Application Requirements Checklist APPLICATION REQUIREMENTS: Name of Location: One completed Application form. One completed Certification of Surface Use Agreement form. One completed Certification of Notice form. One completed Questionnaire. Approved access permit issued by the County s Department of Public Works. One completed Affidavit of Interest Owners Surface Estate form. One completed Authorization form. An Improvements Agreement, if applicable. An approved copy of the Weld County Emergency Action Plan (EAP) or evidence it is not required by the Weld County Office of Emergency Management. One copy of a scaled location drawing see attached page for drawing requirements. One copy of a scaled facility drawing showing the approximate location of flowline corridors. A finalized list of the oil & gas facility components. One legible copy of the deed or legal instrument by which the applicant obtained an interest in the property. A Flood Hazard Development Permit (FHDP), if applicable. One electronic copy of the completed application materials. Application fee of $500.00. Investigation fee, if required (50% of application fee). The applicant shall submit one (1) packet containing one (1) legible copy of all the above items for a 7-day completeness review. If submitting a hard copy (in addition to the electronic copy) the packet shall be bound with either paper clips or binder clips (no substitutes).
Procedural Guide APPLICATION FEE $500.00 For each location* HEARINGS/MEETINGS Administrative Approval Planning Services may defer the WOGLA to the Board of County Commissioners for action PROCESSING TIME 45 days Additional 45 days** Fees are non-refundable and due at time of application submittal. Fees are set by the Board of County Commissioners by Resolution. County Staff is not authorized to negotiate fees and cannot, under any circumstance, change, reduce, or amend the fees set forth in the Weld County Planning Fee Schedule. *Location is defined by each site requiring a COGCC Form 2A **This date may go beyond 45 days depending on scheduling a hearing with the Board of County Commissioners. PURPOSE The purpose of this packet is to provide information to the applicant regarding Weld County s Oil and Gas Location Assessment (WOGLA) for an OIL AND GAS FACILITY. Any words or phrases in this application packet which are in uppercase letters refer to specific definitions that can be found in Weld County Code Section 23-1-90. INTENT AND APPLICABILITY The purpose of this packet is to provide general information to an applicant about the WOGLA application process. It is not intended to be a substitute for the specific requirements of Weld County Code, Chapter 23, Article II, Division 10. It is the responsibility of the applicant to be knowledgeable of the specific requirements of the Weld County Code, Chapter 23, Article II, Division 10, for the WOGLA process. WOGLAs require additional consideration to ensure that they are established and operated in a manner that is compatible with existing and planned land USEs in the NEIGHBORHOOD. The additional considerations of WOGLAs are designed to protect and promote the health, safety, convenience, and general welfare of the present and future residents of Weld County. The Department of Planning Services is responsible for reviewing and processing the WOGLA application in accordance with Sections 23-2-1010 and 23-2-1020 of the Weld County Code. If determined by the Planning Director, the Board of County Commissioners (BOCC) will consider the application in accordance with Section 23-2- 1030 of the Weld County Code. If a WOGLA is referred to the BOCC, it is required that the applicant attend all hearings scheduled for consideration of the application in order to present the proposal and answer any questions. The applicant is also encouraged to communicate with the Planning Department staff assigned to process and review the application once it has been submitted in order to keep up to date with any developments pertaining to the application. There is an additional $2,500.00 fee assessed to the WOGLA if it is referred to the BOCC. PRE-APPLICATION CONFERENCE Upon the Applicant s or Planning Director s request, made either before or after the submittal of the application, there may be an application meeting between the Applicant and the Department of Planning Services, which may be accomplished through a face-to-face meeting, electronic mail exchange, or conference call, as determined by the Department of Planning Services. The purpose of the application meeting is to give the Applicant an opportunity to demonstrate, through written and graphic information, how the OIL AND GAS FACILITY complies with the standards set forth in the Weld County Code.
