nov 8 21':! :srth -j car i -- v pi small temporary ... application.pdfr'ljll dlf\1(~ k pi...

$: NOV 8 21':! :srtH -J CAR I -- v Pi Small Temporary ... Application.pdfr'lJll Dlf\1(~ k Pi l\ ·,,, '' Small Temporary Employee Housing Administrative Checklist GENERAL INFORMATION$
GARFIELD COUNTY Building and Planning Department 108 8 111 Street, Suite 401 Glenwood Springs, Colorado 81601 Telephone: (970) 945-8212 Facsimile: (970) 384-3470 www.garfield-county.com

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NOV 1. 8 21':!

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Small Temporary Employee Housing Administrative Checklist

GENERAL INFORMATION -Submit 1 paper & 1 CD copy of the completed application to Planning Department wlin 48 hours following occupation

(To be completed by the Small Facili ty Operator- e.g. well pad operator)

SectionfTownship/Range Location of Housing Site: Sec 32-T6S-R94W Well Pad Number: RWF 11-32

Tax Parcel Number for Parcel Containing Housing Site: 2175-322-00-041

GPS and/or Lat-Long Coordinates of Housing Facility Site (Often included in APD): Lat: 39.485753 Long: -107.915700

Maximum Number of Occupants at Zone District: Rural Pem1itted 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 Pem1it Number: COGCC 400192504 Date of Installation: November 1 th 2011 Date of Removal: January 1 tn 2012

Name of Landowner: Robert E. Duggan

Street Address: 1550 County Road 320 Telephone: (970)625-2728 Email :

City: Rifle State: CO Zip Code: 81650

!Name of Operator 's Compliance Officer: Williams Production RMT Company LLC BryanS. Hotard

Street Address: PO Box 370 Telephone: 970-285-9377 ext Email : 2754 Brvan.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 Checklist must be received by the Gcrie/d County Planning Deparlment within 48

hours following occupancy of the Small Facility. be delivered to

A copy of this completed Administrative Checklist and all associated submittals shall the Garfield County Sheriffs Office and relevant Fire Protection District (if within 48 hours

applicable) Office and

following occupancy of the Small Facility. Additionally, the Garfield County Sheriff'sreceipt) or verified is relevant Fire Protection District (if applicable) must be notified in writing (return the Operator's

email (return receipt) within 48 hours following removal of the Small Facility. It been received by responsibility to confirm and obtain verification that the Administrative Checklist has

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Fire Suppression Requirements (Per Performance Standard Ll

"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: SOOBBU 21,000 gallons

A. Outline of Process. The Small Temporary Housing Facility(ies) Review process shall consist of the following procedures as more fully outlined in Section 4-109 of Article IV of the Unified Land Use Resolution of 2008.

1. Application to relevant protection districts and the Garfield County Sheriff's 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 infonnation:

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 Sheriffs 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

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districts, Garfield County Sheriff's 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 (0)(3)- All Requirements Applicant Planning

Department Must be Satisfied to be Eligible as a Small Facility Complies (YIN) Complies (YIN)

The Small Facility and any associated infrastructure must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas

YES 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 YES associated infrastructure are completely removed; and,

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. YES Temporary employee housing facilities that do not have the three characteristics listed above, or consist wholly or in part of Recreational Vehicles as defined above, are subject to the administrative permit requirements or the Major Impact Permit process, standards and requirements contained in this document.

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Building Information (Per Unit)

Unit 1

Make: ATCO Structures (USA) Inc. Serial Number or Unit ID Number: 354085939

Manufacture Year: 2008 Size of Unit (Square Feet): 14X56

Unit 2

Make: AmeriTech Building Systems Serial Number or Unit ID Number: 11-100621

Manufacture Year: 2008 Size of Unit (Square Feet): 14X56

Unit 3

Make: Serial Number or Unit 10 Number:

Manufacture Year: Size of Unit (Square Feet):

Unit 4

Make: Serial Number or Unit ID Number:


Unit 5

Make: Serial Number or Unit ID Number:


ISDS Permit

ISDS Permit Number: Submitted 11-10-11- Requested and have ~eived as of 11-17-11

2 YH d~ Sig~ature of Operator's Compliance / ~ Off1cer: .6 - ..-.A..

( By signing this form, I verify that all information provided in this checklist is correct and accurate to the best of my knowledge)

Print NamP.· Brvan S Hotard

Title: Attorney-In-Fact

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Eligibility, Submittal and Performance Standards Certification

Section 7-808(0)(3)- Small Temporary Employee Housing Facilities (Small Facility(ies)) in Article VII - Standards, requires the that the following performance standards be met with each facility:

Small Facilities, in the nature of Factory Built Nonresidential Structures [as defined under C.R.S. 24-32-3302(a)] but NOT recreational vehicles [as defined under C.R.S. 42-1-102 (61 ), including truck, truck tractor, motor home or camper trailer], may be utilized for housing of workers on projects related to commercial, industrial, mineral extraction or highway operations, pursuant to the standards for Small Facilities contained in subsection (2), below. Such facilities are not subject to Garfield County building and fire codes (building code, fire code). However, Small Facilities are subject to all pertinent state (i.e. electrical permits), federal permits and relevant fire protection district(s) code requirements.

