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HomeMy WebLinkAbout1.0 ApplicationGARFIELD COUNTY Building and Planning Department 108 8 to Street, Suite 401 Glenwood Springs, Colorado 81601 Telephone: (970) 945-8212 Facsimile: (970) 384-3470 www.garfield-county.com HUV 30 2011 E Small Temporary Employee Housing Administrative Checklist GENERAL INFORMATION - Submit 1 paper & 1 CD copy of the completed application to Planning Department Win 48 hours following occupation (To be completed by the Small Facility Operator - e.g. well pad operator) Section/Township/Range Location of Housing Site: Sec 8-T6S-R91W Well Pad Number: KP 24-8 Tax Parcel Number for Parcel Containing Housing Site: 2181-172-00-086 GPS and/or Lat-Long Coordinates of Housing Facility Site (Often included in APD): Lat:39.535521 Long: -107379600 Zone District: Rural Maximum Number of Occupants at Permitted Site (e.g. well pad): less than 8 Cumulative Amount of Time (in Days) The Facility Will be at Location: 60days State or Federal Permitting Agency Overseeing Reclamation, Restoration and Revegetation and Relevant Permit Number: COGCC 400175514 Date of Installation: November 29th, 2011 Date of Removal: January 29th, 2012 Name of Landowner: Jolley, Richard & Mary Family LLLP Street Address: 1288 County Road 245 Telephone: (970)379-6669 Email: City: New Castle State: CO Zip Code: 81647 Name of Operator's Compliance Officer: Williams Production RMT Company LLC Bryan S. Hotard Street Address: PO Box 370 Telephone: 970-285-9377 ext 2754 Email: Bryan.Hotard@william s.com City: Parachute State: CO Zip Code: 81635 Company 24 -Hour Emergency Contact: Williams Production RMT Company LLC Phone Number: 970-285-9377 This Administrative Cheddist must be received by the Garfield County Planning Department hours following occupancy of the Small Facility. within 48 be delivered to within 48 hours Office and or verified is the Operator's been received by A copy of this completed Administrative Checklist and all associated submittals shall the Garfield County Sheriffs Office and relevant Fire Protection District (if applicable) following occupancy of the Small Facility. Additionally, the Garfield County Sheriffsreceipt) relevant Fire Protection District (if applicable) must be notified in writing (return email (return receipt) within 48 hours following removal of the Small Facility. It 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: 500BBL121,000 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 (D)(3) — All Requirements Must be Satisfied to be Eligible as a Small Facility Applicant Planning Department Complies (Y/N) Complies (Y/N) The Small Facility and any associated infrastructure must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission (COGCC) approved oil/gas well pad) in which reclamation and revegetation are secured with the permitting agency (Permitted Site); and, YES 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 The Small Facility shall have an occupancy of eight (8) or fewer people within a Permitted Site (e.g. well pad) who are employees, contractors or sub-contractors of the operator of the small facility and are needed for onsite safety of the related commercial, industrial, extraction or highway operation. Temporary employee housing facilities that do not have the three characteristics listed above, or consist wholly or in part of Recreational Vehicles as defined above, are subject to the administrative permit requirements or the Major Impact Permit process, standards and requirements contained in this document. YES 3 Building Information (Per Unit) Unit 1 Make: ATCO Structures (USA) Inc Serial Number or Unit ID Number: 354085622 Manufacture Year: 2008 Size of Unit (Square Feet): 14X56 Unit 2 Make: ATCO Structures (USA) Inc Serial Number or Unit ID Number: 354063605 Manufacture Year: 2006 Size of Unit (Square Feet): 14X56 Unit 3 Make: Serial Number or Unit ID Number: Manufacture Year: Size of Unit (Square Feet): Unit 4 Make: Serial Number or Unit ID Number: Manufacture Year: Size of Unit (Square Feet): Unit 5 Make: Serial Number or Unit ID Number: Manufacture Year: Size of Unit (Square Feet): ISDS Permit ISDS Permit Number: SEPT-11-11-2272 Signature of Operator's Compliance Officer: , lIF if' ( By signing this form, I verify that all informati the best of my knowledge) Print Name: Bryan S. Hotard provided i this checklist is correct and accurate to Title: Attorney-In-Fact 4 Eligibility, Submittal and Performance Standards Certification Section 7-808(D)(3) - Small Temporary Employee Housing Facilities (Small Facility(ies)) in Article VII — Standards, requires the that the following performance standards be met with each facility: Small Facilities, in the nature of Factory Built Nonresidential Structures [as defined under C.R.S. 24-32-3302(a)] but NOT recreational vehicles [as defined under C.R.S. 42-1-102 (61), including truck, truck tractor, motor home or camper trailer], may be utilized for housing of workers on projects related to commercial, industrial, mineral extraction or highway operations, pursuant to the standards for Small Facilities contained in sub- section (2), below. Such facilities are not subject to Garfield County building and fire codes (building code, fire code). However, Small Facilities are subject to all pertinent state (i.e. electrical permits), federal permits and relevant fire protection district(s) code requirements. Small Facilities shall have all of the following basic characteristics: A. The Small Facility and any associated infrastructure must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission (COGCC) approved oil/gas well pad) in which reclamation and revegetation are secured with the permitting agency (Permitted Site); and, B. The Small Facility is located at the Permitted Site for less than a cumulative of one (1) year and at the end of the utilization period, all structures, foundations and associated infrastructure are completely removed; and, C. The Small Facility shall have an occupancy of eight (8) or fewer people who are employees, contractors or sub -contractors of the operator of the small facility and are needed for onsite safety of the related commercial, industrial, extraction or highway operation. Temporary employee housing facilities that do not have the three characteristics listed above, or consist wholly or in part of Recreational Vehicles as defined above, are subject to the administrative permit requirements or the Major Impact permit process, standards and requirements contained in this document. The Small Facility shall adhere to the following Standards: All required submittals (as outlined in (2), above) shall be submitted to the Planning Department within 48 hours following occupation of the Small Facility. Enforcement shall be in accordance with this Resolution. The Small Facility shall demonstrate and certify compliance with the following standards: A. Small Facility must comply with all applicable federal, state and local laws and regulations. B. The Small Facility shall NOT contain recreational vehicles as defined in Section 7- 808 (D). 