Procedural Guide APPLICATION REQUIREMENTS It is the responsibility of the applicant to meet the application requirements outlined in Sections 23-2-1010 and 23-2- 1020 of the Weld County Code. No WOGLA application shall be assigned a case number to be reviewed until all required items on the WOGLA submittal checklist have been completed and submitted to the Department of Planning Services. SIGN POSTING If a public hearing is required, the Applicant will be responsible for posting a sign on the property under consideration in a location readily visible from the adjacent roadway(s). The sign will be posted at least ten days preceding the hearing date, with the BOCC. The sign will be posted adjacent to and visible from a publicly maintained road rightof-way. In the event the property under consideration is not adjacent to a publicly maintained road right-of-way, a second sign at the point at which the driveway (access drive) intersects a publicly maintained road right-of-way will be posted. Evidence that the Applicant posted the sign shall be provided to the Department of Planning Services. INVESTIGATION FEE An additional fifty percent (50%) of the application fee shall be added to the cost of the WOGLA if the USE is started without an approved application. The payment of the investigation fee shall not relieve any persons from fully complying with the requirements of the Weld County Code, Chapter 23, nor from any other penalties.
Application Assistance & Office Locations Weld County Oil & Gas Specialist Department of Planning Services 1555 N 17th Ave Greeley CO 80631 (970) 400-6100 x3579 or x3548 Web link www.weldgov.com/departments/planning_and_zoning Weld County Public Roads Weld County Department of Public Works 1111 H St Greeley CO 80631 (970) 400-3570 Web link www.weldgov.com/departments/public_works Weld County Building Inspection Department of Planning Services 1555 N 17th Ave Greeley CO 80631 (970) 400-6100 x3540 Web link www.weldgov.com/departments/planning_and_zoning Weld County Public Health and Environment Department of Public Health and Environment 1555 N 17th Ave Greeley CO 80631 (970) 400-2702 Web link www.weldgov.com/departments/health_and_environment Weld County Office of Emergency Management Department of Emergency Response P.O. Box 758 Greeley, CO 80632 (970) 304-6540 Web link https://www.weldgov.com/departments/office_of_eme rgency_management Colorado Highways Colorado Dept. of Transportation Region 4 10601 W. 10 th Street Greeley CO 80634 (970) 350-2148 Web link www.codot.gov Dept. of Public Health and Environment (CDPHE) Storm Water Permits - Water Quality Control Division 4300 Cherry Creek Dr. South Denver, CO 80246 303-692-3500 Web link www.colorado.gov/cdphe
Application Parcel Number(s) - - - - Parcel Number(s) - - - - (12-digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.weldgov.com) Legal Description of the Oil and Gas Location: Section Township North Range West Zone District: Flood Plain: Geological Hazard: MS4 Area: Airport Overlay District: Acreage of the Oil and Gas Location (disturbance area): Acreage of the Oil and Gas Facility (interim reclamation): Existing land use of the property where the Oil and Gas Location will be located: Provide the X and Y coordinates (Latitude and Longitude) of the proposed OIL AND GAS FACILITY. Coordinates must be submitted as Decimal Degrees with precision to the fifth decimal place. (Example: 40.45113, -104.69800): Provide the X and Y coordinates (Latitude and Longitude) of the Approved Access for the OIL AND GAS FACILITY. Coordinates must be submitted as Decimal Degrees with precision to the fifth decimal place. (Example: 40.45113, -104.69800): FEE OWNER(S) OF THE PROPERTY: Name: Work Phone # Home Phone # Email Address: City/State/Zip Code: OPERATOR: Name of Company: Name of Location: Applicant Name: _ Work Phone # Cell Phone # Email Address: City/State/Zip Code: PROPOSED USE: I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or contained within the application are true and correct to the best of my (our) knowledge. s of all fee owners of property must sign this application unless an Authorized Agent signs and a letter of authorization from all fee owners is included with the application or an executed Surface Use Agreement is included with the application. If a corporation is the fee owner, notarized evidence must be included indicating that the signatory has to legal authority to sign for the corporation. : Owner or Operator Date : Owner or Operator Date
