HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8'h Street, Suite 401
Glenwood Springs, CO 81601
(970)945-8212
www.garfield-county.com
SMALL TEMPORARY
EMPLOYEE HOUSING
APPLICATION FORM
This Application form must be completed and received by the Garfield County Community Development
Department within 48 hours following occupancy of the Small Facility. In addition, documents shall be
provided to the Sherriff's Office and relevant fire protection district(s) that demonstrate and certify
compliance with the following standards. Notice shall also be provided to these entities within 48 -hours
following removal of a Small Facility. It is the Operators responsibility to confirm and obtain verification
that this Application has been received by the Sheriff's Office and Fire Protection District.
INVOLVED PARTIES
Property Owner Name: Puckett Land company Phone: ( 303 ) M-1003
Mailing Address: 5406 S Quebec Street, Suite 250
City: Greenwood Village State: CO Zip Code: 80111
E-mail:
Operator's Compliance Officer
Name: WPX Energy Phone: ( 970 ) 285-9377
Mailing Address: PO Box 370
City: Parachute State: CO Zip Code: 81635
E-mail: kris.meil@wpxenergy.com
PROJECT NAME AND LOCATION
Location of Housing Site (Section/Township/Range): S 28 TOS R 96`x'
Well Pad Number: GM 11-28 Assessor's Parcel Number: 217129100005
Zone District: Rural Maximum Number of Permitted Occupants: less than 8
Number of Days the Facility will be at Location: 75
State or Federal Permitting Agency Overseeing Reclamation, Restoration and Revegetation (Name):
(Name): State (Relevant Permit Number): API # 05-045-22180-00
Date of Installation: 11/17/2014 Date of Removal: 01/30/2015
24 -Hour Emergency Contact (1):vvPA tnergy Phone Number: y O YtSb-yJ
24 -Hour Emergency Contact (2): Phone Number:
ELIGBILITY
During times of housing shortage or in remote locations, the use of Factory Built Nonresidential
Structures (as defined under C.R.S. § 24-32-3301, as amended, and Resolution #35 of the Colorado State
Housing Board) utilized for a period of time not longer than 1 year or as otherwise specified, for workers
who are engaged in commercial, industrial, mineral extraction, or highway operations and who are
needed to support the proper execution and safety of the related operations. Temporary Employee
Housing, shall not include Recreational Vehicles, except in a Small Facility. A Small Temporary Housing
Facility shall have all of the following basic characteristics:
Complies Y/N
1. The Small Facility and any associated infrastructure must be completely
Yes
contained within a State or Federally -permitted parcel (such as a COGCC-
approved oil/gas well pad) in which reclamation and revegetation are secured
with the permitting agency (Permitted Site); and
2. The Small Facility is located at the Permitted Site for less than a cumulative of 1
Yes
year and at the end of the utilization period, all structures, foundations, and
associated infrastructure are completely removed; and
3. The Small Facility shall have an occupancy of 8 or fewer people who are
Yes
employees, contractors, or subcontractors of the operator of the small facility
and are needed for on-site safety of the related commercial, industrial,
extraction, or highway operation.
SUBMITTAL REQUIREMENTS.
The application submitted to the County shall contain the following information:
1. 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.
2. 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.
3. 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.
1. Small Facilities shall comply with all applicable Federal, State (i.e. Building Codes and electrical
permits), and local laws and regulations (i.e. fire code), but are not subject to County Building
Permit.
2. Water Systems.
a. Water systems shall comply with standards set forth in section 7-705.8. Water systems must
comply with all applicable State and local laws and regulations.
b. All potable water systems must include a meter and the Operator must keep a record of the
daily usage.
C. For sites to which potable water is hauled, Operators shall:
Keep appropriate records, to be provided to the County upon request, to demonstrate
that water supplied to a site is from an approved source and that wastewater is
disposed at an approved facility.