5 C. In no case shall unsafe water be used for drinking nor shall raw sewage or contaminated water be discharged on the ground surface. The operator shall conduct monthly tests (or quarterly if an on-site disinfection system is installed) and maintain records of stored potable water samples specific for coli form bacteria. Any tests indicating coli form contamination must be disclosed to the Garfield County Board of Health or designee within 72 hours from the time the contaminated water was tested. D. Each Small Facility shall be maintained in a clean, safe and sanitary condition, free of weeds and refuse. Any hazardous or noxious materials that must be stored at the Small Facility for operational or security reasons must be managed in accordance with all applicable federal, state and local laws and regulations. E. At least one thirty (30) gallon (4 cubic feet) wildlife -proof refuse container shall be provided for each Factory Built Non -Residential Structure unit. Said container(s) must be durable, washable, non-absorbent metal or plastic with tight -fitting lids. F. Refuse shall be disposed of weekly, at a minimum. Operators must keep appropriate records, to be provided to the County or any interested third party upon request, to demonstrate that refuse is collected in a timely fashion and disposed of at a licensed facility. G. Outdoor food storage is prohibited. H. Factory Built Non -Residential Structures equipped by the manufacturer with a fire sprinkler system, fire detection system, and/or alarm system shall be inspected, tested, and maintained in accordance with the requirements of the relevant fire protection district(s) and the Colorado Division of Housing. I. Single -station carbon monoxide alarms shall be placed in each Factory Built Non - Residential Structure. J. One (1) or more approved fire extinguisher(s) of a type suitable for flammable liquids, combustible materials and electrical fires (Class ABC), or dry chemical, shall be located in each Factory Built Non -Residential Structure and placed in accordance with applicable fire protection district and/or Colorado Division of Housing codes. K. Domestic animals are prohibited at all Small Facilities. L. A water storage tank is required to provide water to the sprinkler system (if applicable) and initial suppression activities. The size of the water tank shall be determined based on sprinkler calculations and initial suppression demands. The relevant fire protection district shall be responsible for determining the size of the water storage tank. If the Small Facility is not within a fire protection district, the Operator shall provide at least 2500 gallons of water dedicated to initial fire suppression which is accessible with a dry hydrant within each Permitted Site for a Small Facility. M. The operator shall document all emergency situations requiring action by any government agency or fire protection district, in writing, and such documentation shall be presented to the Planning Department within 24 hours of the occurrence. N. All required Access Permits shall be obtained from the Garfield County Road and Bridge Department or the Colorado Department of Transportation. 6 O. The Garfield County Sheriffs Office and relevant fire protection district(s) shall be notified and provided with all documentation as outlined in these regulations, within 48 hours following occupation of each Small Facility. In addition, the Garfield County Sheriffs Office and relevant fire protection district(s) shall be notified either by hard -copy or electronically within 48 hours following removal of all Small Facilities. The Planning Department shall be copied on all such notification, whether hard copy or electronic. P. The Operator shall maintain records identifying workers, whether employees, contractors or sub -contractors, and document the dates that each worker is housed at the Small Facility. Such records shall be provided to the County or any additional third party upon request. Q. The Operator shall obtain a certification inspection conducted by a third -party Professional Engineer Licensed in the State of Colorado. The certification shall verify that at the time of inspection the identified Small Facility meets or exceeds the standards set forth in Article 7.808 D. 2. of the Garfield County Land Use Code of 2008, as amended. This certification shall be on forms provided by the Garfield County Planning Department. The certification shall be provided to the Garfield County Planning Department within 48 hours following occupation of the Small Facility. R. The Operator shall accurately complete all required forms provided by the Garfield County Planning Department identifying the location of the facility (Section/Township/Range, relevant Tax Parcel Number, and GPS coordinates or Latitude/Longitude coordinates); relevant zone district; maximum number of occupants; cumulative amount of time (in days) that the Small Facility will be at the specified location; identification of the State or Federal permitting agency overseeing reclamation, rehabilitation and revegetation of the Permitted Site and relevant permit number; date of installation; date of removal; name and contact information of the landowner; name and contact information of the Operator's Compliance Officer; 24-hour emergency contact information for the Operator; building information (make, manufacture year, serial number, size (square feet)); signature and contact information of the Operator's Compliance Officer. S. Wastewater Disposal: 1) Vault System: All vault systems shall be designed and installed to accommodate the maximum number of persons (eight or Tess 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 (D) (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: Print Name: Bryan S. Hotard Title: Attorney -In- Fact Phone Number: 970-285-9377 ext 2754 Email: Bryan.Hotardawilliams.com Bob.CaughlinQwilliams.com 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 Summary Date of Inspection See Summary Print Name and Title: David Fox of Fox Engineering Solutions Signature See Form 8 Inspection Report for: Prepare for: Location: Conducted By: Date Conducted: Paragraph Reference Fox Engineering Solutions LLC 670 Canyon Creek Drive, Grand Junction, CO 81507 Ph: (970) 250-5505 / Fax: (626) 784-0667 Email: coloradofox@bresnan.net KP 24-8 Well Pad - Small Temporary Employee Housing Williams Production RMT SE 1/4 SW 1/4 of Section 8, T6S, R91W, 6th P.M. Garfield County David Fax, P.E. November 28, 2011 Garfield County Article 7-808(D)(3) Land Use Resolution 2008 Characteristic or Standard Description 3.a. 