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( Gar.field County Community Development Department 108 8th Street, Suite 401 T·~ 11-, ,r• -... ~ Glenwood Springs, CO 81601 l~ 1 :· '. --, .. (970) 945-8212 Gt. ' . ,, ( www.garfleld-county.com JW.1 0 4 ZD1 5 ,~TY~P-E -0 -FG-RA~D-IN-G~~~~~~ L I]! MAJ_OR -·-----------Cl MINOR INVOLVED PARTIES Property Owner: See Attached Mailing Address: Contractor: TBD Mailing Address: Architect: NIA Mailing Address: Engineer: Olsson & Associates Mailing Address: 760 Horizon Dr., Ste. 102 Grand Junction, CO 81506 PROJECT NAME AND LOCATION Project Name: West Pumba Loop Phone: ( ) Phone: ( ) Phone: ( ) Phone: ( szo ) 263-ZBQQ Describe Work: Grading of ROW for installation & burial of 12" & 20" pipeline. Proposed pipeline across fee land is 12,285'. (4399' of 12" with 55' ROW, 3167' of 20" with 55' ROW and 4719' of 20" with 75' ROW.) / , 'S Mt I "ZJl /I Permanent easement will be 30' which will be reclaimed to near as pre-construction contours as possi~J:> iz.u ~ 102.-~ Job Address: T7S-R93W-Sections 7-10 Assessor's Parcel Number: See Attached Sub. NIA Lot NIA Block NIA I Earthwork (square feet): 770,055 Earthwork (Cubic Yards): NIA ALL UTILITIES MUST BE LOCATED PRIOR TO ANY GRADING I NOTICE Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or an authorized agent. If the signature below is not that of the Owner, a separate letter of authority, signed by the Owner, must be provided with this Application. Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for purposes of inspections by the Building Division. Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit, (3) another permit required for use on the property identified above, e.g. State or County Highway/ Road Access or a State Wastewater Discharge Permit. Vold Permit. A Building Permit becomes null and void if the work authorized is not commenced within 180 days of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement. CERTIFlcATION I hereby certify that I have read this Application and that the information contained above is true and correct. I understand that the Building Division accepts the Application, along with the plans and specifications and other data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming completeness of the submittals and approval of this Application, a Building Permit will be issued granting permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the I Building Division. In consideration of the issuance of the Building Permit, l agree that I and my agents will comply with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, OWTS I regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s) I and facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law. 1 I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1) requiring the correction of errors in the submittals, if any, discovered after issuance; or (2) stopping construction or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law. Review of this Application, including submittals, and inspections of the work by the Building Division do not constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the I Owner, I acknowledge that responsibility for compliance with federal, state and local laws and County Regulations rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or builder. I hereby acknowledge that I have read and understand the Notice and Certification above as well as have providrt~e required information which is correct and accurate to the best of my knowledge. r:fttJ -!'5,fv/;5 Property Owner Print and Sign Date (/ OFFICIAL USE ONLY Special Conditions: Permit Fee: (j) ¢(/-(JJ. Misc Fees: Total Fees: ~~oo Fees Paid: 0() ~400· A Zoning: Date Pipeline Grading Permit Checklist Project name/operator: lJ t3? ~\.