Small Facilities shall have all of the following basic characteristics:

A. The Small Facility and any associated infrastructure must be completely contained within a state or federally permitted parcel (such as a Colorado Oil and Gas Conservation Commission (COGCC) approved oil/gas well pad) in which reclamation and revegetation are secured with the permitting agency (Permitted Site); and,

B. The Small Facility is located at the Permitted Site for less than a cumulative of one (1) year and at the end of the utilization period, all structures, foundations and associated infrastructure are completely removed; and,

C. The Small Facility shall have an occupancy of eight (8) or fewer people who are employees, contractors or sub-contractors of the operator of the small facility and are needed for ensile 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).

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C. In no case shall unsafe water be used for drinking nor shall raw sewage or contaminated water be discharged on the ground surface. The operator shall conduct monthly tests (or quarterly if an on-site disinfection system is installed) and maintain records of stored potable water samples specific for coli form bacteria. Any tests indicating coli form contamination must be disclosed to the Garfield County Board of Health or designee within 72 hours from the time the contaminated water was tested.

D. Each Small Facility shall be maintained in a clean, safe and sanitary condition, free of weeds and refuse. Any hazardous or noxious materials that must be stored at the Small Facility for operational or security reasons must be managed in accordance with all applicable federal, state and local laws and regulations.

E. At least one thirty (30) gallon ( 4 cubic feet) wildlife-proof refuse container shall be provided for each Factory Built Non-Residential Structure unit. Said container(s) must be durable, washable, non-absorbent metal or plastic with tight-fitting lids.

F. Refuse shall be disposed of weekly, at a minimum. Operators must keep appropriate records, to be provided to the County or any interested third party upon request, to demonstrate that refuse is collected in a timely fashion and disposed of at a licensed facility.

G. Outdoor food storage is prohibited.

H. Factory Built Non-Residential Structures equipped by the manufacturer with a fire sprinkler system, fire detection system, and/or alarm system shall be inspected, tested, and maintained in accordance with the requirements of the relevant fire protection district(s) and the Colorado Division of Housing.

I. Single-station carbon monoxide alarms shall be placed in each Factory Built NonResidential Structure.

J. One (1) or more approved fire extinguisher(s) of a type suitable for flammable liquids, combustible materials and electrical fires (Class ABC), or dry chemical, shall be located in each Factory Built Non-Residential Structure and placed in accordance with applicable fire protection district and/or Colorado Division of Housing codes.

K. Domestic animals are prohibited at all Small Facilities.

L. A water storage tank is required to provide water to the sprinkler system (if applicable) and initial suppression activities. The size of the water tank shall be determined based on sprinkler calculations and initial suppression demands. The relevant fire protection district shall be responsible for determining the size of the water storage tank. If the Small Facility is not within a fire protection district, the Operator shall provide at least 2500 gallons of water dedicated to initial fire suppression which is accessible with a dry hydrant within each Permitted Site for a Small Facility.

M. The operator shall document all emergency situations requiring action by any government agency or fire protection district, in writing, and such documentation shall be presented to the Planning Department within 24 hours of the occurrence.

N. All required Access Permits shall be obtained from the Garfield County Road and Bridge Department or the Colorado Department of Transportation.

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0. The Garfield County Sheriff's Office and relevant fire protection district(s) shall be notified and provided with all documentation as outlined in these regulations, within 48 hours following occupation of each Small Facility. In addition, the Garfield County Sheriff's Office and relevant fire protection district(s) shall be notified either by hard-copy or electronically within 48 hours following removal of all Small Facilities. The Planning Department shall be copied on all such notification, whether hard copy or electronic.

P. The Operator shall maintain records identifying workers, whether employees, contractors or sub-contractors, and document the dates that each worker is housed at the Small Facility. Such records shall be provided to the County or any additional third party upon request.

Q. The Operator shall obtain a certification inspection conducted by a third-party Professional Engineer Licensed in the State of Colorado. The certification shall verify that at the time of inspection the identified Small Facility meets or exceeds the standards set forth in Article 7.808 D. 2. of the Garfield County Land Use Code of 2008, as amended. This certification shall be on forms provided by the Garfield County Planning Department. The certification shall be provided to the Garfield County Planning Department within 48 hours following occupation of the Small Facility.

R. The Operator shall accurately complete all required forms provided by the Garfield County Planning Department identifying the location of the facility (SectionfTownship/Range, relevant Tax Parcel Number, and GPS coordinates or Latitude/Longitude coordinates); relevant zone district; maximum number of occupants; cumulative amount of time (in days) that the Small Facility will be at the specified location; identification of the State or Federal permitting agency overseeing reclamation, rehabilitation and revegetation of the Permitted Site and relevant permit number; date of installation; date of removal; name and contact information of the landowner; name and contact information of the Operator's Compliance Officer; 24-hour emergency contact information for the Operator; building information (make, manufacture year, serial number, size (square feet)); signature and contact information of the Operator's Compliance Officer.

