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Home My WebLink About20130506.tiffe y n r, r.' October 16, 2012 ALLES TAYLOR & DUKE, LLC LICENSED PROFESSIONAL ENGINEERS LICENSED PROFESSIONAL LAND SURVEYORS Subject: Proposed Access for Lots "A" & "B" of RECX 12-0079 Randolph J. & Judy C. Cass 37967 HWY 14 Briggsdale, CO, CO 80611 Dear Madam/Sir: 3610 35TH AVE. UNIT #6 EVANS, 80634 The Mr. and Mrs. Cass are in the process of completing a recorded exemption for a parcel of ground located in Section 20, Township 8 North, Range 62West of the 6th P.M. Access to the property must be permitted before the Recorded Exemption can be completed. A drawing of the existing accesses for the parcel, Proposed Lots "A" and "B", is being attached for your information. The existing property is presently vacant. The existing buildings on the parcel (Proposed Lot "A") consist of one single family dwelling and restaurant (745 SF). There are two existing accesses to these structures, See attached drawing. There is one additional access on the eastern portion of proposed lot "A", this access is used for access to the proposed Lot "B" (Ag) and can also used for the single family dwelling as an access. The property is being sold and the new owners are reopening the restaurant or convert the restaurant to a Liquor Store (745 SF) or a combination of both. The plans of the new owner have not been set at this time. The assumed number of customers per day is 35 (35 "2 = 70 trips/day). The residential structure has an assume trip generation of 6 trips/day. The agricultural access is assumed to generate 4 trips/week. The average daily trip generation is 70 + 6 + 1 = 77 trips/day. The above access information was obtained from the present property owner. If you have any questions, please contact me at (970) 330-0308. Respectfully submitted, Mark A Taylor Colorado P.E. 46065 2012-115 V/≥ -1 ✓ ^ 1 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Issuing authority application acceptance date: Instructions: - Contact the Colorado Department of Transportation (COOT) - Contact the issuing authority to determine what plans and - Complete this form (some questions may not apply to Please print - Submit an application for each access affected. or type - II you have any questions contact the issuing authority. - For additional information see CDOTs Access Management or your local government to determine your issuing authority. other documents are required to be submitted with your application. you) and attach all necessary documents and Submit it to the issuing authority. website at http://wbvw.dolstate.co.us/AccessPermIts/Index.htm 1) Property owner (Permittee) Randolph J. & Judy C. Cass 2) Applicant or Agent for permittee (if different from properly owner) Bruce Johnson Street address 43251 HWY 392 Mailing address 801 8th St., 41220 City, state & zip Briggsdale, CO 80611 Phone x 970 381-5002 City, slate & zip Greeley, CO 80631 Phones (required) 970 356-6110 E-mail address E-mail address if available 3) Address of property to be served by permit (required) 37967 HWY 14, Briggsdale, CO 80611 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? Wanly subdivision bock lot cedion 'Ovmahq mrge Weld I N/A I N/A I N/A 120 18N I 62W 5) What State Highway are you requesting access from? 14 6) What side of the hi hway? � E W ■ N �] S 7) How many feel is the proposed access from the nearest mile post? 176 How many 750+- feet is the proposed access from the nearest cross street? WCR 77/HWY 392 0 feet g ill E=W)from: feetON DS MESW)from: 8) What Is the approximate date you intend to begin construction? 9) Check here if you are requesting a: anticipated: to existing access of an existing access (provide detail) • new access • temporary access (duration ) ■ improvement (] change in access use 0 removal of access Delocalton 10) Provide existing property use See attached letter. 11) Do you have knowledge of any State Highway access permits serving this properly, or adjacent properties in which you have a property interest? permit number(s) and provide copies: and/or, permit date: o no • yes, if yes - what are the 12) Does the property owner own or have any interests in any adjacent properly? . no E yes, If yes - please describe: 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? your plans and Indicate the proposed and existing access points. CI no • yes, if yes - list them on 14) If you are requesting agricultural field access - how many acres will the access serve? The eastern access is ag and will serve 74.6+— Acres 15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. business/land use square footage business square footage See attached letter. 1 I I 16) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units? type number of units type number of units Single Family l 1 j 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate if your counts are If ci passenger cars and kghl Pucks al peak Pour voLmes 76 s Oi multi un Iwcks al peak hour volumes :peak hour volumes or a average daily volumes. a el single unit vehicles in excess of 30 IL 1 s el farm veh¢les maid enugmentl Total count of all vehicles 77 Previous editions are obsolete and may not be used Page 1 of 2 COOT Form P137 01/10 From:ALLES Taylor and puke, I1C 9703520128 10/24/2012 12:31 8962 P. 002/003 IB) Chodrwoh Se kawro eunorlt m a.arnrins welch er1M Io rowrna eooumento ter.gIred m maewae the rewew et yrwr ssinegon a) Property nap hid eat ig She rota bordering noun end net e) eubdrtdon, nano a dovabornomPlan. h) Mpheq al pinp,olle. 4 Ptopoeedaaooudelbn. c) Drugs Pen roses Ned tohhomphnyrights, way. g) Pule end owrnershlpmaps Inclining eawniwra. 