(.,n1.~1f Project general location: Jo-"! ff 'R 11'<..L / t;fJ..1£~ fl,{~M Project acreage: fu " @3'19"'~~ ~(}t~7'>S;f) 1-e711"7o/ = 77(1DS'S"$".f=. ~ )7, 7 I U J4-'4.i/) Project length and pipe size: ~3 ?~1 2 12 ,, 7°2 'b-Ou %t-fl1. 7 B tJfi> 0 Bond Amount (must equal acreage x $2500): /7.7'1-2SO D --: 41/ 2'50 -;pel'rl /5 '91; Z.ov Weed management plan approved by Veg. Management: Property owners including federal lands with easements: ~'1u({ ~h ~ 71~ ~''lJ~ Enginee~8~~1ed plans: ~rJJ Plan set to county e~Jfr.er consultant for review: State storm water permit: D·lu Any county road cut permits needed: Nu Any land use permits needyibased~e~o~ Any Corp of Eng. wetland issu~ ft Original Bond and map to Treasurer's office: l)_ fl Copy of bond in file: CJ r ~ MaptoGIS: Other: Pending items/date: ~ Nc.nvf G arfield County Vegetation Management June 4, 2015 Andy Schwaller Garfield County Community Development Department RE: GRAD-3355 Dear Andy, The Noxious Weed Inventory and Management plan and proposed seed mlxes for this project Is acceptable . The Community Development Department has requested a revegetation security of $44,200 (17.67 acres of disturbance x $2500/acre revegetation security). The security shall be held by Garfield County until vegetation has been successfully reestablished according to the Reclamation Standards section in the Garfield County Weed Management Plan. The Reclamation Standards at the date of permit issuance are cited in Sections 4.06, 4.07 and 4.08 of the Garfield County Weed Management Plan {Resolution #2002-94). Please let me know if you have any questions . Sincerely, Steve Anthony Garfield County Vegetation Manager 0375 County Road 352, Bldg 2060 Rifle, CO 81650 Phone: 970-945-1377 x 4305 Fax: 970-625-5939 ~Liber1),: \P Mutual .. Bond Number: 022050992 LICENSE & PERMIT BOND KNOW ALL MEN BY THESE PRESENTS, that we Red Rock Gathering Company Interchange Corporate Center 450 Plymouth Road. Suite 400 Plymouth Meeting, PA 19462-1644 Ph. (610) 832-8240 ------------------------------· as principal (the "Principar), and Liberty Mutual Insurance Company, a Massachusetts stock insurance company, as surety (the "Surety"), are held and firmly bound unto Garfield County/Board of County Commissioners _______________ _ in the penal sum of Forty Four Thousand, Two Hundred & 00/100--------- -------------------------Dollars($ 44,200.00), for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has applied for a license or permit for Grading Permit -West Pumba Loop. _____ _ AFE: 2015-RRG-POR-WPUMB/CEP1 for the term beginning the 261 h day of~. 20.1§, and ending the 261h day of~. 2016, and this Bond is intended to cover the term of said License or Permit. NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if the license or permit is issued to the Principal, and if Principal shall indemnify and save harmless the Obligee from and against all loss, to which the Obligee may be subject by reason of the Principal's breach of any ordinance, rule, or regulation, relating to the above described license or permit, then this obligation shall be null and void; otherwise to remain in full force and effect. {"'~ROVIDED AND SUBJECT TO THE CONDITIONS PRECEDENT: 1. The liability of the Surety hereunder shall in no event exceed the penal sum of this bond as stated above, regardless of the number of years the bond shall continue in force. 