S. Wastewater Disposal:

1) Vault System: All vault systems shall be designed and installed to accommodate the maximum number of persons (eight or less individuals), who will inhabit the Small Facility. In addition, all vault systems shall be equipped with an overflow alarm device. Vault systems shall be designed to accommodate a minimum of 75 gallons of wastewater per person per day. If a vault system is proposed or has been approved, the Operator must:

a. Demonstrate that year-round vehicular access is available and maintained for safe and regular access for sewage hauling vehicles.

b. Maintain all sewage disposal records including but not limited to trip logs/reports and landfill receipts as public records, available to the County and/or any other interested third party upon request.

c. (b) Individual Sewage Disposal System (ISDS): If an ISDS is proposed, then it shall be designed, installed and operated to accommodate the maximum number of persons who will inhabit the Small

7

Facility (eight or less individuals) and shall otherwise be permitted and operated in accordance with the Garfield County ISDS regulations as contained in BOCC Resolution Number 1994H-136.

I hereby attest that I am the designated Compliance Officer for the aforementioned Small Temporary Employee Housing Facility(ies}. I attest that I have read and understand the standards to which the Facility(ies} shall be installed and operated. I attest that the Facility(ies} will be constructed and maintained in accordance with all applicable Garfield County, State of Colorado and Federal regulations and standards. In addition, I attest that I have read and understand the enforcement provisions as described in Article 12 of the Garfield County Unified Land Use Resolution of 2008. Further, I understand that non-compliance with any of the provisions as outlined in Article 7-808 (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 : _..:B;..:.r ..... y-=a~n~S~ . .:..:H:..::o;..=.t.;;.a.:..;rd::.-__

Title: Attorney -In- Fact

Phone Number: 970-285-9377 ext 2754

Email: Brvan.Hotard@will iams.com Bob.Caughlin@will iams.com

I hereby attest that I am a Licensed Professional Engineer in the State of Colorado. I attest that I have conducted a visual inspection of the Small Facility identified in this Administrative Checklist, as installed, and, based on information from that inspection I certify that the Small Facility complies with the standards set forth in Article 7-808 (D) (3) of the Unified Land Use Resolution of 2008.

PE Certification Number PE Stamp See

Date of Inspection See Summary Summary

Print Name and Title: David Fox of Fox Engineering Solutions

Signature See Form

8

Fox Engineering Solutions LLC 670 Canyon Creek Drive, Grand Junction, CO 81507

Ph: (970) 250-5505/ Fax: (626) 784-0667

Email: co/[email protected]

Inspection Report for:

Client:

RWF 11-32 Small Temporary Employee Housing

Williams Production RMT

Location:

Conducted By:

NE 1/4 NW 1/4 of Section 32, T6S, R94W, 6th P.M. Garfield County

David Fox, P.E.

Date Conducted: November 17, 2011

Garfield County

Paragraph Article 7-808(0)(3) Land Use Resolution 2008

Reference Characteristic or Standard Description

3.a. Small Facilities, in the nature of Factory Built Nonresidential

Structures [as defined under C.R.S. 24-32-3302(a)] but NOT

recreational vehicles [as defined under C.R.S. 42-1-102 (61), including

truck, truck tractor, motor home or camper trailer]. may be utilized

for housing of workers on projects related to commercial, industrial,

mineral extraction or highway operations, pursuant to the standards

for Small Facilities contained in subsection (2), below. Such facilities

are not subject to Garfield County building and fire codes (building

code, fire code). However, Small Facilities are subject to all pertinent

state (i.e. electrical permits), federal permits and relevant fire

protection district(s) code requirements.

3.a.(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,

3.a.(2} 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.

3.a.(3}

1

2

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 on site safety of the

related commercial, industrial, extraction or highway operation.

Small Facility must comply with all applicable federal, state and local

laws and regulations.

The Small Facility shall NOT contain recreational vehicles as defined

in Section 7-808 (D).

Page 1 of 5

Inspection Comments

Colorado Division of Housing certifications noted on

Company trailer, Unit I D. 354085939, Certification

No. 19709, manufactured by ATCO Structures USA

Inc. in 2008; and Driller's trailer, Unit ID.ll-100621

with Certification No. 22178, manufactured by

Ameritech Building Systems in 2008. All other

aspects not subject to visual inspection and

certification by third party Professional Engineer.

Not subject to visual inspection and certification by

third party Professional Engineer.







No recreational vehicles observed on site.

RWF 11-32 Mancamp Inspection Williams Production RMT

3

4

5

6

7

8

9

10

11

In no case shall unsafe water be used for drinking nor shall raw

sewage or contaminated water be discharged on the ground surface. The operator shall conduct monthly tests (or quarterly if an on-site

disinfection system is installed) and maintain records of stored

potable water samples specific for coli form bacteria. Any tests indicating coli form contamination must be disclosed to the Garfield County Board of Health or designee within 72 hours from the time

the contaminated water was tested.

Each Small Facility shall be maintained in a 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.

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.

Refuse shall be disposed of weekly, at a minimum. Operators must

keep appropriate records, to be provided to the County or any

interested third party upon request, to demonstrate that refuse is

collected in a timely fashion and disposed of at a licensed facility.

Outdoor food storage is prohibited.

Factory Built Non-Residential Structures equipped by the

manufacturer with a fire sprinkler system, fire detection system,

and/or alarm system shall be inspected, tested, and maintained in

accordance with the requirements of the relevant fire protection

district(s) and the Colorado Division of Housing.

Single-station carbon monoxide alarms shall be placed in each

Factory Built Non- Residential Structure.

