RECEIVED MAY 2 R 7014 ce GJ'}JM=TJtw

Community Development Department 108 8th Street, Suite 401

Glenwood Springs, CO 81601 (970) 945-8212

www.garfield-county.com

INDIVIDUAL SEWAGE DISPOSAL SYSTEM

(ISDS) PERMIT APPLICATION

TYPE OF CONSTRUCTION l!I New Installation JD Alterat ion I D Repair

WASTE TYPE l!I Dwelling JD Transient Use I D Comm/I ndustria I I Non-Domestic D Other Describe

INVOLVED PARTIES Property Owner: Chevron USA Inc Phone: (713 ) 372-1450

Mailing Address: PO Box 285, Houston, TX 11001

Contractor: WPX Energy Rocky Mountain, LLC Phone: ( 910 ) 285-9377 ext 2209

Mailing Address: PO Box 370, Parachute, co 81635

Engineer: David Fox Phone: (~) 250.5505

Mailing Address: PO Box 370, Parachute, co 81635

PROJECT NAME AND LOCATION Job Address: TR 24-28-597 - See attached plat for description

Assessor's Parcel Number: 213728300004 Sub. Lot Block --Building or Service Type: Temporary office & house #Bedrooms: 2 Garbage Grinder No

Distance to Nearest Community Sewer System: NA

Was an effort made to connect to the Community Sewer System: NA

Type oflSDS D Septic Tank I D Aeration Plant 111 Vault I D Vault Privy I D Composting Toilet

D Recycling, Potable Use D Recycling I D Pit Privy I D Incineration Toilet

D Chemical Toilet ii Other Hauled lo Down Valley Wasle for their disposal

Ground Conditions Depth to 1" Ground water t able NA I Percent Ground Slope NA

Final Disposal by D Absorption trench, Bed or Pit j D Underground Dispersal I D Above Ground Dispersal

D Evapotranspiration D Wastewater Pond I D Sand Filter

Iii Other Hauled to Down Valley Waste for their disposal

Water Source & Type D Well I D Spring I D Stream or Creek I D Cistern

Ii Community Water System Name DownValley SepticandWaste

Effluent Will Effluent be discharged directly into waters of the State? D Yes Ii No

CERTIFICATION Applicant acknowledges that the completeness of the application is conditional upon such further mandatory 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 rules and regulations made, information and reports submitted herewith and required to be submitted 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 by the local department of health in evaluating the same for purposes of issuing the permit applied for herein. I further understand that any falsification or misrepresentation may result in the denial of the application or revocation of any permit granted based upon sa id application and legal action for perjury as provided by law.

I hereby acknowledge that I have read and understand the Notice and Certification above as well as

which is correct and accurate to the best of my knowledge. --~~-+.~

Property Owner Print and Sign

OFFICIAL USE ONLY

Special Conditions:

Perk Fee: Fees Paid:

Balance Due: ,4

~5- ,;o -"2_0 "' DATE

Section 28 T. 5 S., R. 97 W.

c

PAD 0 0 0 0

PIT 0 0

REVISED: 2/21/ 14

'NOTE: 1.) No Additional Earthwork Anticipated at this site. 2.) Total Disturbed Area= ±7.98 ac.

Construction Plan Prepared for: .-----------;WPXENERGY. .

WPX Energy Rocky Mountain, LLC SCALE: J"c JOQ'

DATE: 1121114 PLAT: 2 of 9 PROJECT: Trail Ridge DFT: cs

Section 28 T. 5 S, R. 97 W.

ACCESS DESCRIPTION: FROM THE INTERSECTION OF THE 1-70 FRONTAGE ROAD AND COUNTY ROAD 215 AT PARACHUTE, PROCEED IN A NORTHERLY DIRECTION ALONG COUNTY ROAD 215 ±7.2 MILES TO THE INTERSECTION WITH GARDEN GULCH ROAD, PROCEED LEFT IN A WESTERLY DIRECTION ALONG GARDEN GULCH ROAD ±23.1 MILES TO AN INTERSECTION WITH A DIRT/GRAVEL ROAD, PROCEED LEFT IN A SOUTHERLY DIRECTION ±2.1 MILES TO THE EXISTING TR 24-28-597 DRILL PAD LOCATION, AS SHOWN HEREON.