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.5. 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. 3.a.(1) 3.a.(2) 3.a.(3) 1 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, 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 regulations. 2 The Small Facility shall NOT contain recreational vehicles as defined in Section 7-808 (D). Page 1of5 Inspection Comments Colorado Division of Housing certifications noted on Company trailer, Unit ID. 354085622 with FBNR Certification No. 19043 manufactured by ATCO Structures USA, Inc. on 01-17-2008; and Driller's trailer, Unit ID. 354063605 with FBNR Certification No. 21939 manufactured by ATCO Structures USA, Inc. on 12-20-2006. Ail 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. KP 24-8 Inspection Fox Engineering Solutions LLC Williams Production RMT November 28, 2011 3 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. 4 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. 5 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. 6 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. 7 Outdoor food storage is prohibited. 8 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. 9 Single -station carbon monoxide alarms shall be placed in each Factory Built Non- Residential Structure. 10 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. 11 Domestic animals are prohibited at all Small Facilities. Page 2 of 5 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 non- residential structures. Colorado Division of Housing (CDH) compliance tags on all factory built non- residential structures stating compliance with nonresidental construction standards of the 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. KP 24-8 Inspection Fox Engineering Solutions LLC Williams Production RMT 12 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. 13 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. 14 All required Access Permits shall be obtained from the Garfield County Road and Bridge Department or the Colorado Department of Transportation. 15 The Garfield County Sheriffs 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. 16 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. 17 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 November 28, 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. of the Garfield County Land Use Code of 2008, as amended, that are subject to visual inspection. KP 24-8 Inspection Fox Engineering Solutions LLC Williams Production RMT November 28, 2011 18 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, 19(a) 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: 19(a)(1) Demonstrate that year-round vehicular access is available and maintained for safe and regular access for sewage hauling vehicles. 19(a)(2) 19(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. 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 ISDS 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 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. KP 24-8 Inspection Fox Engineering Solutions LLC Williams Production RMT November 28, 2011 1 hereby attest that 1 am a Licensed Professional Engineer in the State of Colorado. l attest that 1 have conducted a visual inspection of the Small Facility identified in this Administrative Checklist, as installed, and, based on information from that inspection l 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 Date of Inspection: November 28, 2011 Print Name and Title: David J. Fox, Pincipal Engineer Signature: --1 tr- Page 5 of 5 PE Stamp Williams Production RMT KP 24-8 Well Pad r a 8. Ru/a I -- ACCESS DE50mPnON: FROM TNE,NTERSEGTGN OF COLORADO INTERSTATE 70OVERPASS IE,n STI AND RIVER FRONTAGE ROAD SCAR{ OF SILT COLORA00. PROCEED EAST _OR RILES ALONG RNER FRONTAGE ROAD TO THE INTERSECTION 'ANN COUNTY 8000 7111 I10.70E CREI]r ROW, PROCEED ALONG DIVIDE CREEK ROAD ES -1 MLLES TO THE INTERSECTION WRO n DIRT/GRAvEL ROAD IMain PROF -EEC LER IN AN rasTCRLY DAC -Mos et o NILES To A r9UR.0Av INTER1CCTION pgOCEr.O sTRUJGNT IN A NORTHEASTERLY DIRECTION UP ARIEL 10! MILES TO AN M1ERSECTON 0111)1 A OINT1GRAVEL ROAD PROCEED LEP; IN 5 NORTHERLY DIRECTION rib MVO 70714E 65157INO 6! Alt DRILL RAO LOQ TICK AT nip TOP OF THE MESA, A5 SHOWN NERE0IL BOOKVJ.F! 1 Sir Serbirrs. Arne. scALF onstruction •laa repared for: Mims Production, RMT KP24-R- Plat 5 ACCESS READ MAP Directions to Site. S1nUen k T nS. 951 1P Ar Om Om ,...-... ,. Apponimale Drill Rig & Equipment Area AoproAr400 r Awe Amin., ExR1 TRn r BOOK.eIll I ` Surrey Services. fo-. Identification & Location Kev 1. Wastewater Aboveground Tank (4000 gal.) 2. Potable Water Aboveground Tank (4000 gal) 3. Three Portable Toilets 4, wildlife -proof dumpster 5. Company Man Office/Housing 6. Drillers Inc lousing 7. Shed ' Subject to relocation for construction activities. REVISED I//9/Ir Construction Plan Prepared for: ocur l•- 1L0 peri n. Williams Production, RMT nAT' Pr(yrt'T 1CP24 Jl Pn14 DRILL RIC 9.1 POUT Emergency Contact List - Main Office: 970-285-5377 answered 24 Hours Bob Gaughan- Williams Drilling 070-589.0673 Cell Scott Brady- Williams Drilling Sup•970-270-9187 Cell Kevin McDermott- Williams Safety -970-309-1195 Celt Mark Mumb5 - Spill Contractor 875-200-1516 Gel] Williams, Notes: The well pad site is located in the SEV4 SW 114 of Section 8, T6S, R91 W, 6th P.M. (NAD83 1439.5355° W107.57981 The site will temporarily office and house up to a maximum of four individuals during natural gas drilling activities and is expected to be completed in one year or fess- The individuals will occupy two individual trailer offices/houses located on the well pad- Office/houses have Colorado Division of Housing compliance tags. 