Garfield County Building & Planning Department

108 Bth Street Suite 401

Glenwood Springs, CO 81601-

Phone: (970)945-8212 Fax: (970)384-3470

Permit NO. SEPT -8-11-2168 Pemit Type: Septic Permit

Worlc Classification: New Perinit Status: Active

Issue Date: 8/26/2011 Expires: 08/25/2012

Project Address

MV8-4 Parachute, CO

Owner Information

Bureau of land management

Contractor{s! Williams Production RMT

Proposed Construction I Details septic for MV 8-4

FEES DUE

Fee

Septic Fee- New

Total:

Friday, August 26, 2011

Parcel No. Subdivision Section Township Range

000000000000 VALLEY MOBILE HOME PARK

Address Phone Cell

2300 River Frontage RD Silt CO 81652

970-876-9000

Phone Primary Contractor (970)285-9377 Yes

Valuation: $0.00

Total Sq Feet: 0

FEES PAID

Amount lnvTotal Paytype Amt Paid Amt Due

$73.00

$73.00 lnv # SEPT-8-11-21349 $ 73.00 Check# 30572349 $73.00

$0.00

Required Inspections:

For lnspeclions call: 1 {888)868-5306

Inspection IVR

See Permit Record

Building Department Copy

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15

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GARFIELD COUNTY SEPTIC PERMIT APPLICATION

1 088'"Street , Suite401, Glenwood Sprin~s. CO 81601

Phone: 970-945-8212 I Fax: 970-384-3470 / Inspection Line: 970-384-5003

AUG 2 5 2011

www.garficld-countv.com r-A ot. '-I ! , C ' l l H~ Parcel No:(this Information is available at the assessors office 970-945-9134) BUILDING & 0 LANt I 2409-212-00-952 Job Address: (if an address has not been assigned, please provide Cr,Hwy or Street Name & City) or legal description

MV 8-4 See the attached plat for description.

Lot Size: Lot No: Block No: Subd/Exemplion:

See Attached Survey Plat

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

Bureau of Land 50629 Hwy 6 & 24 970- 947- 2757

Management Glenwood Springs, CO 8 1601

Contractor: Ph: All Ph:

Williams Production PO Box 370, Parachute, CO 970-285-9377 ext 2754

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

IN/A

Permit Reouest For: rX \New Installation ( \ Alteration ( \ Reoair

Waste Type: eX )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 supplier: 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 (ISOS) 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 Filler

l Wastewater pond eX )Other-Describe Hauled to Down Valley Waste for their disposal

Will effluent be discharged Int o waters of the state? ( )Yes cX lNo

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

Minutes per inch in hole No.1 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 absorpt ion t est: 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,

""'~''" "'' '""""' wbml""' ho'"'"" '"' <~bmmod by <ho ""'""'"' ••• m will bo •••~•""'' to bo '"' '"' =•« to lho bo.O of my knowledge and belief and are designed to be relied o local epartment of health In evaluationg the same for purposes of issuing the permit applied for heri~tand that any falsification or · rens talon may result in the denial of the applica~revocation of any permit granted based upon

said applicati _,...,';:_a~actiorzrj~. . M ~~/// ~otard Owner s Si.afiature: Brvan S . I Date / /

')-~~ · II L C~ "BC>S'":\-.~~ l.lJI ~I At- I"' U~t: UNL Y Penult F~c: Pc:rk Fcc: Total f ees: I Build.::: Pc:rmll #1:

1-3 - 1-~ :e~lp~~~-)ip~

Issue Date: ~-3LQ .. ~ll

Building~ 1}"1onni

~7\) API'R~~ \; k\.. y

~ 6·~ - II DATE

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One aboveground sewage holding tank with 4000-gallon capacity on-site. The Vault System is displayed in both of the pictures. Sewage flows esti­mated to be 300 gallons/day (4 individuals x 75 gpcd). Sewage holding tank needs to be emptied approximately every 13 days (4000 gallons/ 300 gallons per day). Wastewater vault is equipped with overflow alarm device. Williams utilizes the services of a licensed contractor to removed and haul the wasterwater to a state certified treatment/disposal facility.

One potable aboveground water tank of approximately 4000 gallons ca­pacity on-site. Posted on the front of the Tank there is a Sign that states "Potable Water Only". 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 demand is estimated to be 4000 gal­lons.

Road access to the site is maintained year round through the services of pri­vate road maintenance and construction contractor.

SEPTIC

e

MV8-4 Vault System Description

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 less. The individuals will occupy two individual trailer offices/ houses located on the well pad. Office/houses have Colorado Division of Housing compliance tags.