Construction Plan Prepared for: ..---- --------1 WPXEN ERGY .

WPX Energy Rocky Mountain, LLC

High level Alar11 If 111'1 r Alan!

ISPl'allt

Tank Is Full

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 facil ity.

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.

c:::J.

TR 24-28-597 Vault System Description

The site will temporarily office and house up to a maximum of four individu­als during natural gas drilling activit ies and is expected to be completed in one year or less. The individuals will occupy two ind ividual trailer offices/ houses located on the well pad. Office/houses have Colorado Division of Housing compliance tags.

LIMITED POWER OF ATTORNEY

WPX ENERGY ROCKY MOUNTAIN, LLC ("Company") a Delaware limited liability company, having its principal place of business in tbe City of Tulsa, County of Tulsa, Slate of Oklahoma, does hereby make, constitute and appoint Bryan S. Hotard with the full authority hereinafter provided, the true and law fill 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 real e,•tate rights of the Company as more specifically set forth below: :

I. Applications and documentation associated with Garfield County or Rio Blanco permitting requirements for including, but not limited to, Independent Sewage Disposal Systems, Small Temporary Employee Housing, Major Impact Reviews, Limited Impact Reviews, Oil and Gas well pennitting, Driveway Access, County Road Maintenance, Temporary Living Quarters, Temporary Use Permits, Surface Use Permits. Surface Use LicensM, Utilitie,•, Snow Removal and Private Construction of County Roads;

2. Agreements and other documentation that grant e,asements, righL• 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, license,s, permits or surface leases in coMection with the Company's operations;

4. Releases and Partial Releases of easements and rights of way; 5. Agreements allowing encroachments onto easements and rights of way owned by

Company and landowner instruments and conveyances on others casements; 6. Agreements subordinating mortgage rights to e,asement or lease ; 1. Agreements relating to the modification and relocation of Company facilities; 8. Rental or lease agreements for surface use or od1er surface use agreements and all notices

related to the pipeline agreements; 9. Agreements for the purchase or sale ofreal property nnd for the lease ofreal property for

residential or commercial purposes or otherwise in connection with the Company's operations;

10. Agreements to obtain water services, electrical, gas or oil services or the provision of other utility services utilized by Company's facilities;

11. Agreements modifying, amending, renewing, extending, ratifying forfeiting, canceling and terminating any and all of the aforementioned types of instruments and documents.

WPX ENERGY ROCKY MOUNTAlN, LLC hereby declares that each and every act, matter and thing which shall be given, made and done by Bryan S. Hotard in connection with the exercise of any or all of the aforesaid powers shall be as good, valid and effectual to all intents and purposes as if the same had been given, made and done by WPX Energy Rocky Mountain, LLC 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 full force and effect until tenninated by Company.

r

•

IN WITNESS WHEREOF, WPX Energy Rocky Mountain, LLC has caused U1is 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 I" day of January, 2012.

AJN,LLC

ACKNOWLEDGMENT

STATEOFOKLAHOMA ) ) SS.

COUNTY OF TULSA )

BEFORE ME, the undersigned authority, a Notary Public in and for said County and State, on this day personally appeared, Jerry D. Barnes personally known to me lo be the Vice President of WPX Energy Rocky Mountain, LLC a Delaware limited liability coltlpany, who acknowledged to me that he has executed the above LIMITED POWER OF ATTORNEY authomed by Company's Management Committee.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my notary seal, theZoUJ day ofJaftu"f)', 2012.

Fci:¥uoxj

Notary Pu lie

My Commission Expires: l -'2-B-'2- Oli_/

After Recordation Please Return To: WPX Energy Rocky Mountian, LLC

Attn: Land Dept. POllox 370

Parachute, CO 81635

t<IMSE:Rl..V J. DEHT lWll!r ....... 111.,..Wllt ----·-Mt~ .. l,lll,!IGtt

2