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 tank needs to be emptied approximately every 13.3 days {4000 gallons / 300 gallons per day). Wastewater vault equipped with overflow alarm device- Williams utilizes the services of a licensed contractor to remove and haul the wastewater to a State certified treatment/disposal facility. One potable aboveground water tank of approximately 4000 gallons capacity on-site. Potable water demand is estimated to be 309 gallons/day (4 individuals x 75 gpcd). Required minimum 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 hydrants observed On water tank. Road access to the site is maintained year-round through the services of private road maintenance and construction contractors. Base mapping by Bookcliff Survey Services, Inc. Site features including housing trailers, water 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 subject to change. Factory•Built Nonresidential Structures (Office/Housing) have a minimum separation distance of 28 ft. KP24-8 Site Plan Garfield County, Colorado Small Temporary Employee Housing and Septic Permit Application Applicant: Williams Production RMT Date: November 28, 2011 Checked: 11,1E Fox Engineering Solutions LLC 670 Canyon Creek Orive. Grand Junction, CO 61507 Ph: (870)250-55051 Fax: (620) 784-0607 Erred) calaradotaa@bresnan.nel Version: 001 Nif GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT FEE SCHEDULE Garfield County, pursuant to Board of County Commissioners ("Board") Resolution No. 98-09, has established a fee structure ("Base Fee") for the processing of each type of subdivision and land use applications. The Base Fee is an estimate of the average number of hours of staff time devoted to an application, multiplied by an hourly rate for the personnel involved. The Board recognized that the subdivision and land use application processing time will vary and that an applicant should pay for the total cost of the review which may require additional billing. Hourly rates based on the hourly salary, and fringe benefits costs of the respective positions combined with an hourly overhead cost for the office will be used to establish the actual cost of County staff time devoted to the review of a particular project. Actual staff time spent will be charged against the Base Fee. After the Base Fee has been expended, the applicant will be billed based on actual staff hours accrued. Any billing shall be paid in full prior to final consideration of any land use permit, zoning amendment or subdivision plan. If an applicant has previously failed to pay application fees as required, no new or additional applications will be accepted for processing until the outstanding fees are paid. Checks, including the appropriate Base Fee set forth below, must be submitted with each land use application, and made payable to the Garfield County Treasurer. Applications will not be accepted without the required application fee. Base Fees are non-refundable in full, unless a written request for withdraw from the applicant is submitted prior the initial review of the application materials. Applications must include a Payment Agreement Form ("Agreement") set forth below. The Agreement establishes the applicant as being responsible for payment of all costs associated with processing the application. The Agreement must be signed by the party responsible for payment and submitted with the application in order for it to be accepted. The following Base Fees shall be received by the County at the time of submittal of any procedural application to which such fees relate. Such Base Fees shall be in addition to and exclusive of any cost for publication or cost of consulting service determined necessary by the Board for the consideration of any application or additional County staff time or expense not covered by the Base Fee, which have not otherwise been paid by the applicant to the County prior to final action upon the application tendered to the County. GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT BASE FEES TYPE OF LAND USE ACTION BASE FEE Vacating Public Roads & Rights -of -Way $400 Sketch Pian $325 $675 + application agency review fees and outside Preliminary Plan / Conservation Subdivision consultant review fees, as authorized pursuant to the Regulations, such as the Colorado Geologic Survey Preliminary Plan Amendment $325 Final Plat $200 Final Plat Amendment / Correction Plat $100 Combined Preliminary Plan and Final Plat $1,075 Minor Exemption / Amendment $300 / $300 Major Exemption / Amendment $400 / $300 Rural Land Development Option Exemption / Amendment $400 / $300 General Administrative Permit $250 Floodplain Development Permit $400 Pipeline Development Plan / Amendment $400 / $300 Small Temporary Employee Housing $50 Minor Temporary Employee Housing $250 Limited Impact Review / Amendment $400 / $300 Major Impact Review / Amendment $525 / $400 Rezoning: Text Amendment $300 Rezoning: Zone District Amendment $450 Planned Unit Development (PUD) / Amendment $500 / $300 Comprehensive Plan Amendment $450 Variance $250 Interpretation $250 Takings Determination NO FEE Planning Staff Hourly Rate • Planning Director $50.50 • Senior Planner $40.50 • Planning Technician $33.75 • Secretary $30.00 County Surveyor Review Fee (includes review of Amended Determined by Surveyor$ Plats, Final Plats, Exemption Plats) $1 1 — Mylar Recording Fee st $10 each additional page Page 2 The following guidelines shall be used for the administration of the fee structure set forth above: 1. All applications shall be submitted with a signed Agreement for Payment form set forth below. 2. County staff shall keep accurate record of actual time required for the processing of each land use application, zoning amendment, or subdivision application. Any additional billing will occur commensurate with the additional costs incurred by the County as a result of having to take more time that that covered by the base fee. 3. Any billings shall be paid prior to final consideration of any land use permit, zoning amendment, or subdivision plan. All additional costs shall be paid to the execution of the written resolution confirming action on the application. 4. Final Plats, Amended or Corrected Plats, Exemption Plats or Permits will not be recorded or issued until all fees have been paid. 5. In the event that the Board determines that special expertise is needed to assist them in the review of a land use permit, zoning amendment, or subdivision application, such costs will be borne by the applicant and paid prior to the final consideration of the application. All additional costs shall be paid prior to the execution of the written resolution confirming action on the application. 6. If an application involves multiple reviews, the Applicant shall be charged the highest Base Fee listed above. 7. Types of "Procedures" not listed in the above chart will be charged at an hourly rate based on the pertinent planning staff rate listed above. 8. The Planning Director shall establish appropriate guidelines for the collection of Additional Billings as required. Page 3 GARFIELD COUNTY BUILDING AND PLANNING DEPARTMENT PAYMENT AGREEMENT FORM (Shall be submitted with application) GARFIELD COUNTY (hereinafter COUNTY) and Jolley, Richard & Mary Family LLLP Property Owner (hereinafter OWNER) agree as follows: 1. OWNER has submitted to COUNTY an application for KP 24-8 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 AUT! RIZED REPRESENTATIVE) ,/ASignat Date Bryan S. Hotard Print Name Mailing Address: Williams Production RMT Company LLC PO Box 370, Parachute, CO 81635 Page 4 Bonuales, Gia From: Bonuales, Gia Sent: Tuesday, November 29, 2011 3:58 PM To: 'jsears@garcosheriff.com'; 'Vola Mercer; 'Julie Taylor' Cc: Reed, Gary Subject: KP 24-8 Rig Move On Notification Attachments: KP 24-8 Sheriff Letter & Map dated 11-29-11.