2. This bond shall continue in force until (surety shall elect either option a orb) D a. the day of _______ , 20 ___ , or until the expiration date of any Continuation Certificate executed by the Surety. C::3 b. the Surety notifies the Obligee in writing of its cancellation of the bond. The Surety shall be relieved of any further liability under this bond thirty (30) days after receipt of said notice by the Obligee, except for defaults occurring prior thereto. 3. Any claim under this bond must be presented in writing to the Surety to the attention of The Surety Law Department at the following address: Interchange Corporate Center, 450 Plymouth Road, Suite 400, Plymouth Meeting, PA 19462-1644. Should the address of the Surety change, then notice shall be delivered by the Obligee to the Surety as directed in writing by the Surety. DATED as of this 261 h day of May, 2015. WITNESS I ATIEST LMJC-6500 Rev. 03/04 .:.> u J\.JJ ,J'-1 J J-r J'JJ 'J D £ T E E A NJ (West Pumba Loop) INVOLVED PARTIES Red Rock Gathering Company, LLC 2128 Railroad Avenue, Suite 106 Rifle, CO 81650 Phone: 970.440.1000 Fax: 970.440.1019 www.summltmldstream.com PROPERTY OWNER/MAILING ADDRESS!PHONE NUMBERS!PARCEL NUMBERS 1. Hubbell Cabin, LLC 5480 Grass Mesa Rd. Rifle, CO 81650 (970)963-0130 2. Youberg Beaver Creek Ranch 215 South 101h Street Sac City, IA 50583 (712) 662-3285 3. James L. Rose 7665 County Road 319 Rifle, CO 81650 (970) 876-5724 4. BLM CRV Field Office 2300 River Frontage Road Silt, CO 81652 (970)876-9300 2403-093-00-048 2403-073-00-001 2403-153-00-046 2403-171-00-952 2403-034-00-951 ( Garfield County PAYMENT AGREEMENT FORM GARFIELD COUNlY ("COUNlY"} and Property Owner ("APPLICANT") _________ _ _ R_e_d_R_o_c_k_G_a_t_h_e_ri_n_g_C_o_m__._p_a_ny_,~L_L_C ______________ agree as follows: 1. The Applicant has submitted to the County an application for the following Project: __ _ West Pumba Loop 2. The Applicant understands and agrees that Garfield County Resolution No. 98-09, as amended, establishes a fee schedule for each type application, and the guidelines for the administration of the fee structure. 3. The Applicant and the 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. The Applicant agrees to make payment of the Base Fee, established for the Project, and to thereafter permit additional costs to be billed to the Applicant. The Applicant 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, the Applicant shall pay additional billings to the County to reimburse the County for the processing of the Project. The Applicant acknowledges that all billing shall be paid prior to the final consideration by the County of any Land Use Change or Division of land. I hereby agree to pay all fees related to this application: Billing contact Person: Tracey Jensen Phone: ( 970 ) 440-1006 Billing Contact Address: 707 Wapiti Ave., Ste. 202 City: Rifle State: CO Zip Code: _8_1_6_50 ___ _ Billing contact Email: tjensen@summitmidstream.com Printed Name of Person Authorized to Sign: _T_r_a_c_e_y_J_e_n_s_e_n ______________ _ <{:2},g_,JL, _ _os_12_612_01_s ___ _ ' $.t"Ure) (Date) f cE Garfield County STATEMENT OF AUTHORITY Pursuant to C.R.S. §38-30-172, the undersigned executes this Statement of Authority on behalf of Red Roi:k Galh•rlna Company, LLC a Umlltd UabHlty Comp1111y (corporation, llmlted llabllltv company, general partnership, registered limited Uablllty partnership, registered limited llablllty limited partnership, llmlted partnership association, government agencv, trust or other), an entity other than an Individual, capable of holding tllle to real properly (the "Entity"), and states as follows: The name of the Entity Is Rad Rock O•lhorl1111 Company, UC and Is formed under the laws of_lh..;..a_s1'"'"111''"'"111..;..0e_rawar..;.....a _______________ _ The malling address for the Entity ls-=2-=1211=-Rll=•ro.:.:•::..d A:..:;:'le~·.:...:• 6:.;;l•~t.;.;oo ____________ _ The name and/or position of the person authorized to execute Instruments conveying, encumbering, or otherwf5e affecting tltle to real property on behalf of the Entity Is Mldlllel w. Ro•o 1111d Tracey J111 .. n The !Imitations upon the aulhorlty of the person named above or holding the position described above to bind the Entity are as follows (If no llmltatlons, Insert "None"): •lfll•wm1•1'1'1 .... ,......,,.,...1u ... 11111111oNeoun11. Other matters concerning the manner In which the Entity deals with any Interest In real property are (If no other matter, leave lhls section blankJ: _________________ _ EXECUTED this /;f ~ay of -tM rlitJt ~gnature:~ Name (print . · Tltle(llany):? ?-;= STATEOF ~ ) )SS. COUNTVO~ ) T~e~. ''i"'·'":'.l'"mentwas acknowledged before me thb~1!£i 20~ cr~~-£e~y .. on behalfof ~-~-Wl8N'i, U.C.1 Witness my hand and offlclal,g,e~I. A My commission expires: "'~ _ :JIJ I ::t: Date) JESSICA lVNIU.RWIN ~ Notary Public, lf\li~.bfT11111 My Commlulon ExplrH May 01, 2014 Legend •••• PROPOSED PUMBA LOO P PIPELINE (19,309' +/·) Wasatch Surveying Associates 906 Main Streel E von$1Dn. Wyomm;; 8 l ?30 Phone No (3 07) 789-4545 Fax (307) 78•).)?2~ 0 0 .,, N iii Ill 0 LI.. .,, 5 N Ill ~ ~ (J) 0 Summit Midstream PROPOSED PUMBA LOOP PIPELINE SECTIONS 7, 8, 9 & 10, T7S, R93W, 6th, P.M. GARFIELD COUNTY, COLORADO PROJECT No 14·12.07 1 VICINITY MAP DATE 12/3012014 SCALE 1inch=2,500 feet oft I • I SE l/.f HEI/./ ' 1/f C4-7t..,. - ----i/f S4tCUCt) r~f ------ -- - - -- - - - - -z~ I , I I ~ I I °"'"' rot/{j!/IC eE~ICil Cfi({J( liA.llOt P~ l/o: UOJ-QlJ-00-001 ............. ~~ : ~~CT l o,,y 8 -- - --------- - -~f/11!) L.."'•--- ------- ®~ I o~ . ~ I ~ "' i ~ a: i I I I I I I I __......v-- 1 I I r I I I I I I I I l I I I I I I I -A~-~.__~¢'~ P.0.8. PIPELINE s unCN O•OO ~ I .tr E JrSTlffG "'°)i f'lnLINI! FUNGI! ,jj HEl/-1 .SE 1/--1 -I I °"""' ltlJl1tl;C E!ALfR c;l((I( R'ANC11 l'=d II~· 1101-0l.J 00-001 l Sec/ion 7 "" l•o?.u I 77S lr9.JIY l't: •••S.z.t I l't: 1•11.I• I ,.Ah~oo J ~·.,,,.,.,_.. I se =\"'t_..' : !l~ll~"_.. 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T7S R93W 1375.55 CREEK RANCH Sec. 8. T7S R93W 302J.57 4399.12 Sec. 8, T7S R93W 2753.73 BUREAU OF LAND Sec. 9, T7S R93W 3381.61 7023.74 MANAGEMENT Sec. 10. T7S R93W 888.40 HUBBELL CABIN LLC Sec. 9, T7S R93W 1327.88 1327.88 JAMESLROSE Sec. 9, T7S R93W Sec. 10, T7S R93W 3171.84 3386.48 6558.32 Tola/ 19309.06 NOTES: -50' x 50' VALVE YARD SITE LOCATED ON YOUBERG BEAVER CREEK RANCH PROPERTY NEAR STATION 0+00 -100' x 100' VALVE YARD SITE LOCATED ON BUREAU OF LAND MANAGEMENT PROPERTY NEAR STATION 104+60.111 PPE BE/\D TABLES ANGUPOINr STATION PJPEBEND P.I. 3&+M 7.!l"LT r.t. eEGINP IPE 00.00 P.I. SS.74 10.J" lT Pl. P.I. 01+15 4 .rLT '-1. 