Certification of Surface Use Agreement (SUA) Name of Location: I (We) hereby certify, under penalty of perjury that the below stated information is true and correct to the best of my knowledge. I (We) have a Surface Use Agreement (SUA) or other document, including, but not limited to, a Memorandum of SUA or an affidavit by the Applicant, which has been executed by the operator and the surface owner(s) of the property where the OIL AND GAS LOCATION will be located. I affirm and acknowledge that the above statement is true and correct. Subscribed and sworn to before me this day of, 20 My commission expires Notary Public OR If no SUA or other document is available at the time of applying for the WOGLA, the Applicant shall provide a statement that it is currently in SUA, or other agreement negotiations, and that it will bond onto the OIL AND GAS LOCATION through the Colorado Oil and Gas Conservation Commission, or otherwise utilize its legal right of access as codified in C.R.S. 34-60-127. Statement: I affirm and acknowledge that the above statement is true and correct. Subscribed and sworn to before me this day of, 20 My commission expires Notary Public
Certification of Notice to Building Units within 1,000 feet, Weld County Local Government Designee (LGD), And LGD s for Municipalities Located within 1,000 feet of the Oil and Gas Location Name of Location: I (We) hereby certify, under penalty of perjury and after carefully reading the entire contents of this document, that the below stated information is true and correct to the best of my knowledge. I (We) have notified the owner(s) of building units located within 1,000 feet of the OIL AND GAS LOCATION (as determined by Weld County Assessor s record at the time of notice), the Weld County Local Government Designee (LGD), and LGD s for municipalities located within 1,000 feet of the OIL AND GAS LOCATION and have met with those notice recipients who have requested consultation. I affirm and acknowledge that the above statement is true and correct. Subscribed and sworn to before me this day of, 20 My commission expires Notary Public
Questionnaire The following questions are to be answered and submitted as part of the WOGLA application. If a question does not pertain to your use, please respond with not applicable, with an explanation as to why the question is not applicable. A. A statement which explains that the application complies with Article V and Article XI of Chapter 23 of the Weld County Code, if the proposal is located within any Overlay District Area or a Special Flood Hazard Area identified by maps officially adopted by the County. B. A statement which provides evidence of compliance with the following standards: 1. The OIL AND GAS FACILITY shall be located to minimize impact on agricultural operations. 2. Dust * This control date may measures go beyond 45 shall days depending be employed on scheduling as necessary a hearing with during the Board high of County traffic Commissioners. periods for both on-site and off-site haul roads, including unpaved COUNTY roads when necessary and in consultation with the COUNTY s Department of Public Works. 3. Traffic reduction measures shall be employed by operators when feasible: such as, utilizing fresh water supply pipelines for completions and the use of centralized storage facilities and/or transmission of crude oil via pipeline. 4. Haul routes shall be designated and developed in consultation with the COUNTY. Municipalities, with roadways which are part of the haul routes, should be included in such consultation. 5. Liquid and solid wastes shall be stored and removed for final disposal in a manner that protects against surface and groundwater contamination. 6. The OIL AND GAS FACILITY shall comply with the Colorado Water Quality Control Commission regulations. 7. Noise from drilling, completion activities, and production shall comply with the Colorado Oil and Gas Conservation Commission Noise Control Regulation A-Scale Limits. 8. Light sources shall be shielded or directed downward, and in a manner to reduce impacts onto adjacent properties and dwellings. 9. Visual mitigation measures shall be considered and employed when feasible. 10. Site security measures shall be employed as necessary. 11. The OIL AND GAS FACILITY shall be maintained in such a manner to prevent noxious weeds. Fees are non-refundable and due at time of application submittal. Fees are set by the Board of County Commissioners by Resolution. County Staff is not authorized to negotiate fees and cannot, under any circumstance, change, reduce, or amend the fees set forth in the Weld County Planning Fee Schedule. C. A statement describing the size and approximate location of all oil and gas, and/or water pipelines, and connecting to the OIL AND GAS FACILITY. D. A statement describing the kind of vehicles (type, size, weight) that will access the OIL AND GAS FACILITY during drilling and completion operations, and a defined access route. This shall include a traffic narrative with the following information: 1. The number of roundtrips/day expected for each vehicle type: Passenger Cars/Pickups, Tandem Trucks, Semi-Truck/Trailer/RV (Roundtrip=1 trip in and 1 trip out of site). 