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 will notify you of the removal of the Employee housing. This notification is per the GARCO Regulations for our pad located in Sec 8- T65-R91W. Attached please find a map with directions to the pad, a pad lay out and emergency contact information. Should you have any questions please let me know. �i BOnUl:&&R$ Land Data Technician I Williams Production RMT Company LLC 1058 County Road 215/PO Box 370 Parachute, Co 81635 970.263.2746 -Office 970.216.8537 -Cell 970.285 -2047 -Fax gia.bonuales@williams.com 1 November 29t, 2011 Garfield County Sheriffs Office Emergency Operations Attn: Jim Sears 108 8th Street Glenwood Springs, CO 81601 Ph: 970-945-0453 RE: Emergency Response Notification KP 24-8 pad Dear Jinn: Williams® Williams Production RMT Company LLC 1058 CR #215 P.O. Box 370 Parachute, CO 81635-0370 970/285-9377 970/285-9573 fax This letter is to inform the Garfield County Sheriff's 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 information and driving directions for the Williams KP 24-8 pad. Should you have any further questions or concerns regarding this notification, feel free to contact me at (970)263-2754. Bryan S. Hotard Field Land Team Lead-Piceance District gb Williams Production RMT KP 24-8 Well Pad .0001S 0050SafON: rRDLL 133E arrxrRSlcn1N OF raL08A001N1f.RSTATE mouErm•ss rEn,r1 Allo RIVER rat. -Ace 00.0 SOD, fF Ski COLORADO_ PROCEED €A ell• raLES ALONG Riven VR°NTAOE ROAD TO ',AD l$TERSECTrorl MITI [MITT ROT03,1RO:vme MEEK ROAM_ PROC'-^AMO40 Dh106 CREEK A040 ma 1Y1,Es TO THE RSECT:p13:m33 A DiRoGRA`EL ROAD rM£ir Gantt RROcrrCLER MMI 13511 1 006Cn0N ♦R LIMITS TO ArnYR.o*TknrRereelon PROM' on %near NA ISYnIEASTERI0 DRECTO. W A NM JO 4•11.40 To 40 JoTeneecdo4 3.:733 A IxRI eRAvSL ROA° Tmodee0 L43071 AnRn.ER:,v 1IRECTl0I .: 014315 TO TNf. freleIC en TA8ORAL Pn0LOf4T10r1 AT TN: TOP - -Nr RASA AS ancon ADRE036 \ ' !inn, o-, o s. hat. ofiaVMetiOn tan repared ot: WAftams Production. RMT oar 17,11J1,7 „y1,,,m ,1 Directions to Site - Apy0.omate Dnll Rtg 6 Equipment Area .• Etti eon Lem DoluTano r . 1 Can Two Muth.' M.* 1! + P1m.reEAmis1r! r.,,: BOOTCCLIFF , ` S'rurnry5irt•irer, !er. Identification 6, Location Kev' 1 Wastewater Aboveground Tank (4000 gar.) 2. Potable Willer Aboveground Tank (4000 gal) 3. Three Portable Toilet, 4. WIIOde-propl dumpster 5. Company Man Off:e&Housi g G Dnllers Ottice/HDvvnq 7- Shea Subject to reI002INn for construe: on activities. RENSPJI SCA, Mfr nx Amoco ..,.• Conolructxon Nan Prepared for: Willems ProductIOn, RMT RN VI71 Mat 4 /MAI. RH: IA mirrr Emergency Centact List' Mon Office 970.265.9377 Answered 24 lTOTATS Bob CaLgMm- Wilkens Ontbrg 970-5890673 Co Scott Brady- William, Dolling Sup -970-270-9187 Cee Kevin M1Dermon- Wa:ama Safely -970.309119.5 Mark Mumby - 5911 Contractor 970-260-1576 Cell it W/Ilula S.. &ties: The well pad site is located in the SE 114 SW 114 of Section 8. T6S. R91 W, 6th P,141. (NAD83 N35.5355° 71107.57581 The s4e will temporarily office and house up to a maximum of four individuals during natural gas drilling activities and Is expected 10 be completed in one year or less The individuaIs will occupy two individual (railer offices/houses located on the well pad. Office/houses have Colorado Division of Housing compliance tags. One aboveground sewage holding tank with 4000 -gallon capacity on-site. Sewage flows estimated to be 300 gallonslday (4 individuals x 75 geed). Sewage holding tank needs to be emptied approximately every 13-3 days (4000 gallons f 300 gallons per day)- Wastewater vault equipped with overftow alarm device. Williams utilizes the services of a licensed contractor to remove and haul the wastewater to a State certified treatment/disposal facility. One potable aboveground water tank of approximately 4000 gallons capacity on-site. Potable water demand is estimated to be 300 gallonslday (4 individuals x 75 gpcd). Required minimum fire suppression demand is 2500 gallons. Total potable and fire suppression volume required is estimated 10 be 4000 gallons. Water supply appears adequate with 4000 gallons of storage with refills scheduled at 5 day intervals. Dry hydrants observed en water tank. Road access to the site is maintained year-round through the services of private road maintenance and construction contractors. Base mapping by B9okclif1 Survey Services. Inc. Site features including housing traders. water and wastewater tanks. portable toilets and dumpier surveyed with Trimble Geo-Xf GPS equipment. Please note that this is a construction site and that the locations of drill equipment and other items are subject to change. Factory -Built Nonresidential Structures (OfficelHousing) have a minimum separation distance of 2811 KP 24-8 Site Plan Garfield County, Colorado Small Temporary Employee Housing and Septic Permit Application Applicant: Williams Production RMT Date November 28, 2011 Checked: LVF Fox Engineering Solutions LLC 670 Canyon Creek ()rive, Grand June -Imo CO 111501 Ph. (0791255-5505 r Fax- )029) 784-0667 E:Taf, eenoradofoo@breenan.net Version 001 Bonuales, Gia From: Bonuales, Gia Sent: Tuesday, November 29, 2011 3:58 PM To: 'Orrin.moon@burningmountainsfire.org'; 'Vola Mercer; 'Julie Taylor' Cc: Reed, Gary Subject: KP 24-8 Rig Move On Notification Attachments: KP 24-8 BMFPD Letter & Map dated 11-29-11.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 will notify you of the removal of the Employee housing. This notification is per the GARCO Regulations for our pad located in Sec 8- T6S-R91W. Attached please find a map with directions to the pad, a pad lay out and emergency contact information. Should you have any questions please let me know. Borntal$ Land Data Technician I Williams Production RMT Company LLC 1058 County Road 215/P0 Box 370 Parachute, Co 81635 970.263.2746 -Office 970.216.8537 -Cell 970.285 -2047 -Fax gia.honuales@williams.com 1 Williams Williams Production RMT Company LLC 1058 CR #215 P.O. Box 370 Parachure, CO 81635-0370 970/285-9377 970/285-9573 fax November 29`x', 2011 Burning Mountain Fire Protection District Emergency Operations Attn: Fire Marshall Moon 5255 County Road 335 New Castle, CO 81647 Ph: 970-984-3323 RE: Emergency Response Notification KP 24-8 pad Dear. Fire Marshall Moon: This letter is to inform the Burning Mountain Fire Protection District 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 information and driving directions for the Williams KP 24-8 pad. Should you have any further questions or concerns regarding this notification, feel free to contact me at (970) 263-2754. Sincerely, Bryan S. Hotard Field Land Team Lead-Piceance District gb Williams Production RMT KP 24-8 Weil Pad 4.4 15 » Td.t-Pw x' err-, •` , .