41+.42 H'RT P.I. P.I. Olt4J 14.!rRT u. 42•39 4.9'lT P.I. P.I. Ol+l!9 25.J'RT P.I. 4.l+A 24.7'lT ,J, P.I. 03+32 17.rAT P.I. 4J•2l J.7'LT l".I. PJ. OJ+91 9.S"RT P.I. 46>21 1'.7' lT P.I. PJ. 114+65 $4.,.RT P.l 47+115 lO.t"RT ,_ .. P.I. 115+30 M.rLT P.I. .... si 4.7'lT P.I. 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UNDDICROUNO U'llJll£$ WER£ lOCAlm USlHG A PIP£ L.DCA TClt, MO IJME$ -ElCP05[1). llOtFOlt(, l!NE LOCATIONS MAY VAAY FllOW lHOSt SH01IN OH~ DRA'MNCS. txtREME CAUTION SHOUUI llE usm 'M€H CRQSSll!G OR CCllllNG ClOSE TO ntESt [lQSIJIC IJllE:S Cl\IRING CCNSTllllCTION. lH£llt 1$ NO WAA!IAHTY, DCPfltSSDI OR lllf'lD, BY SWlllT UIDSlREAM PARllltRS. U'. GllAICI Rl\O CAntERINC. l.lC, OR WASAltH ~C AS TO nit: COUl'l!1tND5 OR EXACT UlCA TIOH CF [lQS11NC U'llJMS. 2. Pll'ElJNE IHRlRllAllON NG SUIW:T DATA PftOW>ED llY WASAltH --IACICGR<IUHO INFCllMATIOH PROVl0£D 8Y WASAltH U~ H'als.IATIOH ,._OED llY WASA101 SUll~C WAS ~ 9Y Q.SSOH ASSOOA TD. l fOGE OF WORKSPACE_/ I (TYPICAL) I I NtJ't":JON·1v, 259.J..29 D9tJHAC£ Qmi!irNG$ orp1J!11q ttgc12 IHSUU. COFRJI JM UPS1ll£All Cl CllOSSINQ, Dl\CISIOll ll[1)lOO SHAU. BE SIZED APPR<l'RIAID.Y TO CONVEY 1HE fl.OW CF TllE mCH. 1 Tve8tH'SO"IY. 25fl1 J.j *"' z~ o~ V>o V>: -1~ 0 I ! ~ 6 .... ~ .... l.llSTM UTUfT 1.0CAnoN• CtCJIUQi!TM.Olll\OftCAU. 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CClllTllAC!OR 'II) FUD \VIFY DOS1llC CIJl.i,mT rOR Pl.ACDIENT OF M.tT/OU1\£T Pfl01tC1lGrt I N ' ~ 100' 200' ~ SCAU: IN fttT ® "' I z~ o~ I V>o i V>"' ..J: £! 0 16 v, J-JS 11 d ,, •M)~'°" Ult1'Mvturr LCCAT1CNI I tom*TM.Olll~ncAU." p~unmn~ON lHIDM....OtM."' ... ~"'°"nc•n A~N'CRMnDllJffl torlW'.UllMN~ OID9~TOnllb \UW'l' nc LOCATOtOI A&&. U'fUNl...,..TOnc ~"'"',.,,, --below. can ..... ,. ... ,I c.io. •n tllUIT'f·1"1G IO.llt• I ""°'TQ~~°' IDU\M,_ PClll "4 llWID40I !M!Tlwt ..... ~· i I ~ h .., z a. :5 ::t ...I a.. a. -~ :c Cl) -.... a:: Cl) '° ~ w w a: . zzws:o -1-....,.., ....l~<°'o ~a.~~~ ~:;;~i::g Oi:J1-0 0 Oo::Cl)"jU ...I I-z ...... . ~~s~~ :5 :iE g Q ::J a. I:: !!= b 8 ::t Cl) w Cl :iE z Cl) ..J :J 0 w Cl) (.) u: __ ..,. AA -.. -....... ~ ~· ---!'.!.!!.... .... ....: 01 ... 1' ......... .:---'* 11,..,.1• ~ ~:I ~"I ... i~ SHEET QQ 9 ( ( -3u1'.JJ J'.J J J-r NJ l D £ T ;~ E 1-~ J~J May 26, 2015 Attention: Andy Schwaller Garfield County Community Development Department 108 Eighth Street, Suite 401 Glenwood Springs, CO 81601 Re : Grading Permit West Pumba Loop Dear Mr. Schwaller: Red Rock Gathering Company, LLC 707 Wapiti Avenue, Su ite 20 2 Ri fle, CO 81650 Phone: 970.440.1006 Fax: 970.440.1312 In association with Red Rock Gathering Company's Grading Permit Application Submission, this letter shall serve as notice that Grand River Gathering will comply with all of the terms and conditions associated with rights to lay one or more pipelines as set forth in the below listed documents. Document Type Date Grantor Recording Data Right-of-Way Easement 03/11/15 Hubbell Cabin LLC 860221 Right-of-Way Easement 03/11/15 Beaver Creek Ranch 860222 Right-of-Way Easement 04/09/15 James l. Rose 861304 Right-of-Way Grant 05/19/15 BLM COC77059 Copies of the foregoing documents have been provided to Garfield County with the submittal of the Grading Permit Applicati on. Sincerely, Red Rock Gathering Company, LLC