Ii. For water facilities not permitted by the CDPHE, the Operator must conduct monthly
tests (or quarterly if an on-site disinfection system is installed) and maintain records of
potable water samples specific for coli form. Any tests indicating coli form
contamination must be disclosed to the County Public Health Department.
iii. Water systems facilities permitted by the CDPHE must obtain all necessary State permits
or demonstrate that applications for any necessary permits have been submitted prior
to a determination by the County that an application is complete.
IV. Maintain compliance with State regulations at all times during operation.
d. In no case shall unsafe water be used for drinking nor shall raw sewage or used water be
discharged onto the ground surface.
3. Wastewater Systems.
a. Wastewater systems shall comply with standards set forth in section 7-705.C. Wastewater
systems must comply with all applicable State and local laws and regulations.
b. Wastewater may be disposed of using either an OWTS or a vault -and -haul system. A vault -
and -haul system must demonstrate the following:
L Year-round access is available and maintained for safe and regular access for sewage
hauling vehicles;
ii. The Operator can demonstrate and guarantee an arrangement for hauling sewage;
iii. The Operator will maintain all records, including but not limited to, trip logs/reports and
landfill receipts;
iv. The sewage disposal records will be maintained as public records to be available to the
County upon request;
V. The facility will not exceed a cumulative of 1 year at the approved location; and
4. The facility has been designed to accommodate 75 gallons of wastewater per person per day or an
amount derived from engineered calculations taken from metered usage rates at a similar facility
that has been reviewed and approved by the County.
S. 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.
6. Wildlife -proof refuse containers must be provided for trash. Outdoor food storage is prohibited
unless facilities are provided that prevent the attraction of animals to the Major Facility site.
7. Fire Protection and Suppression.
a. Provisions for giving alarm in case of fire and fire suppression must be installed per fire codes
and as required by the fire protection district.
b. Single -station carbon monoxide alarms must be placed in each Manufactured Home or
Recreational Vehicle unit.
C. 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:
550 BBU21,000 gallons
8. Domestic animals are prohibited.
9. The Operator shall obtain a certification inspection conducted by a qualified professional engineer.
The certification shall verify that at the time of inspection the identified Small Facility meets or
exceeds the requirements of this section.
BUILDING INFORMATION (per unit)
Unit 1
Make:
Atm SW cWres in 2008
Serial Number/Unit ID #:
354085132
Division of Housing Insignia (provide copy)
Square feet if unit:
Unit 2
Make:
Ametlech Buildny Systems in 2008
Serial Number/Unit ID #:
11-100821
Division of Housing Insignia (provide copy)
Square feet of unit:
Unit 3
Make:
Serial Number/Unit ID #:
Division of Housing Insignia (provide copy)
Square feet of unit:
ONlfS PERMIT
Permit #:
I hereby attest that I am the designated Compliance Officer for the aforementioned Small Temporary
Employee Housing Facility. I attest that I have read and understand the standards to which the Facility
shall be installed and operated and that the Facility shall be constructed and maintained in
accordance with all applicable Garfield County, State of Colorado and Federal Regulations and
standards. I have read the statements above and have provided the required attached information
which is correct and accurate tgt efi yestpf my knowledge.
11/172014
Signature of Compliance Officer Date
I hereby attest that I am a Licensed Professional Engineer in the State of Colorado and that I have
conducted a visual inspection of the installed Small Temporary Housing Facility identified in this
application. Based upon my inspection, I certify that the Small Temporary Housing Facility complies
with the standards as forth above and as codified in the Garfield County Land Use and Development
Code.
PE Certification Number:
PE Stamp
See attached report
Date of Inspection:
See attached report
Name and Title:
Dave Fox, Principal Engineer
Signature
OFFICIAL USE ONLY
File Number: ___--- --- Fee Paid: $_ n/a
'VTV Fox Engineering Solutions, Inc.
670 Canyon Creek Drive, Grand Junction, CO 81507
Ph: (970) 250-5505
Email.. coloradotox@bresnan.net
Inspection Report for: GM 11-28 Small Temporary Employee Housing
Client: WPX Energy Rocky Mountain LLC
Location: NW 1/4 of Section 28, T6S, R96W, 6th P.M. Garfield County
Conducted By: David Fox, P.E.