- g. -a- eocr ry yR0.W 3.75., r. • XP -.-.- 24-8 DRILL PAD i3OCA TION •. Ra d ACCEEs pE.gCrernoR; FROM of rrn1RSEC,ICR Oi CoulabainittRSYATE 700.1100455 t p nn 9.w errrm lOrOn-ACA ROAD SO," pr 5117 COLORADO. PSOCEE0 VAST 744 ACES ALOrr6RNER reokr.vas ROAb107011 rSrSf.E5np, wrraG T50040S0'I07c0 MEEK ROAM. FROCEE0,U0MO WIDE META AOAO 1.13 4111.95 TO MRFFSet nov non, A 0Rft.p.ve. ROAD We.. [.Aria. nROr{rO LrrTW AN CASTCTa.r fQCCRON 1, 0.4f5 TO A rrkra-WAV WTERSECO0w ',mourn miaow si A rxWn1E xsERir OPECT?YM UP AHAA .014,LE510 AV MRERSE17ONN1TM A anArC94454 ROAD PAICE11O LE'T ry A ,CPTIE -T 0R1151or al 0.9E5 To Twn•x,57.70Rn 7.1 4 AR1A1 •-'MLOOATO*AT 7y TOn 00 hE UPS, 4597000)0401 N. p BOOKCLIFF •) !'� .S1007 ,S; -mins, Int. Construction Plan Prepared for: �.�Ufrig75 Williams Production, RMT 11,7 K/' 24.R . 1011 5 ACCESS ROAD MAP Directions to Site' Aga --� eiZeg r.man.se f% 7 __r /: IJJa 1 f / AOpxn 0r7re DnafZg _ ti, , 4 Equipment Area C , 7_ t 1 ;t / I 11 1 •1 it.I . 1 \ 0 e � l r -tit . lE C2.. 1 11,1506.4,90‘0115 kw rw--£,wr Nal T.v, BOOKCIIFF Sorry krritex, tor. i tdentificatien d LOCatlonJIAv 1. Wastewater Aboveground Tank (4000 gal ) 2. Potable Water Abevegrourd Tank (4000 gat) 9. Three Portable Toilets 4. Wddlife-pool dumpater 5. Company Man Olhce7sovmng 6. DnIlers 0BicdHouurq 7. Shed 5ubtecl la rebrniien for construction uctent es. PLYFTC0 1 We: PA1r- ' PRO 4w. R r 'xer,r. •• Conatruet:on Plan Prepared for- wirramiWiliams Production, RMT Al' 74 Mar 1)9151 RA? LAYOUT FoiProPnry Contact Lust' Main Office 970.285.9377 answered 24 Hours Sob Ga,gH,n. Williams Dolling 970-51160673 Ceti 5c011 Brady- Williams Dulling 5up-970-270-9187 Gee Kevin MdDerroO!- W,Ilur015 Safety -970-309-1195 CN: Mad, Mumbr - 51711 Contractor 970-260-1576 Celt Matra The well pad site is located in the SE 114 SW 1/4 of Section 8, T6S. R91 W. fith P.M. (NAD83 I439.5355° W107.5798, The site will temporarily office and house up 10 8 maximum of four individuals during natural gas drilling activities and is expected to be completed in one year or less. The Individuals will 0ceupy two individual trailer offices/houses located on the well pad. Office/houses have Colorado Division of Housing complia000 tags. 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 tank needs to be emptied a0pr0ximately every 13.3 days (4000 gallons 1 300 gallons per day). Wastewater vault equipped with overflow alarm Oev10e. Williams utitze5 the 5erv1ce5 Of a licensed contractor 10 remove and haul the wastewater to a State certified treatmentldisposal faciiity- 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 minimum fire suppression demand is 2500 gallons. Total potable and fire suporess:On v0lume required is estimated to be 4000 gallons. water supply appears adequate with 4000 gallons of storage with refills scheduled at 5 day intervals. Dry hydrants Observed on water tank. Road access to the site is maintained year-round Through the services of private road maintenance and construction contractors. Base mapping by Book.cliff Survey ServIce6, Inc. Site features including housing trailers. water and wastewater tanks, ponable toilets and dumpsler surveyed with Trimble Geo -XT GPS eou,pment, Please note that this i5 a construction site and that the locations of drill equipment and other items are subject to change. Factory -Built Nonresidential Structures (Office/Housing) have a minimum separation distance of 28 ft. KP 24-8 Site Plan Garfield County, Colorado Small Temporary Employee Housing and Septic Permit Application Applicant: Williams Production RMT Date' November 29, 2011 Checked- FSR version 091 Fox Engineering Solutions LLC 670 Canyon Creek Cleve, Grand JuoThon, CO 7'50/ Ph (4705 250-5505 I Fn. (026) 704.0667 Enool. ceiorndoloo@bresnan net Section 8 T. 6 S., R 91 IV A I SW#7 F0.0' 6 ez 14\___Edge of Existing Pad 5a 5$5P�• Proposed r317d %,5‘'' PrpposeKx1. E0Proposed EP 324-0 �15[J y PPr+,0 '5.8d E411.17 5a a 006 Proposed KP 21.17 Proposed KP 321-17 Prope.ed KP -1 Proposed KP 3318421.177 Proposed KP 331•17 Pr Prnpooposed .ed KP KP 31.17631-0 Proposed 8P 334-0 I 50' 0/S REF. PNT. Exist. Limit of Disturbance J 900' #8 F0.0' Cuttings Managment Area S #6 NAz. 176.67' 175' Exist. and Proposed Pad Et= ±6526.0 c Exist. Limit of Disturbance SE #5 F0.0' Exist. Two Track Trail (to be maintained)+\ T \, I \\ • J • • bons 5 5� REF. PN 1 Proposed Access Rba Preserve Exist Two Trac ESTIMATED EARTHWORK QUANT TIES (cy) ITEM CUT FILL TOPSOIL EXCESS PAD 0 0 0 0 PIT 0 0 TOTALS 0 0 0 0 U I Edst 38-245D Proposed Id' 523-8 Proposed VP 423-0 Exist . 28-23 D ProPo21-8 Proposeedd EP 23-8 Cast J8 -313D Proposed KP 533-8 EWA. J&3150 Proposed KP 437-8 Proposed KP 333.8 Ertel. Jolley 1.8 F0.0' 185' Tank Farm (45'x150') GtAPHIC SCALE IN FEET %I WA. 1[0 fFET NW #1 c 0.0' Ir #2 40,8' Exist, Prix Eq XPmeni E€ #4_- C Q0' 1 l`` 'b 15�cn Exist L1{lverl It 3 /� �\ \ \. REVISED: 6/24/ 11 1 lAA BB CC 'NOTES: 1.) No Additional Pad Expansion. 2.) Tolal Disturbed Area =17.88 ac. IJ6is.1 IL, •E-'4 r 1'4r, Car ado 146.54 lA 1970) 62.5 13.10 Fn. N 76, r..'S 2773 BOOKCIJTFF Sur v' ' Services, Inc. SCALE: 1"= 100' DATE: 6/3/ 11 PMT: 2 of PROJECT: Williams Kokopefli DFT CWS Construction Plan Prepared for: Whams Williams Production, RMT KP24-8 - Plat 2 CONSTRUCTION LAYOUT Section 8 T. 6S, R91 W • 0, — • - — •••7,-... - 10 • -1'- 11. t ) ,:.=-' it.A"-, 2t •,\ ,,,4„,-..: (• 1'• - 1 c;- . : . ii r ,---*„ /- -• ji - (1 - - - • - I ( olivOs9i''P..1, (. (•,---;. -'.-)- ii )10 i' `i .05' (11' I 1...,•!-.. ',,,' _, - .,.' i k l'cr",i-e4,,, ,(L-"::--%. I? ' \ i,,,,\ '-- i - ----4-...11 !)-•• f"-' 3 ‘ ).. \ • ' - i7 - / --...)/.#. • , -•-•:_i"....' . .,_j. 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'N ,,, 4,....,,... .. . - - 1; e_.,:-.-.../ \e_____...,:s.,1 4,\ \ ----:•::-.7.\-------- :A.?' - ---S.-7 - e. - -_•...,•\ -.., .._,i_.„ ' (.. :,-"? ,../411,-7 /:-.)- 1 %,, .' „,,, 1-- -,...---...2::\;\.:—.. —,...,.11..., , s, • -----z., .., •,,,, .... .ss, i , ., ,, „:„.....,,,,,.....„...-, • ., r ; V, ).'"),..."• '‘,•rs. .%Z.ec • I;: "' -_-.-,....- \ \ \:',' ei•scr"--\"-.-'''''s ( ;•-:'.':-..------ -, ,,,,,,.. •• ) ( Ii...:I.:‘,-..„,::\.,..,. ...., T....,, ,v.... -,....,-,;.:-.,_ '41 ' ( L - )•3 , ..,.. , •,......:\ 1 --- • .: "„,..„ v, ,, cy \ .........., ,..-- ,,,,,i_...„-.,..._ ''-'0'..,:.-, •k.,.. 1 -1.. -.? f...,,- ,,,..- - - - • -,...- ...? r ../). . ,r,-....._--._-_- _ "—di -- -......\—z-y„, ..-;$.:„ )-- - - - --' • - \'''• ;•-• • • --'"-- -t..\:_•A"\‘,(\ 1.4$,$, --:''''''\-:-.