2. The expected travel routes or haul routes for the site traffic. 3. The travel distribution along the routes (e.g. 50% of traffic will come from the north, 20% from the south, 30% from the east, etc.). 4. The time of day when the highest traffic volumes are expected. A statement describing who will provide fire protection to the site. If the drilling waste (cuttings and fluids) will be disposed of on the oil and gas location, including a statement describing the location and disposal method. Updated 10/2018
Weld County Public Works Dept. 1111 H Street P.O. Box 758 Greeley, CO 80632 Phone: (970)304-6496 Fax: (970)304-6497 ACCESS PERMIT APPLICATION FORM Property Owner Name Company _ Address City State Zip Phone E-mail Authorized Agent/Applicant (if different from Owner) Name Company _ Address City State Zip Phone E-mail Information The access is on CR Nearest intersection: CR & CR Distance from intersection: ft. Parcel number: Section/Township/Range:_ Total number of existing accesses to parcel: Total number of proposed accesses: Latitude _ Longitude Planning/building case number Description of Work Proposed Access Information Culvert size & type (15 CMP/RCP min.) Materials used to construct access Access construction schedule Approx. width of access_ Proposed Access Count Residential Commercial Oil and Gas Agricultural Temporary Required Attached Documents Property map or sketch (template available on pg. 2) indicating all proposed and existing accesses Access Pictures (N, S, E, & W at the location where the access meets a county maintained road) Access Authorization Form (Not required if the application is signed by the property owner) Additional application materials may be required by the Public Works Department Fee schedule $75 - Temporary, Small Commercial & Residential $150 - Industrial & Large Commercial Existing Access Count Residential Commercial Oil and Gas Agricultural Submit application to accesspermits@weldgov.com By accepting this permit, the undersigned Property Owner/Authorized Agent, under penalty of perjury, verifies they have received all pages of the permit application; they have read and understand all the permit requirements and provisions set forth on all pages. By virtue of their signature the Property Owner/Authorized Agent is bound by and agrees to comply with all said permit requirements and provisions, all Weld County ordinances, and state laws regarding access construction. _ Printed Name _ Date Printed Name _ Date (In case of multiple Property Owners/Authorized Agents) Accesses must be constructed within 1 year of issuance. An extension can be requested from the Weld County Public Works Department. Accesses must be in accordance to Chapter 12, Article V and Appendix 12-A of County Code Page 1 of 2
Parcel Sketch = Existing Access = Proposed Access CR CR CR CR Page 2 of 2
Affidavit of Interest Owners Surface Estate Name of Location: Property Legal Description: Parcel Number (s) - - - - Parcel Number (s) - - - - (12-digit number - found on Tax I.D. information, obtainable at the Weld County Assessor's Office, or www.co.weld.co.us) (Include all lots being included in the application area, if additional space is required, attach an additional sheet) There are no Building Units within 1,000 feet of the location. See attached list of Building Unit Owners within 1,000 feet of the location. THE UNDERSIGNED, being first duly sworn, states that to the best of his or her knowledge the attached list is a true and accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned by the Weld County Assessor of the owners of Building Units within 1,000 feet of the oil and gas location. This list was compiled from the records of the Weld County Assessor, or a person qualified to do the task, and shall be current as of a date no more than thirty days prior to the date the application is submitted to the Department of Planning Services. s of all fee owners of property must sign this application. If an Authorized Agent signs, a completed authorization form must be included with the application. If a corporation is the fee owner, notarized evidence must be included indicating the signatory has the legal authority to sign for the corporation. I (We) hereby depose and state under the penalties of perjury that all statements, proposals and/or plans submitted with or contained within the application are true and correct to the best of my (our) knowledge. Subscribed and sworn to before me this day of, 20 My commission expires Notary Public