Date Conducted: November 17, 2014
Garfield County
Paragraph Article 7-707 Land Use& Development Code (7/15/13)
Reference Characteristic or Standard Description Inspection Comments
A. Within 48 hours following occupation of the small Facility, Not subject to visual inspection and certification by third party
documentation shall be provided to the Community Development Professional Engineer.
Department, Sheriff's Office, and relevant fire
protection district(s) that demonstrates and certifles compliance with
the following standards. Notice shall also be provided to these
entities within 48 -hours following
removal of a Small Facility.
B. General information reguirements Not subject to visual inspection and certification by third party
Professional Engineer.
C. Small Facilities shall comply with all applicable Federal, State (i.e. Colorado Division of Housing certifications noted on Company
Building Codes and electrical permits), and local lawsand regulations trailer, Unit ID. 354085432 with Certification No. 19195,
(i.e. fire code), but are not subjectto County Building Permit. manufactured by ATCO Structures in 2008; and Driller's trailer,
Unit ID. 11-100621 with Certification No. 22178, manufactured by
Ameritech Building Systems in 2008. All other aspects not subject
to visual inspection and certification by third party Professional
Engineer.
Water systems shall comply with standards set forth in section 7-
705.B.
Page 1 of 3
The water system at this location is not a public water system, as
defined by the Colorado Department of Public Health &
Environment- WQCC Regulation No. 11. It is not subject to State
permitting requirements. A potable water tank with a capacity of
approximately 4000 gallons and a water meter were located at
the permitted site.
GM 11-28 Inspection
INFIX Energy Rocky Mountain LLC
E Wastewater systems shall comply with standards set forth in section
7-705.C.
F. 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.
G Wildlife -proof refuse containers must be provided for trash. Outdoor
food storage is prohibited unless facilities are provided that prevent
the attraction of animals to the Major Facllity, site.
H.1 Provisions for giving alarm in case of Ore and fire suppression must
be installed per fire codes and as required by the fire protection
district.
H.2 Single -station carbon monoxide alarms must be placed in each
Manufactured Home or Recreational Vehicle unit.
Domestic animals are prohibited.
J. The Operator shall obtain a certification inspection conducted by a
qualified professional engineer. The certification shall verify that at
the time of Inspection the identified Small Facility meets or exceeds
the requirements of this section.
Page 2 of 3
Fox Engineering Solutions, Inc.
November 17. 2014
Wastewater disposal at the permitted site will be a vault -and -haul
system. One 4000 -gallon sewage holding tank onsite. 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). Wastewatervault
equipped with overflow alarm device.
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.
Smoke detectors and fire extinguishers (ABC -rated) located in all
factory built non-residential structures. Factory -Built
Nonresidential Structures have a minimum separation distance of
20 ft. One potable aboveground water tank of approximately
4000 gallons capacity on-site. Potable water demand is estimated
to be 300 gallons/day (4 individuals x 75 gpcd). Required fire
suppression demand is 2500 gallons. Dry hydrant connection
observed on water tank.
Single -station carbon monoxide detectors located in all factory
built non-residential structures
No domestic animals observed on-site.
This inspection was conducted by a qualified Professional
Engineer licensed In Colorado and certifies compliance with
applicable standards set forth in Article 7.707 of the Land Use and
Development Code (7/15/13), as amended, that are subject to
visual inspection.
GM 11-28 Inspection
WPX Energy Rocky Mountain LLC
Professional Engineer's Attestation
Fox Engineering Solutions, Inc.