-\\,:\ '1\ - --$;1 • tir_t-^, ,1,•Y '')/1,.('• \.' .. $11 • 1 •.$ 1 . , -, ___,-,1:1,>:,.1 V •-•":"", ....., ' ... - ......}11$ (,......,:\ $ 1 .` % l'. / ••-•,,, \I ( ' '')'11 '-`,1"•--- 11 ; -..,\ ..1,$.\. r ik IF 0, 1.1. „, L.,..,,,, ,,,z:„..,,..., kV...........;\,- • • ...- -..,;;;.... \s ' 14 (‘-t---k "--. ?\,./ .I _,...-. - -... \ ( ' - ---- -r-://`,':/e.:,'"--t''.'::,,'-7-; -'‘I/11-17-''), . .7'. e - f -•-•k`',.---•:•.2:.!,00., \•----;)/L.,.-.— '.;! ; --•:'.•:--`'...-: -..:, • - c-- I .'-, :.,,. -,W • .%L!,k..s, GRAPHIC SCALE IN FEET 1 POCH • 2000 FEET ACCESS DESCRIPTION: FROM THE INTERSECTION OF COLORADO INTERSTATE 70 OVERPASS (Exit 97) AND RIVER FRONTAGE ROAD SOUTH OF SILT, COLORADO, PROCEED EAST ±0.4 MILES ALONG RIVER FRONTAGE ROAD TO THE INTERSECTION WITH COUNTY ROAD 311 (DIVIDE CREEK ROAD), PROCEED ALONG DIVIDE CREEK ROAD ±3.3 MILES TO THE INTERSECTION WITH A DIRT/GRAVEL ROAD (McLin Cutoff), PROCEED LEFT IN AN EASTERLY DIRECTION ±1.0 MILES TO A FOUR-WAY INTERSECTION, PROCEED STRAIGHT IN A NORTHEASTERLY DIRECTION UP A HILL ±0.8 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A NORTHERLY DIRECTION ±1.0 MILES TO THE EXISTING KP 24-8 DRILL PAD LOCATION AT THE TOP OF THE MESA, AS SHOWN HEREON. E.oe Thr., I 5.11 inala 111634 (170J C15.1132 r47.111 $25-277.1 SCALE: V =2000' DATE: 6/3/11 PLAT 5of7 PROJECT: Wiiliams Kokopelti DFT: CLOS Construction Plan Prepared for: Williams Production, RMT KP 24-8 - Plat 5 ACCESS ROAD MAP June 28th, 2011 Mr. Fred Jarman, Director Garfield County Building and Planning Department 108 8th Street, 4th Floor Glenwood Springs, CO 81601 RE: KP 32-17, KP 24-8, KP 41-28, KP 13-17 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 (STEN) and Individual Sewage Disposal System (ISDS) permits on the above drilling pad locations. Sincerely Richa d By: Title: , LLLP STATEMENT OF AUTHORITY Pursuant to C.R.S. §38-30-172, the undersigned executes this Statement of Authority on behalf of Richard and Mary 'Tolley Family LLLP a (registered limited liability limited partnership), an entity other than an individual, capable of holding title to real property (the "Entity"), and states as follows: The name of the Entity is Richard and Maly Jolley Family LLLP and is formed under the laws of Colorado. The mailing address for the Entity is: 1288 County Road 245 New Caslte Co 81647. The name and/or position of the person authorized to execute instruments conveying, encumbering, or otherwise affecting title to real property on behalf of the Entity is Kent Ool.ley. The limitations upon the authority of the person named above or holding the position described above to bind the Entity are as follows: ( Pad locations Permitting ) (if no limitations, insert "None") Other matters concerning the manner in which the Entity deals with any interest in real property are: (if no other matter, leave this section blank) Ar ai i ee Signature: Name typed: Title (if any) : STATE OF COLORADO ) ss. COUNTY OF GlARFISLD The foregoing instrument was Sr r , 2009 by AGS 1 , 2009. Signature: Name typed: Title (if any): acknwlvilitPdAaRfore Age'X70.. s: Witness my hand Notary Public offici: a. seal toom),' s PUBLIC' r og F4. iirrrrrmiM .. 14101) eXpite me his �� day of Jae% , on behalf of ■Ili ',�I+ aNlt'h01 e1fit 1t 147:64114{ �iilRfl�lf�lfl��k 11 NI Reaeptiantt ; 75l50 04/G272O09 03146:24 PM Jean Alberioa 1 of 1 Roe Fee1S6,00 Dao Fee:D.OD GARFIELD COUNTY co Statement of Authority Kent Jolley, as General Partner of Richard and Mary Jolley Family, LLLP, A Colorado Limited Llabalty Limited Partnership, is authorized to act on behalf of, and represent the Richard and Mary Joley, UP In ail matters related to appt'ications for land use change permits (and may execute such applications] submfted to Garfield County until such time as Richcrd and Mary Jolley Family. LLLP tiles of record statement that Kent Jolley no longer has this authority. The Richard and Mary Jolley Family. W P acknowledges that when any such permits are issued by Garfield County, they may contain covenants that tun with the particular lands identified In such its, Tars Statement of Authority Includes, but is not limited lo, that certain un -recorded and confidential Water Pipeline Easement, dated effective as of December 1.2008, by and between JACE LLC and Richard and Mary Jolley family, LtJP, together designated as "Grantor, and Orlon Energy Partners L.P. Richard and M . Jo y Family, LIP By: Kent Jolley, as en Partner of Richard and Mary Jolley Family, LLLP, A Colorado Limited Liability Partnership State of Colorado County of The Foregoing Instrument was subscribed and Swam to Before Me on `.M l 3 2009 by Kent Jofey. as Genesi Partner of Richard and Mary Jolley Family, WP, A Colorado Limited lability Limited Partnership. My Commission Expires 4,/ac3/ &Div Witness My Rand and Seal CAROL .tt'At.I KRAIG NOTARY PUBLIC STATE OF COLORADO My Cc:rmfeston Expires 00!90/2010 \Zt� czc.c? Notary Pu 11111IPA MIfft140184101#1 1111 RetNtIonkF: AllirO MepNet 1 F2 Rn Fa. $18.00 1U.D cAI fY 00 LIMIFED POWER OF ATTORNEY WILLIAMS PRODUCTION RMT COMPANY LLC ("Company") a Delaware limited liability company, having its principal place of business in the City of Tulsa, County of Tulsa, State of Oldahoma, does hereby make, constitute and appoint Bryan S. Retard with the full authority hereinafter provided, the true and lawful Attorney -in -Fact of the Company, authorized and empowered on behalf of the Company and in the Company's name, and for the sole and exclusive benefit of the Company and not on behalf of any other person, corporation or association, in whole or in part, to enter into, execute, deliver, file and accept all instruments and documents affecting the real property or rtal estate rights of the Company including but not limited to, the following described instruments and documents; 1. Applications and documentation associated with Garfield County or Rio Blanco permitting requirements, ia.chiding, but not limited to, Independent Sewage Disposal Systems, Small Temporary Employee Housing, Major Impact Reviews, Limited Impact Reviews, Oil and Gas well permitting, Driveway Access, County Road Maintenance, Temporary Living Quarters, Temporary Use Permits, Surfane Use Penults, Surface Use Licenses, Utilities, Snow Removal and Private Construction of County Roads; 2. Agreements and other documentation that grant easements, rights of way, licenses, or permits to Company and also instruments where the Company grants such rights to others; 3. Agreements that assign easements, rights of way, licenses, permits or surface leases in connection with the Company's opentiona; 4. Releases and Partial Releases of easampots and rights of way; 5. Agreemeata allowing encroachments onto easements and rights of way owned