One (1) or more approved fire extinguisher(s) of a type suitable for

flammable liquids, combustible materials and electrical fires (Class

ABC), or dry chemical, shall be located in each Factory Built Non

Residential Structure and placed in accordance with applicable fire

protection district and/or Colorado Division of Housing codes.

Domestic animals are prohibited at all Small Facilities.

Page 2 of 5

Fox Engineering Solutions LLC November 17, 2011

One potable water tanks of approximately 4000

gallons and one 4000-gallon sewage holding tank

onsite. All tanks and piping located above ground.

No on-site disinfection systems installed.

Site appeared to be maintained in clean, safe and

sanitary condition, free of weeds and refuse.

One wildlife-proof trash recepacle with a capacity of

approximately 20 cubic yards to be located onsite.

Individual refuse containers in each office/housing

structure.



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 detectors located in all factory

built non-residential structures.

Fire extinguishers observed in all structures.

No domestic animals observed on-site.


12

13

14

15

16

17

A water storage tank is required to provide water to the sprinkler system (if applicable) and initial suppression activities. The size of the

water tank shall be determined based on sprinkler calculations and initial suppression demands. The relevant fire protection district shall

be responsible for determining the size of the water storage tank. If the Small Facility is not within a fire protection district, the Operator shall provide at least 2500 gallons of water dedicated to initial fire suppression which is accessible with a dry hydrant within each Permitted Site for a Small Facility.

The operator shall document all emergency situations requiring action by any government agency or fire protection district, in

writing, and such documentation shall be presented to the Planning

Deoartment within 24 hours of the occurrence.

All required Access Permits shall be obtained from the Garfield

County Road and Bridge Department or the Colorado Department of

Transoortation.

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.

The Operator shall maintain records identifying workers, whether

employees, contractors or sub-contractors, and document the dates

that each worker is housed at the Small Facility. Such records shall be

provided to the County or any additional third party upon request.

The Operator shall obtain a certification inspection conducted by a

third-party Professional Engineer licensed in the State of Colorado.

The certification shall verify that at the time of inspection the

identified Small Facility meets or exceeds the standards set forth in

Article 7.808 D. 2. ofthe Garfield County land Use Code of2008, 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


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.



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.


18

19(a)

19(a)(1)

19(a)(2)

19(b)

The Operator shall accurately complete all required forms provided

by the Garfield County Planning Department identifying he location

of the facility (Section/Township/Range, relevant Tax Parcel Number,

and GPS coordinates or Latitude/Longitude coordinates); relevant zone district; maximum number of occupants; cumulative amount of time (in days) that the Small facility will be at the specified location;

identification of the State or Federal permitting agency overseeing

reclamation, rehabilitation and revegetation of the Permitted Site

and relevant permit number; date of installation; date of removal; name and contact information of the landowner; name and contact

information of the Operator's Compliance Officer; 24-hour

emergency contact information for the Operator; building

information (make, manufacture year, serial number, size (square

feet)); signature and contact information of the Operator's

Compliance Officer.

Vault System: All vault systems shall be designed and installed to

accommodate the maximum number of persons (eight or less

individuals), who will inhabit the Small Facility. In addition, all vault

systems shall be equipped with an overllow alarm device. Vault

systems shall be designed to accommodate a minimum of 75 gallons

of wastewater per person per day. If a vault system is proposed or

has been approved, the Operator must:

Demonstrate that year-round vehicular access is available and

maintained for safe and regular access for sewage hauling vehicles.

Maintain all sewage disposal records including but not limited to trip

logs/reports and 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 IS OS 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




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 I 300

gallons per day). Wastewater vault equipped with

overflow alarm device.







RWF 11-32 Mancamp Inspection

Williams Production RMT

Fox Engineering Solutions LLC

November 17, 2011

I hereby attest that I am a Licensed Professional Engineer in the State of Colorado. I attest that I have conducted a visual inspection of the Small Facility identified in this Administrative Checklist, as installed, and, based on information from that inspection I certify that the Small Facility complies with the standards, subject to and limited to visual inspections items as identified above; set forth in Article 7-808 (D) (3} of the Unified Land Use Resolution of 2008, for Garfield County, Colorado.

PE Certification Number: No. 25420 (Colorado

Date of Inspection: November 17, 2011

Print Name and T~ David \F~incipal Engineer

Signature: u~ «1-r0

Page 5 of 5

PE Stamp

Williams Production RMT RWF 11-32 Well Pad

.AGCESSOE.SCRIPTION:

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Directions to Site·

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ApproXimate Drill Rig & Equipment Area ""' !li~

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1. Wastewater Aboveground Tank (4000gal.) 2. Potable Water Abovegi'O<Jnd Tank (4000 gal) 3. Three Portable Toilets 4. Wildlife-proof dumpster 5. Company Man Off~C$/Housing 6. Driller's Office/Hol.I:Slng 7. Shed

• Subject to relocation for construction adivities.