November 17, 2014
I hereby attest that I am a Licensed Professional Engineerin the State of Colorado. I attest that l army
agent have conducted a visual inspection of the Small Facility identified in this 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 7-707 of the Land
Use& Development Code (Effective 7/15/13), for Garfield County, Colorado,
PE Certification Number:
Date of Inspection:
No. 25420 (Colorado)
November 17, 2014
Print Name and Title: David J. Fox, Principal Engineer
Signature: f -'r
Page 3 of 3
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Goudle, Dylan
From: Goudie, Dylan
Sent: Monday, November 17, 2014 4:04 PM
To: 'opschief@gvfpd.org'
Cc: Reed, Gary
Subject: GM 11-28 Pad Rig Move On Notification - Fire District & County
Attachments: GM 11-28 Grand Valley Fire Letter.pdf; GM 11-28 PE Certification (11-17-14) Map.pdf
I am notifying you on the attached pad locations we will be commencing drilling operations in the next few days and
these operations will continue for approximately 75 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 28 -T6S R96W. Attached please find a map
with directions to the pad lay out and emergency contact information.
Should you have any questions please let me know.
Thanks,
Dylan Goudie
Drilling Engineer - Piceance Basin
WPX Energy- Rocky Mountain, LLC
Email: Dvlan.Goudie@waxenerev.com
Office: (970) 623-8936
Cell: (970) 319-8089
WPXENERGY.
Vel �lK I'J � II ij1�..,
IF
WPX Energy
1058 County Road 215
P.O. Box 370
Parachute, Colorado 81635
(970)285-9377
11/17/14
Grand Valley Fire Protection District
Emergency Operations
Attn: Rob Ferguson
0124 Stone Quarry Rd
Parachute, CO 81635
Pli: 970-285-9119
RE: Emergency Response Notification
GM 11-28 pad
Dear Rob:
This letter is to inform the Grand Valley Fire Protection District that WPX Energy will soon
commence drilling operations on the above mentioned drilling location. WPX will provide rig
site housing accommodations for the duration of the drilling operation approximately 75 days.
In accordance with Garfield County Planning and Zoning Regulations, the attached
documentation provides emergency response information and driving directions for the WPX
GM 11-28 pad.
Should you have any further questions or concerns regarding this notification, feel free to contact
me at (970)319-8089,
Sincerely
Dylan Goudie `
Drilling Engineer — Piceance District
Dylan.Goudici
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Goudie, Dylan
From: Goudie, Dylan
Sent: Monday, November 17, 2014 4:04 PM
To: 'jsears@garcosheriff.com'
Subject: GM 11-28 Pad Rig Move On Notification - Sheriff
Attachments: GM 11-28 GARCO Sheriff Letter .pdf; GM 11-28 PE Certification (11-17-14) Map.pdf
I am notifying you on the attached pad locations we will be commencing drilling operations in the next few days and
these operations will continue for approximately 75 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 28 -T6S R96W. Attached please find a map
with directions to the pad lay out and emergency contact information.
Should you have any questions please let me know.
Thanks,
Dylan Goudie
Drilling Engineer - Piceance Basin
WPX Energy- Rocky Mountain, LLC
Email: Dvlan.GoudiePwDxenerev.com
Office: (970) 623-8936
Cell: (970) 319-8089
WRXENERGY.
WPX Energy
1058 County Road 215
P.O. Box 370
Parachute, Colorado 81635
(970) 285-9377
11/17/2014
Garfield County Sheriff's Office
Emergency Operations
Attn: Jim Sears
108 81" Street
Glenwood Springs, CO 81601
Ph: 970-945-0453
RE: Emergency Response Notification
OM 11-28 pad
Dear Jim:
This letter is to inform the Garfield County Sheriffs Department that WPX Energy will soon
conmienee drilling operations on the above mentioned drilling location. WPX will provide rig
site housing accommodations for the duration of the drilling operation approximately 75 days.
In accordance with Garfield County Plamung and Zoning Regulations, the attached
documentation provides emergency response information and driving directions for the WPX
GM 11-28 pad.
Should you have any further questions or concerns regarding this notification, feel free to contact
me at (970)319-8089.