by Company and landowner irsstrumcntn and conveyances on others easements; 6. Agreement$ subordinating easement or lease to mortgage rights; 7. Agreements relating to the modification and relocation of Company facilities; 8. Rental or lease agreement for aurface use or other surface use agreements and all notices related to the pipeline agreements; 9. Agreements for the punchaae or sale areal property and for the lease of real property for residential 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 otherutility 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 docuosexnts. The Company hereby declares that each and Ivory act, matter and thing which shall be given, made and done by Bryan S. Retard 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 Company in its limited liability company presence and it hereby ratifies whatsoever Attorney -in -Fact shall lawfully do or cause to be done by virtue hereof This Limited Power of Attorney shall remain in hull force and affect until terminated by Company. Zi Ell PA cholairiv llERNCI IttidiIlittiIII! A tiardf: !96428 e7R 11815 ai2B•27 P11 Jaen Rlbrriaa 1 of 2 Rao Fr.:21414 Daa Frr:11.88 GARFIo.o GOVNTv CO IN WITNESS YVUER EOF, the Company has caused this Limited Power of Attorney to be signed by one of its Vice Presidents, duly authorized by its Management Committee to grant powers of attorney this Lt.t' day of July, 2011. STATE OF OKLAHOMA COUNTY OF TULSA as. ) ACKNOWLEDGMENT BEFORE MB, the undersigned Authority, allotary public hi and for said County and State, on this day personally appeared, Jerry D. Games personalty known to me to he the Vice President of WILLIAMS PRODUCTION RMT COMPANY 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, 1 have hereunto aetmy hand and affixed my notary seal, the . day °fluty, 2011 My Commission Expires: 2. - 23 - 20 1'+ Milan 111wi.�l.,rrrgetalN WILLIAMSAECEELLtECOROATIQEmazEgEamtuja PRODUCTION CO Rita LLC ATTN: LANG DEPT. P.O. SOX 370 PARACHUTE, CO 81635 2 Project Address Garfield County Building & Planning Department 108 Sth Street Suite 401 Glenwood Springs, CO 81601 - Phone: (970)945-8212 Fax: (970)384-3470 Parcel No. Permit NO. SEPT -11-11-2272 Permit Type: Septic Permit • Work Classification: New Permit Status: Approved Issue Date: 11 /312011 Expires: 11/02/2012 Subdivision Section Township Range KP 24-8 SILT, CO 81652 - 218117200086 Owner Information Address Phone Cell Jolley, Richard & Mary Family LLLP 970-379-6669 1288 CR 245 New Castle CO 81647 Contractor(s) Phone Primary Contractor Williams Production RMT (970)285-9377 Yes Proposed Construction I Details Temporary employee housing FEES DUE Fee Septic Fee - New Total: Amount $73.00 $73.00 Valuation: $ 0.00 Total Sq Feet: 0 FEES PAID Inv Total Paytype Amt Paid Amt Due Inv # SEPT -11-11-21505 $ 73.00 Check # 30572406 $73.00 $ 0.00 Required Inspections: For Inspections can: 1(888)868-5306 Inspection IVR See Permit Record Building Department Copy Thursday, November 3, 2011 2 GARFIELD COUNTY SEPTIC PERMIT APPLICATION 1088'"Street, Suite401, Glenwood Springs, CO 81601 Phone: 970-945-82121 Fax: 970-384-34701 Inspection Line: 970-384-5003 www. eart-mid-count .com OC r 28 2011 1 Perk Fey: Parcel No:(this information is available at the assessors office 970-945-9134) 2181-172-00-086 2 Septic Per #: Jt©11 Job Address: (if an address has not been assigned, please provide Cr,Hwy or Street Name & City) or legal description KP 24-8 See the attached plat for description. 3 Bun.J� Plan..' ildi Lot Size: Lot No: Block No: Subd/Exemption: See Attached Survey Plat 4 APPR 4 V L DATE I Owner: (property owner) JOLLEY, RICHARD & MARY FAMILY LLLP Mailing Address 1288 COUNTY ROAD 245 New Castle, CO 81647 Ph: 970-379-6669 Alt Ph: 5 Contractor: Williams Production RMT Company LLC PO Box 370, Parachute, CO 81635 Ph: 970-285-9377 ext 2754 Alt Ph: 6 Engineer: N/A Mailing Address Ph: Alt Ph: 7 Permit Reauest For: (X 1 New Installation ( 1 Alteration ( ) Repair 8 Waste Type: (X ) Dwelling ( ) Tranient Use ( ) Commercial or Industrial ( ) Non- Domestic Wastes ( ) Other- Describe 9 Building Or Service Type: Number of Bedrooms: 2 Garbage Grinder ( )Yes (X )No 10 Source & Type of Water Supply: ( ) Well ( ) Spring ( ) Stream Or Creek ( } Cistern If supplied by COMMUNITY WATER, give name of supplier: Down Valley Septic and Waste 11 Distance to Nearest Community Sewer Was there an effort to connect to the System: _N/A community System? N/A YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN 12 Ground Conditions: Depth to 1st Ground Water Table N/A Percent Ground Slope N/A 13 Type of Individual Sewage System (ISDS) Proposed: ( ) Septic Tank ( )Aeration Plant ( X ) Vault ( ) Vault Privy ( }Composting Toilet ( ) Recycling, Potable Use ( )Recycling, Other use ( ) Pit Privy ( } Incineration Toilet ( ) Chemical Toilet (X)Other-Describe: Hauled to Down Valley Waste for their disposal 14 Final Disposal By: ( ) Absorption trench, Bed or Pit ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Evapotranspiration ( ) Sand Filter ( ) Wastewater pond (X )Other -Describe Hauled to Down Valley Waste for their disposal 15 Will effluent be discharged into waters of the state? ( )Yes (X )No 16 Percolation Test Result: (to be completed Minutes per by Registered Professional Engineer, if the inch in hole No.1 in hole No.2 made soil absorption test: NIA Engineer does the Percolation Test) Minutes per inch in N/A hole No.3 No.4 Minutes per inch Minutes per inch in hole Name, address & telephone of RPE who Name, address & telephone of RPE responsible for design of the system:N/A 17 Applicant acknowldges that the completeness of the application is conditional upon such further mandatiory and additional test and reports as may be required by the local health department to be made and furnished by the applicant or by the local health department for purposed of the evaluation of the application; and the issuance of the permit is subject to such terms and co i •'tions as deemed necessary to insure compliance with the rules and regulations made, information and reports submitted herewith and required t. -e su 'milted by the applicant are or will be represented to be true and correct to the best of my knowledge and belief and are designed to be relied on • 10 :I d partment of health in evaluationg the same for purposes of issuing the permit applied for herin. !further understan that any falsification or m'- r: sen : ion may result in the denial of the application revocation of any permit granted based upon said application an I action for p'iffy y law Owners Sign re: Bryan S. otard Date Permit Fcc: Perk Fey: Total tees: Building Permit #: Septic Per #: Jt©11 ,� �i ..... ``d, Issue Date: 11-3,a01( Bun.J� Plan..' ildi g �. ..../ii&1 APPR 4 V L DATE I