Authorization Form for Building, Planning and Environmental Health Department Permits and Services **For WOGLA Applications, this Authorization Form will also be accepted for Public Works Access Permit Applications ONLY** Name of Location: I (We),, give permission to _ (Owner please print) (Applicant / Agent please print) to apply for any Planning, Building or Health Department permits or services on our behalf, for the property located at (address & parcel numbers): Fees are non-refundable and due at time of application submittal. Fees are set by the Board of County Commissioners by Resolution. County Staff is not authorized to negotiate fees and cannot, under any circumstance, change, reduce, or amend the fees set forth in the Weld County Planning Fee Schedule. Legal Description: of Section _, Township _ N, Range _ W Property Owners Information: * This date may go beyond 45 days depending on scheduling a hearing with the Board of County Commissioners. Address (including City & Zip): Phone: E-mail: _ Applicant/Agent Contact Information: Main Contact: Company: Address (including City & Zip): Phone: E-Mail: Email correspondence to be sent to: Owner Applicant / Agent Both Postal service correspondence to be sent to: (choose only one) Owner Applicant / Agent Additional Info: Owner : Date: _ Owner : Date: _ Subscribed and sworn to before me this day of, 20 My commission expires Notary Public
Drawing Requirements SCALED LOCATION DRAWING A final drawing showing the OIL AND GAS LOCATION and disturbed areas after collaboration with the property owner, building units located within 1,000 feet, the Weld County Local Government Designee (LGD), and LGD s for municipalities located within 1,000 feet through the WOGLA notice process. The drawing shall be a scaled drawing, or scaled aerial photograph showing the approximate outline of the OIL AND GAS LOCATION. Fees are non-refundable and due at time of application submittal. Fees are set by the Board of County Commissioners by Resolution. County Staff is not authorized to negotiate fees and cannot, under any circumstance, change, reduce, or amend the fees set forth in the Weld County Planning Fee Schedule. The drawing shall * This include date may all go visible beyond 45 improvements days depending on within scheduling 1,000 a hearing feet with of the Board proposed of County OIL Commissioners. AND GAS LOCATION, with a horizontal distance and approximate bearing from the OIL AND GAS FACILITY. Visible improvements shall include, but not be limited to, all buildings and properties, publicly maintained roads and trails, fences, aboveground utility lines, railroads, pipelines or pipeline markers, mines, oil wells, gas wells, injection wells, water wells known to the operator and those registered with the Colorado State Engineer, known springs, plugged wells, known sewers with manholes, standing bodies of water, and natural channels, including permanent canals and ditches through which water may flow. If there are no visible improvements within 1,000 feet of a proposed OIL AND GAS LOCATION, it shall be so noted on the map. The Scaled Location Drawing shall also include the approved access(es) and any proposed mitigation measures. SCALED FACILITY DRAWING A final drawing showing the OIL AND GAS FACILITY. The drawing shall be a scaled drawing, or scaled aerial photograph showing the approximate outline of the OIL AND GAS LOCATION and all wells and/or production facilities and equipment used for measuring distances. The drawing shall also show corridors for all flowlines, oil and gas lines, and water pipelines integral to production, and connecting to the oil and gas facility. The drawing shall include all visible improvements adjacent to the proposed OIL AND GAS LOCATION, with a horizontal distance and approximate bearing from the OIL AND GAS FACILITY. Visible improvements shall include, but not be limited to, all buildings and properties, publicly maintained roads and trails, fences, aboveground utility lines, railroads, pipelines or pipeline markers, mines, oil wells, gas wells, injection wells, water wells known to the operator and those registered with the Colorado State Engineer, known springs, plugged wells, known sewers with manholes, standing bodies of water, and natural channels, including permanent canals and ditches through which water may flow. If there are no visible improvements adjacent to the proposed OIL AND GAS LOCATION, it shall be so noted on the map. The Scaled Facility Drawing shall also include the approved access(es) and any proposed mitigation measures. Updated 10/2018