Emergency Contact List·

Main Office: 970-285-93n answered 24 Hours

Sob Brown- Williams Drilling 970-300-5479 Cell Scott Brady- Williams Drilling Sup-970-270..~187 Cell Kevin McOennott- Win lams Safety-970-300-11 Q6 Cefl

Mafk MumbJ- Spill Contractor 970--260-1576 Cell

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The well pad site is located in the NE 1/4 NW 1/4 of Section 32. T6S. R94W, 6th P.M. (NADB3 N39.4857" W107.9157")

The site will temporarily office and house up to a maximum offour individuals during natural gas drilling activities and is expected to be completed in one year or less. 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 300 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 26 ft.

RWF 11-32 Site Plan Garfield County, Colorado

Small Temporary Employee Housing and Septic Permit Application

Applicant: Williams Production RMT

Date: November 17, 2011 Checked: DJF

Fox Engineering Solutions LLC 670 Canyon Creel< Drive, Grand Junction, CO 81507

Ph: (970) 250-5505 1 Fa.: (626) 784-0667 Err&~: [email protected]

Version: 001

__ r_ ----- ----

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

Vacating Public Roads & Rights-of-Way Sketch Plan

Preliminary Plan I Conservation Subdivision

BASE FEE

$400 $325 $675 + application agency review fees and outside 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 I Correction Plat $100 Combined Preliminary Plan and Final Plat $1 ,075 Minor Exemption I Amendment $300 I $300 Major Exemption I Amendment $400 I $300 Rural Land Development Option Exemption I Amendment $400 I $300 General Administrative Permit $250 Floodplain Development Permit $400 Pipeline Development Plan I Amendment $400 I $300 Small Temporary Employee Housing $50 Minor Temporary Employee Housing $250 Limited Impact Review I Amendment $400 I $300 Major Impact Review I Amendment $525 I $400 Rezoning: Text Amendment $300 Rezoning: Zone District Amendment $450 Planned Unit Development (PUD) I Amendment $500 I $300 Comprehensive Plan Amendment $450 Variance $250 Interpretation $250 Takings Determination NO FEE Planning Staff Hourly Rate

• Planning Director • Senior Planner • Planning Technician • Secretary

$50.50 $40.50 $33.75 $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 Robert E. Duggan ______ _ ___ Property Owner (hereinafter OWNER) agree as follows:

1. OWNER has submitted to COUNTY an application for _____________ _ RWF 11-32 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 IZED REPRESENTATIVE)

Date /

Bryan S. Hotard Print Name

Williams Production RMT Company LLC Mailing Address:

PO Box 370, Parachute, CO 81635

Page 4

Bonuales, Gia

From: Sent: To: Cc: Subject: Attachments:

Bonuales, Gia Friday, November 18, 2011 9:55AM '[email protected]'; 'Julie Taylor' Reed, Gary RWF 11-32 Rig Move On Notification RWF 11-32 Sheriff Letter & Map dated 11-17-11 . 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 32- T65-R94W. 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.

Gia d3onua1~Z<D Land Data Technician I Williams Production RMT Company LLC 1058 County Road 215/PO Box 370 Parachute, Co 81635 970.263.2746-0ffice 970.216.8537-Cell 970.285-2047-Fax [email protected]

1

November 17th' 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 RWF 11-32 pad

Dear Jim:

Williams Production RMT Company llC 1058 CR #2 15 P.O. Box 370 Parachute, CO 8 1635-0370 970/285 -9377

970/285-9573 f:tx

This letter is to inform the Garfield County Sheriffs Department that Williams Production RMT Company LLC will soon commence drilling operations on the above mentioned drilling location. Williams will provide rig site housing accommodations for the duration of the drilling operation approximately 60 days.

In accordance with Garfield County Planning and Zoning Regulations, the attached documentation provides emergency response information and driving directions for the Williams RWF 11-32 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

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Ojrectjoos to Site·

I?'A'F I J -32 Oriiii'Od • f'tot .f ACCESS ROAD MAP

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8. Otiller's Office/Housing 7. Shod

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Emergency Contact List·

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The well pad s1te 1s located 1n the NE 1/4 NW 1/4 of Section 32. T6S, R94W, 6th P.M. (NAD83 N39.4857" W107.9157")

The site will temporarily office and house up to a max1mum of four individuals during natural gas drilling activities and is expected to be completed in one year or less. The individuals w 11l occupy two •ndividual trailer officesfhouses 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 utili:tes 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 approlCimately 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 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 ma•ntained year·round through the services of private road maintenance and construction contractors .

Base mapping by Bookcliff Survey Services, Inc. S ite features including housing trailers. water and wastewater tanks. portable toilets and dumpster surveyed with Trimble Geo-XT G PS 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/Hous•ng} have a minimum separation distance of 26 ft.



Applica nt: Williams Produclion RMT

Date: November 17. 2011 Checked o..F

Fox Engineering Solutions LLC 670Canyon Cr~ Onve, Gntr<l Junc::tJOn, CO 81507 Ph. (Q70) 250-5505 I Fax (82&) 76'-oc5e7

En'al: [email protected]

VeBA00: 001

~ , ; a

Bonuales, Gia

From: Sent: To: Cc: Subject: Attachments:

Bonuales, Gia Friday, November 18, 2011 9:57 AM 'Kevin Whelan'; 'Julie Taylor' Reed, Gary RWF 11-32 Rig Move On Notification RWF 11-32 RFPD Letter & Map dated 11-17-11 . 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 32- T6S-R94W. 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.