4 IMe and timelessly!, flrsd etene Why bcelers balm end altar h) Trifle ones. ob^9 te dghlasway. s Proof oloonenNa 1 • II Is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply to their activities. Such clearances may Include Corps of Engineers 404 Permits or Colorado Discharge Perron System permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances Information Summary presents contact Information for agencies administering certain dearettces. Information about prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the CDOT Planting/Conelucton.Environmental-Guidance wobpago Mpy/Kgw,dot,slste.co,adenvlronmenle /Fomithpq. 2- Al) workers within the State Highway right of way shall complywith their employer's safety and health polkleo/ procedures, and all applicable U.S. Occupational Safety and Health Adminlstradon (OSHA) regulation - including, but not limited to the applicable sections of 29 CFR Part 1910.Ocwpslonal safety and Health Standards and 29 CFR Part 1926 • Safety and Health Regulations for Construction. Personal protective equipment (o.g. head protection, footwear, high vielbillty apparel, safety pleases, hearing protection, respirators, gloves, etc.) shell bo worn as appropriate tor the work being portormod, and as apecl0ed In regulation. At a minimum, all workers In the State Highway right of way, except when in Moir vehicles, shall wear the following persons' protective equipment: High visibility apparel as specified In the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit (al a minimum, ANSInSEA 107-1999, clew 2); head preloction that complies with the ANSI 289.1-1097 standard; end at ail construction sites or whenever there is danger of Injury to feet, workers shall comply with OSHA's PPE requirements for toot protection per 29 CFR 1910.139, 1929.95. and 1926.90. It required, such footwear shall meet the requirements of ANSI 241 1999. Where any of the above4rererenoad ANSI standards have been revised, the meet recent version of the Standard shall apply. 3- The Permitee is roapenelble for complying with the Revised Guidelines that have been adopted by the Access Board under to American Olsabltba Act (ADA). These guidelines define Imamate slope roqulremenb and prescribe the use of a defined pattern of truncated domes as detectable warnings at tercet crossings. The now Standards Plane and can be found en the Design and Construction Project Support web page at reh ttoJ/weM dot-etete.Co.ae/D.NAn6YBD0rt/a, then click on Design SullaOr% If an access permit le issued to you, it will elate the terms and condition for Its use. Any changes In the use of the permitted mites meal not corSlstent rah the terms and conditions listed on the permit may be con&dered a violation of the perm• The applicant declares under penalty et perjury In the second degree, and any other applicable state or federal laws, that all Infomglon provided on this form and submitted etteehmsnta are to the best of their knowledge true and complete. I understand reptpt of an scan permit does not constitute permission to start access construction work. Appncent or Aged for PannM ES rlpnafun Pdmnune aura A. Bruce Johnson 10/17/2012 If the applicant Is not the owner of the property, we require this application also to be signed by the property owner or their legally authorized representative (or other acceptable written evidence). This signature shat constitute agreement with this application by all owners•oHHnterest unless slated In writing. If a permit is issued, the property owner, in most cases, will bo listed es the permitter). Pnoe aatymme Motown, De L'-_ 11 ((F / Randolph J. a Judy C. Can 10/17/2012 Paging eemas w ebsohni cif may na be wee rye zeta coorfaa fur tine ec Tec.:E:C1 J,3-11')fl :903J:Wi=i33 90:es] 2Rna,-;C-I:lfi 18) Check with the issuing authority to determine which of the following documents are required to comptete the review of your application. a) Property map indicating other access, bordering roads and streets. b) Highway and driveway plan profile. c) Drainage plan showing impact to the highway right-of-way. cf) Map and letters detailing utility locations before and alter development In and along the right-of-way. e) Subdivision, zoning, or development plan. f) Proposed access design. gi Parcel and ownership maps including easements. h) Traffic studies. i) Proof of ownership. 1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances Information Summary presents contact information for agencies administering certain clearances, information about prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the CDOT Planning/Construction-Environmental-Guidance webpage http://www.dot.state.co.us/environmental/Forms.asp. 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head protection that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there is danger of injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41.1999. Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall apply. 