Elev. Ungraded Ground At Loc. Stoke

FINISHED GRADE ELEV. AT LOC.

Existing-. Ladder Existing Tanks

\

Sta. 1+00

Existing Existin

l Fen~e Fence Existing Dehy

C Existing 0 Tank

LEGEND: ---------------- PROPOSED ACCESS ROAD -------- EXI:>TINOROAD

Uintah Engineering & Land Snrveying 85 South 200 E:.s t Ven 1.'U. Ut:.h 84078 (435 ) 789- 1 0 1 7 ~ FAX (4 35) 789- 18 1 3

N \VILLIMv:t:S PRODUCTION RlviT COlv!PANY

lvfV 8-4 SECTION 4, T7S, R96Vl, 6th P.l'v1.

LIMITED POWER O:F ATIORNEY

WD..LIAMS 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 Oklahoma, does hereby make, constitute and appoint Bryan S. Hotard with the full authority hereinafter provided, lhe true and lawful Attorney-in-Fact of the Company, authori2ed 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, COIJ>Oration or association, ln whole or in part, to enter into, execute, deliver, file lllld accept 811 instruments and documents affecting the real property or real estate rights of lhe Company including but not limited to, the following described inslnlrnents and doC'lffi'!llls:

I. Applications aod documentation associated with O.rfield County or Rio Blanco permitting requirements, includitlg, but not limited lo, Independent Sewage Disposal Systems, Small Temporary l!mployee Housing, Major Impact RJ:views, Limited Impact Reviews, Oil and Gas well potmitting, Driveway Access, County Road Maintenance, Temporary Livins Quarters, Temporary Usc Permits, Surface Use Permits, Surface Use Licenses, Utilities, Snow Removal and Prlvalo Construction of County Roads;

2. Agreements and other documentation that grant easements, righlll of way, licenses, or permits to Company and also instruments where the Company granls such rights to others;

3. Agreements that assign easements, rights of way, licenses, permits or surface leases in connection with the Company's operations;

4. Releases and Partial Releases ofease.menll! and rights of way; 5. Agreements allowing cncroochmcnls onto easenionts and rights of way owned by

Company and landowner instiUrnOnts and conveyances on others easements; 6. Apemcnts subordinating easement or lease to mortgage rights; 7. Agreements relating to the modification and relocation of Company facilities; 8. Rental or lease agreements for surfiwo use or other surface use agreements and all notices

related to the pipeline agreements; . 9. AgreemcniS for the pllnlhase or sale of real property and for the lease of real property for

residential pUIJ>OseS or otherwise in connection with the Company's operations; 10. Agreements to obtaln water services, electrioal, gas or oil services or the provision of

other utility services utilb:ed by Company's facilities; II. Agreements modifying, amending, renewing, extending, ntif}'iog forfeiting, canceling

and terminating any and all of the aforementioned types of instruments and documents.

The Company hereby declares that each and every act, matter and thing which shall be given, made and dono by Bryan S. Hotard in connection with tho 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 beeo given, made and done by the Company in its limited liability company presence and it hereby ratifies whall!oever Attorney-in-Fact shall lawfully do or cause to be done by virtue btreot: This Umited Power of Attomey shall remain in full force and cffec;t until terminated by Company.

IN WITNESS WHEREOF, the Company bas caused lhis Limited Power of Attorney to be signed by one of its Vice Presidents, duly authorized by its Management Committee to grant power~ of attorney this U:"day of July, 2011.

ACKNOWLEDGMENT

STATBOFOKLAHOMA )' ) ss.

COUNTY OF TULSA )

BEFORE ME, the undersigned aulhority, a Notlll)' Public In aud for said County and State, on this day personally appeat<Jd, Jerry D. Barnes personally known to me to belhc Vice President of WILLIAMS PRODUCTION RMT COMPANY LLC a Delaware limited liability company, who acknowledged to me that he bas executed the above LIMITED POw:BR OF ATTORNEY authorized by Company's Management Conuniuee.

IN WITNESS WHBR'BOF, I have hereunto set my band and affixed my nolary seal, the JL day ofJuly, 20 II.

H;m.b.ut~d :I J) o it Notlll)' Public

My Commission Expires: 2 - '2. 3 - :2 0 I '-f

AnFR RfCORQAUON PLEASE RETURN TO

WILUAMS PRODUCTION CO RMT LLC ATTN: LAND DEPT. P.O.BOX370 PARACHUTE, CO 81635

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