Gie l?onuel)ls Land Data Technician I Williams Production RMT Company LLC 1058 County Road 215/PO Box 370 Parachute, Co 81635 970.263.2746-0ffice 970.216.8537 -Cell 970.285-2047-Fax [email protected]

1

November 17th, 2011

Rifle Fire Protection District Emergency Operations Attn: Kevin Whelan 1850 Railroad Ave Rifle, CO 81650 Ph: 970-625-1243

RE: Emergency Response Notification RWF 11-32 pad

Dear Kevin:

Williams Producrion RMT Company LLC 1058 CR #2 15 P.O. Box J70

Parachute, CO 81 635-0370

970/285-9377 970/285-9573 hx

This letter is to inform the Rifle 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 RWF 11-32 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


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ACCES.SOEX~ f~ THf lf(f(ftsECTlON Of' STATE HtGKNAY GN#J CCJUWTY IIt(W) l2'l (RIJUSOH Ro.t.O) HOR'Tl-1 OF RWSO .... I"RRCC£0 SOVT'H£"'-Y AL.0NC COUNTY ROAD 37l {RlA. ISON ROAOl t1. , lrotlt£$ TO 'flofE ~CTlON ~TH COIJft(TV A0AD 300 flliUI ISOH JOA.AACt •• lfi': A¢'.0). PROCfED l [l'q IH AH '-"STna VOIM'C"nON ~t.!i Wl.rS TO A"'' rHT'fiii:M'C"nOH W1'TH A OIRTICRAvtl. RQoJ.O, ~0 LE" IN A NOimitltl'f TO WfSTERl'f OIR'ECTION 10.S ~lES TOni£ E'I(]ST..C RWF 11·32 DAl.L II"AO LOCATION. AS~ kEf't€0N.

Ojrectjons to Site·

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" · Wildhf•proof dumpslef S. Compeny ~n OffreeiHouslf"'Q 6. Orinet"'s Office/HoUSing 7. Shed

• Subjoe1 to relocation for con5truclion adiv•ties.

Emergency Cootac;t Us t·

Ma.n Ofrtee· D70.28S·G3n answMed 24 Hours Bob 8raMl- Wiliams Drilling Q7().309-547Q CeU Scon Brlldy- Williams Drifting 8~970-270-9187 Cen Kevin Mc:Oen'non· Wtlllams Safety.970.J09.11 05 Cell Mark Mum~· Spill Contractor 970-200..1570 Cell

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The well pad site is located in the NE 1/4 NW 1/4 of Section 32. T6S. R94W, 6th P.M. (NA083 N39.4857" W107.91 57")

The site will temporarily office and house up to a max1mum of four individuals during natural gas dri lling activities and is expected to be completed in one year or less. The individuals will occupy two individual trailer offices/houses IDeated on the well pad. Office/houses have Colorado orvtsion of Housing compliance tags .

One aboveground sewage holding tank with 40QO..gallon capacity on·site. Sewage flows estimated to be 300 gallons/day (4 individuals • 75 gpcd). Sewage holding tank needs to be emptied approximately every 13.3 days (4000 gallons I 300 gallons per day). Wastewater vault equipped with overflow alarm device. Williams utilizes the services of a licensed contractor to remov e and haul the wastewater to a State c ertified treatment/disposal facilit y.

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 suppresston demand is 2500 ganons. 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. Ory hydrants observed on water tank.

Road access to the site is maintained year.round through the servic es of priv ate road maintenance and construction contractors .

Base mapping by Bookcliff Survey Services. Inc . Site features including housing trailers. wa ter and wastewater tanks, portable toilets and dumpster surveyed with Trimble Geo-XT GPS equipment. Please note that this is a constructton site and that the locations of drill equipment and other items are subject to change.

F actory·Built Nonresidenttal Structures (Office/Houstng) hav e a minimum separation distance of 26 ft.



Applicant: W illiams Production RMT

Date: November 17. 2011 Checked· D.F

Fox Engineeri ng Solutions LLC 670 Canyon Cr~ Drive. Gral"d J unction. CO 81507 Ph: (970 ) 250.5505/ F•.: (~2~) 784-0067

&rail: eolo,adofolt@ bresnan.net

V~n: 001

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Section 11 T. 6S., R 94 W

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ACCESS DESCRIPTION:

1000 0 2000

~~- I GRAPHIC SCALE IN FEET 1 INCH = 2000 FEET

FROM THE INTERSECTION OF STATE HIGHWAY 6 AND COUNTY ROAD 323 (RULISON ROAD) NORTH OF RULISON, PROCEED SOUTHERLY ALONG COUNTY ROAD 323 (RULISON ROAD) ±1.1 MILES TO THE INTERSECTION WITH COUNTY ROAD 309 (RULISON PARACHUTE ROAD), PROCEED LEFT IN AN EASTERLY DIRECTION ±1.5 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A NORTHERLY TO WESTERLY DIRECTION ±0.5 MILES TO THE EXISTING RWF 11-32 DRILL PAD LOCATION, AS SHOWN HEREON.

