12f07/201D DA 28.56 PM Je~n Alberico 1 of 2 Reo Foe-S16 00 Doc Fee·O 00 GARFIELD COUNTY CO POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, that Williams Production RMT COMPANY LLC, a Delaware limited liability company, having its principal place of business in the City of Tulsa, County of
Tulsa, State of Oklahoma, hereinafter sometimes referred to as the uCompany," does hereby make, constitute and appoint Sandra J. 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 sale and e~clusive benefit of the Company
and Dot 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 the following described instruments and documents: (1) Agreements that grant easements, rights of way, licenses, or permits; (2) Releases
and Partial Releases of easements and rights of way; (3) Agreements allowing encroachments onto easements and rights of way owned by Company; (4) Agreements subordinating easements,lease
or mortgage rights; (5) Agreements relating to the modification and relocation of facilities; (6) Rental or lease agreements and all notices related to lease agreements; (7) Agreements
modifying, amending, renewing, extending, ratifying forfeiting, canceling and tenninating any and all of the aforementioned types of instruments and documents; (8) Agreements for the
purchase or sale of real property or facilities; and (9) Agreements to obtain the provision of utility services to facilities. with such terms and conditions as said Attorney-in-Fact
shall deem proper and advisable, giving and granting unto said Attorney-in-Fact full and complete power and authority to do and perform any and all acts and things as may be necessary
and proper in the premises. This Power of Attorney shall remain in full force and effect for twelve months from the effective date of this Power of Attorney unless tenninated sooner
by an officer of the Company. Not by way of limitation, but by way of confirmation, the powers of authority conferred shall ex.tend to and include any and all of the instruments andlor
acts above described which may pertain to lands of the United States of America, or to be acquired by the United States of America, lands of any slale, lands of any fee owner, and tribal
or allotted Indian lands.
The Company hereby declares that each and every act. maUer and thing which shaJl be given. made and done by the said Sandra J. 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 the said Company in its legal presence and it hereby
ratifies whatsoever the said Attorney-in-Fact shall lawfully do or cause to be done by virtue hereof. IN WITNESS WHEREOF. Williams Production RMT Company LLC has caused this Power of
Attorney to be signed by one of its Vice Presidents. duly authorized by its Management Commitlee to grant powers of attorney effective as of September 18. 2010. STATE OF OKLAHOMA ) )
"". COUNTY OF TULSA ) BEFORE ME. a Notary Public in and for the State of Oklahoma. on this 1 Slh day of September. 2010, personally appeared Jerry D. Barnes, a Vice President of Williams
Production RMT Company LLC, who acknowledged to me that he has executed the above POWER OF ATTORNEY as his free and voluntary act and deed and as the free and voluntary act and deed
of Williams Production RMT Company LLC for the 1Jl!es and purposes therein set forth. Given under my hand and seal the day and year last a~writbten. o_ ve MY COMMISSION EXPIRES: G -------.4-""""""'''
''--I 7J{1ftk.c4 .1-<;, ;;{or 7' NOTARY PUBLIC Commission No.: 0 (019.3 OeD .l, After Recordation Please Return To: Williams Production RMT Co. Attn: Land Dept. P.O. Box 370 Parachute,
CO Sl635