Sincerely,
Dylan Goudie
Drilling Engineer — Piceance District
Dylan.Goudie(a nxenergy.com
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GM 11-28
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LIMITED POWER OF ATTORNEY
WPX ENERGY ROCKY MOUNTAIN, LLC ("Company") a Delaware limited
liability company, having its principal place of business in the City of Tulsa, County of'fulsa,
State of Oklahoma, does hereby make, constitute and appoint Bryan S. Hotard with the fill
authority hereinafter provided, the true and lawful Attorney -in -Fact of the Company, authorized
and empowered on behalf of the Company and in the Company's name, and for the sole and
exclusive benefit of the Company and not on behalf of any other person, corporation or
assoclation in whole or in pan, to enter into, execute, deliver, file and accept all instruments and
documents affecting the real property or real estate rights of the Company as more specifically
set forth below: :
1. Applications and documentation associated with Garfield County or Rio Blanco
permitting requirements for including, but not limited to, Independent Sewage Disposal
Systems, Small Temporary Employee Housing, Major Impact Reviews, Limited Impact
Reviews, Oil and Gas well permitting, Driveway Access, County Road Maintommue,
Temporary Living Quarters, Temporary Use Permits, Surface Use Permits, Surface Use
Licenses, Utilities, Snow Removal and Private Construction of County Roads;
3. Agreements and other documentation that grant easements, rights of way, licenses, or
permits to Company and also instruments where the Company Stints such rights to
others;
1. Agreements that assign easements, rights of way, licenses, permits or surface leases in
connection with the Company's operations;
4. Releases and Partial Releases of easements and rights of way;
5. Agreements allowing encroachments onto easements and rights of way owned by
Company and landowner instruments and conveyances on others casements•,
6. Agreements subordinating mortgage rights to easement or lease ;
7. Agreements relating to themodiftcationand relocation ofCompany facilities;
8. Rental or lease agreements for surface use or other surface use agreements and all notices
related to die pipeline agreements;
9. Agreements for the purchase or sale of real property and for the lease of real property for
residential or commercial purposes or otherwise in connection with the Company's
operations;
10. Agreements to obtain water services, electrical, gas or oil services or the provision of
other utility services utilized by Company's facilities:
11. Agreements modifying, amending, renewing, extending, ratifying forfeiting, canceling
and terminating any and all of the aforementioned types of instruments and documents.
WPX ENERGY ROCKY MOUNTAIN, LLC hereby declares that each and every
act, matter and thing which shall be given, made and done by Bryan S. Hotard in connection with
the exercise of any or all of the aforesaid powers shall be as good, valid and effectual to all
intents and purposes as if the same had been given, made and dome by WPX Energy Rocky
Mountain, LLC in its limited liability company presence and it hereby ratifies whatsoever
Attomey-in-Fact shall lawfully do or cause to be done by virtue hereof. This Limited Power of
Attorney shall remain in full force and effect until terminated by Company.
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IN WITNESS WHEREOF, WPX Energy Rocky Mountain, LLC has caused this
Limited Power of Attorney to be signed by one of its Vice Presidents, duly authorized by its
Management Conunitiee to grant powers of attorney this V day of January, 2012.
WPX ;Prident O 1 NTAIN,LLC
By.
mes
Its:
ACXNOWLEDGMENT
STATE OF OKLAHOMA )
ss.
COUNTY OF TULSA )
BEFORE ME, the undersigned authority, a Notary Public in and for said County and State,
on this day personally appeared, Jerry D. Eames personally known to me to be the Vice President of
WPX Energy Rocky Mountain, LLC a Delaware limited liability company, who acknowledged to me
that he has executed the above LIMITED POWER OF ATTORNEY authorized by Company's
Management Committee. �/
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notary seal, the& r )
day of4aaw ry; 2012.
F&Y,Iaty wim
NotaryPublic
My Commission Expires: Z. - 23 - 2 01q
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After Recordation Please Return To:
WPX Energy Rocky Mountian, LLC
1lttn: Land Dept.
PO Box 370
Parachute, CO 81635