~ ~~------------------~------~~----~---r------------------~~~~~-1 ~

November lOth, 2011

Mr. Fred Jarman, Director Garfield County Building and Planning Department 108 gth Street, 41h Floor Glenwood Springs, CO 8160 I

RE: RWF 11-32 and RWF 14-29 Drilling Pad Locations Garfield County, Colorado

Dear Mr. Jannan:

This letter authorizes Williams Production RMT Company LLC to represent me in the submittal and processing of the required Garfield County Small Temporary Employee Housing (STEH) and Individual Sewage Disposal System (ISDS) pennits on the above drilling pad locations.

Sincerely,

--

L~DPOWERO~ATTORNEY

WlLLIAM8 l'RODUC110N RMT COMPAN'l( LLC ("Company") a Delawue limited liability company, having its principal plal:e of business in the City of Tulsa, County of Tulsa, Stale of Oklahoma, does hereby mako, CODJtitute and appoint Jlrya1:1 S. Hotard with the full aulhoril)l hereinafter provided, the truo and lawful Allomey-in-Fact of the Company, authorized md empowered on behalf of lhc Company and in tho Company's name, and tor the sole and exclusive bonofit of lho Company and not oo bcbalf of any other person, coxporation or as.~ociation, in whole or in put. to enter into, execute, deliver, fila and aoc:ept all instnuncnt. and doewncnts affecting the real property or real estate rights of tho Company includiog but not limited to, lho following descnbed instrumeola and doc~l:l:

I. Applications aod documentation liBIIOCillled with Gvfiold Col1llty or Rio Blaru:o permllling requirements, including, but oct limited to, lndcpeudenl Sewage Disposal Systems, Small Tomporuy Bmployoo Housing, Major Impact Rt:views, Limited Impact Reviews, Oil and Gas well permitting, Driveway Access, County Road Maintenance, Temporuy Living Quartm, Temporary Use Petmits, Sumec Uae Ponoibl, Surface Use Licenses, Utilities, Snow Removal and Priv!'le Construction of Colllll)l Roads;

2. Agrecmcola and other documentation that 811101 casements, rights of way, licenses, or peanits to Company and also ins!rumenl$ where the Company granl8 such rights to others;

3. Agrcet~~enl8 that assign caac:mcots, right& o! way, licenses, permits or surface lea= In connoctioo with the Company's opmllioJUI;

4. Releases B11d Partial Releases of cascmc:nlll B11d rights of way; 5. Agreemcola allowiog cncroacbmculs onto oaseoianiS and rights of way owned by

Compaoy and landowner i.ostruments and convC)'811CeS on olhcn easements; 6. Apements subordinstlug casement or lease to mortpge rights; 7. Agreements relating to th~ modification andrelocatioo of Company facilities; 8. Rculal or lease 118tflCmenl!l for eurfilc<o use or other surfa<:<> uac agreemonts and all nofu:es

related to the pipeline &gRC~Dcnlll; . 9. AgRC!DcniS for tbo p\IJ1lbua or sale of real property and for tbe lease of real property for

residential purposes or olberwlsc in connection with the Company's operations; l(l. Agraement& to obtain water services, electrical, gas or oil services or lhc provisioo of

other utility senrlces uhlbecl by Company's filcilides; 11. AgrcemeniS modifyiltg, IIIIII'Dding, 1e11owiog, mtll:ndlng, ratll}ling forfeiting, canceling

and terminating lillY and aU of tho afonwentioncd types of instnllnent& and documents.

Tbe Company hereby deelarcs that each and evcl}' act, matter and thing which. sball bo given, made and done by Bryan S. Hotard in oooocction with ~ mu:roisc of any or all of the aforesaid powors shall bo as good, valid aod effectual to aU intents and purposes as if the same had boco given, mad& and dono by tho Company In Its limited liabt1il)l company prcscooe ;md it hereby ratifies wbalsocver Attorney-jn..Pact $hall lawfully do or cause to be done by virtue hmoo£ Tbis Limited Power of Attomey shall nomaill in Jlili lbrce and eflio<;t until tennlnalcd by Company.

IN WITNESS WIIERE0)1, lhe Company bas W~S<:d this Limited Power of Attorney to be &igned by one of its Vice Pl1lSiclen!s, duly authorized by its Management Committee lo gn1nt powers ofaltomoy tbisl..ltday of July, 201 I.

ACKNOWLEllGMENT

STATB OF OKLAHOMA )" ) ...

COUNTY OF TULSA )

BBFO'RE Mil, the UDdusigntd autbority, aNomy Public in and for said C01Dity and State, on tbJa day parscmally oppcan:d, Ieny D. Ba:mea persormlly knowlllo me to bo the Vice P!esidenl or WD..LlAMS PRODUCTION JtMT COMPANY lLC a Delaw= Urnited liability colllpany, wlw acknowledged to 1110 !hot he bas executed tbe above LlMITJID POWER OF A TIORNEY 1111hori:ud by Company's Manasement Committee.

IN Wl'l'NSSS WHEREOF, 1 have here\mlo set my hand and affixed my nolal)l seal, the lL. day ofJuly, 20 II.

11;~~d :t.J) orlt' NomyPu lio

My Co!Miiss!on .Bxpi""': 2 - 1.. 3 - '2 0 I t.f

AFTER BECQRQAifON PI fiAAE BffiiBN TO

V'IILllAMS PROOUcnoN CO RMT LLC ATTN: U\ND DEPT. P.0.80X370 PARACHlJTE, CO 81635

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Garfield County Building & Planning Department

108 8th Street Suite 401

Glenwood Springs, CO 81601-

Phone: (970)945-8212 Fax: (970)384-34 70

Permit NO. SEPT -11-11-2284 Permit Type: Septic Pennlt

Worlc Classification: New Permit Status: Active

Issue Date: 11/18/2011 Expires: 11/17/2012

Project Address

1550 RWF 11-32 CR 320 RD RIFLE, CO

Owner Information

Robert E Duggan

Contractor(s) Williams Production RMT

Proposed Construction I Details Septic for STEH

FEES DUE

Fee

Septic Fee - New

Total:

Friday, November 18, 2011

Parcel No.

217532200041

Address

1550 CR 320 Rifle CO

1550 CR 320 Rifle CO

Phone (970)285-9377

FEES PAID

Subdivision

Primary Contractor Yes

Valuation:

Total Sq Feet:

Section Township Range

Phone Cell

(970)625-2728

Required Inspections:

For Inspections call : 1 {888)868-5306

Inspection IVR

$0.00

0 See Perm it Record

Amount lnv Total Paytype Amt Paid Amt Due

$73.00

$73.00 lnv #SEPT -11-11-21527 $ 73.00 Check# 000071 82 $73.00

$0.00

Building Department Copy

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GARFIELD COUNTY SEPTIC PERMIT APPLICATION

1088"'Street, Suite401 , Glenwood SprinQs, CO 81601 I

Pho ne· 970 945 8212/ Fax· 970 384 3470 / Inspection Line· 970 384 5003 - - ' - - - -R ll.~ fr' -i Jrl ?r ' www. e.arfield-countv.com

Parcel No:(this information is available at the assessors office 970-945-9134) ~

2175-322-00-041 A \ 1 I v J, Job Address: (if an address has not been assigned, please provide Cr,Hwy or Street Name & City) or legal description ~IU I LU t ~\.1 U l"'ll-\1~1' !; RWF 11-32 See the attached plat for description. J$7>0 Cf.. '3W ,tlfle Lot Size: Lot No: Block No: Subd/Exemption:

See Attached Survey Plat

Owner: (property owner) Mailing Address Ph: AltPh:

Robert E . Duggan 1550 County Roa d 320

970-625-2728 Rifle , Colo rado

Contractor: Ph: AltPh:

Williams Production PO Box 3 70, Parachute, CO 970-285-9377 ext 2754

RMT Company LLC 81635 Engineer: Mailing Address Ph: AltPh:

N/A

P"rmlt R"ou.,sl For: IX \ New Installation I \ Alteration I \ Reoair

Waste Type: ( X )Dwelling ( ) Tranient Use ( ) Commercial or Industrial ( ) Non- Domestic Wastes

( ) Other- Describe

Building Or Service Type:

Number of Bedrooms: 2 Garbage Grinder ( )Yes (X )No

Source & Type of Water Supply: ( )Well ( )Spring ( ) Stream Or Creek ( ) Cistern

If supplied by COMMUNITY WATER. give name of sup_j)lier: Down Valley Septic and Waste

Distance to Nearest Community Sewer System:_ N/A

Was there an effort to connect to the community System? N/A

YOUR INDIVIDUAL SEWAGE DISPOSAL SYSTEM PERMIT WILL NOT BE ISSUED WITH OUT A SITE PLAN

Ground Conditions :

Depth to 1st Ground Water Table N/A Percent Ground Slope N/A

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 Vallev Waste for their disposal

Final Disposal By:

( ) Absorption trench, Bed or Pit ( ) Underground Dispersal ( ) Above Ground Dispersal ( ) Evapotranspiration ( ) Sand Filter

1

1 ) Wastewater pond <X )Other-Describe Hauled to Down Valley Waste for their disposal

Will effluent be discharged Into waters of the state? ( )Yes (X )No

Percolat ion Test Result: (to be completed by Registered Professional Engineer, if the Engineer does the Percolation Test) N/A

Minutes per inch in hole No.I Minutes per inch in hole No.3

Minutes per inch in hole No.2 Minutes per inch in hole No.4

Name, address & telephone of RPE who made soil absorption test: N/A

Name, address & telephone of RPE responsible for design of the system:N/A 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 conditions as deemed necessary to insure compliance with the rules and regulations made, information and reports submitted herewith and ~~bmitted 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 y al epartment of health in evaluationg the same for purposes of issuing the permit applied for

herin. 1 fu~~d that any falsification o i e en a ion may result in the denial of the ap~z or revocation of any permit granted based upon

said ap::ation ::al action.?~~ // ~- //

Owners Si!il6ature: Brvan $(Hotard Date / / ~IAt-t- U~t:. UNLY

P~rmlt F~t{ 1 ~ ,()D I P~rkF~~ I To:f!/j'~, {59- J I Building P~rmll N:

septic ~rp~ _ r--;< ~ Issue Date: /I /1 ?/II Building & PlonAnc D~pt:\ ( ) APPROVAL .../t.L p "- I A" DATE lf/7v Ill ~ '\'--- \.

"'---..) ,

nov 8 21':! :srth -j car i -- v pi small temporary ... application.pdfr'ljll dlf\1(~ k pi...

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