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be found on the Design and Construction Project Support web page at: chttp://www.dot.state.co.us/DeslgnSupport/>, then click on Design Bulletins. It an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal laws, that all information provided on this form and submitted attachments are to the best of their knowledge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. Applicant or Agent for Perrnittee signature Print name A. Bruce Johnson Date 10/17/2012 If the applicant is not the owner of the property, we require this application also to be signed by the property owner or their legally authorized representative (or other acceptable written evidence). This signature shall constitute agreement with this application by all owners -of -interest unless stated in writing. If a permit is issued, the property owner, in most cases, will be listed as the permittee. Property owner signature Print name Dale Randolph J. & Judy C. Cass 10/17/2012 Previous editions are obsolete and may not be used Page 2 of 2 CDOT Form #137 01110 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED cool Permit No. 412104 SH/S/MP 14 C / 175.766 / L Local Jurisdiction Weld County Permittee(s): Applicant: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street Briggsdale, CO 80611 #220 Greeley, CO 80631 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior t pr dtTng cortsfructibt) as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department /N Colorado Department of Transportation //./ By Bye//�+��\\/� {IU�I �1n(I;A,� (X \ 1 jinn �.A A Y� \1 W" `) Title �f^(C -`M,f J PCP c 7 WNI i.glip Date / i9 O</ Copy distribution: Required: Region (original) Applicant Staff Access Section Make copies as ecessary for: Local Authori y Inspector Tim Bilob MICE Patrol Traffic Engineer 20 -Ault COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT COOT Permit No. 412104 State Highway No/Mp/Side 14 C / 175.766 / L Permit fee $0.00 Date of transmittal 11/8/2012 Region/Section/Patrol 4 / 01 /20 -Ault Local Jurisdiction Weld County The Permittee(s); Applicant: Ref No.: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street, #220 Briggsdale, CO 80611 Greeley, CO 80631 970-381-5002 970-356-6110 is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and used in accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked by the issuing authority if at any time the permitted access and its use violate any parts of this permit. The issuing authority, the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location: This access to be closed is located on State Highway 14, a distance of 4048 east of mile post 175 on the north/left side of the road. Access to Provide Service to: (Land Usc Code:) (Size or Count) (Units) 997 - Agriculture I EACH Additional Information: MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Title Date Upon the signing of this permit the perm nee agrees to the terms and conditions and referenced attachments contained herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to being used. The Dermittee shall notify Tim Bilobran with the Colorado Department of Transportation in Greeley, Colorado at (970) 350-2163, at least 48 hours prior to commencing construction within the State Highway right-of-way. The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to accept the permit and its terms and conditions. germ ee Signatures — lbb� Print Name r� Date �r ? �> permit is not valid until signed by a duly authorized representative of the Department. ORADO DEPARTMENT OF TRANSPORTATION re�/� (l I slx>•+1 Karl1 tName�` 1t m k 1kXo 1 Title NC c it SC Krat :L0C ( Date of issue) \ 1 't.) tl' Ibutlon: Required: 1. Region 2 Applicant Make copies as necessary for: 3.Staff Access Section Local Authority Inspector 4.Cenlral Files MTCE Patrol Traffic Engineer Previous edlUbns are obsolete and may no used Page 1 of 3 CDOT Form #101 5/07 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the option of including within the appeal a request for a review by the Department's internal administrative review committee pursuant to [Code] subsection 2.10. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law Judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 1. A permit shall be considered expired if the access is not under construction within one year of the permit issue date or before the expiration of any authorized extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4] 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 2.14. All materials used in the construction of the access within the highway right-of-way or on permanent easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working' days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the construction according to the terms and conditions of the permit. Failure by the permittee to abide by all permit terms and conditions shall be sufficient cause for the Department or issuing authority to Initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the summary suspension of the permit. If the permittee wishes to use the access prior to completion, arrangements must be approved by the issuing authority and Department and Included in the permit. The Department or Issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element falls within two years due to Improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or public or private utilities for the construction of a permitted access, the relocation, removal or repair shall be accomplished by the permittee without cost to the Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed In the permit shall be repaired Immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the Individual or office specified on the permit at any specified phases in construction to allow the field Inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the perm'ttee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -In -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine If a new access permit and modifications to the access are required. 2. When an access is constructed or used In violation ol the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure ol the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, and the removal or clearance of snow or Ice upon the access even though deposited on the access in the course of Department snow removal operations. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary Is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility. Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not all -Inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT — Please Review The Following Information Carefully — Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information - (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website http://www.cdohestate.co.us/permits,aso. • COOT Water Quality Program Manager: Rick Willard (303) 757-9343 hh�://www.coloradodot,info/programs/environmental/water- quality • COOT Asbestos Project Manager: Theresa Santangelo-Drelling, (303) 512-5524 • Colorado Office of Archaeology and Historic Preservation: (303) 866-3395 • U.S. Army Corps of Engineers, District Regulatory Offices: Omaha District (NE Colorado), Denver Office (303) 979-4120 http://www.nwo.usace.annv,mil/html/od-tl/tri-lakes.htmt Junction Office (970) 243-1199 htto://www,sok.usace.armv.mil/cesok-co/reaulatorv/ Sacramento Dist. (Western CO), Grand Pueblo Reg. Office (719)-543-6915 http://www.spa.usace.armv.mil/reo/ Albuquerque District (SE Colorado), • CDOT Utilities, Special Use and Access Permitting: (303) 757-9654 htto•//wwW,d9lstate.co.u$JPermits/ fcotoglcal Resources — Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or If suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by COOT prior to the continuation of work. Information about threatened or endangered species may be obtained from the CDOT website, htto://coloradodot,info/programs/environmental/wild lifelauidetines or the Colorado Division of Wildlife website htto://wildlife.state.co.us/WildlifeSoecies/SpeclesOfConcerni. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources — The applicant must request a file search of the permit area through the Colorado Office of Archaeology and been identified. Inventory of Historic Preservation (OAHP), Denver, to ascertain If historic or archaeological resources have previously the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file search at (303) 866-3395. Paleontological Resources • The applicant must request a fossil locality file search through the University of Colorado Museum, identified. Boulder. and the Denver Museum of Nature and Science to ascertain if paleontological resources have been previously Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: Contact the CDOT Paleontologist at (303) 757-9632. jazardous Materials, Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Certificate Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25.15.301 et al. and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the CDOT Regional Permitting Office for direction as to how to proceed. Contact Info: Andy Flurkey, CDOT Hazardous Materials Project Manager, (303) 512-5520. Asbestos Containing Materials, Asbestos Contaminated Sol( — All work on asbestos containing materials (ACM) must comply with done in the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's (HMWMD) Solid Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information concerning clearance on CDOT protects is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santangelo-Dreiling, Property Management Supervisor (303) 512-5524. Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation December'10 Transportation of Hazardous Materials • No person may offer or accept a hazardous material for transportation in commerce unless 49 CFR, Part 171. The that person is registered in conformance with the United States Department of Transportation regulations at hazardous material must be properly classed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by applicable requirements, or an exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For authorization and more info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT Registration (303) 969-6748. Colorado Public Utilities Commission: (303) 894-2868. Administered By the U.S. Army Corps of Engineers, and Section 401 Discharge of Dredged or Fill Material —404 Permits Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 Permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 Permits, including Nationwide Permits, which are issued for activities with relatively minor impacts. For example, there is a Nationwide Permit for Utility Line Activities (NWP #12). However, depending upon the specific circumstances, it is possible that either a "General" or "Individual" 404 permit would be required. If an individual 404 Permit is required, Section 401 water quality certification from the CDPHE WQCD is also required. Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (contact information above). Contact the CDPHE Water Quality Control Division at (303) 692-3500. Working on or in any stream or its bank - In order to protect and preserve the state's fish and wildlife resources from actions that be to may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may necessary obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream is defined as 1) represented by a solid blue line on USGS 7.5' quadrangle maps; and/or 2) intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands present within 200 yards upstream or downstream of the project. The Colorado Division of Wildlife (CDOW) application• as per guidelines agreed upon by CDOT and CDOW, can be accessed at http://www.F4leradodol.info/programs/environmental/wild) ifelouidelines. Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from constructon sites disturbing one acre or more - or certain types of industrial facilities, such as concrete batch plants - requires a CDPS Stormwater Construction Permit. Contact Information: For Utility/Special Use activities being performed in conjunction and coordination mith a CDOT highway construction contract, please contact the CDOT Water Quality Program Manager at (303) 757- 9343. Otherwise, contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: htted/www.cdohe.s1ate.coalLwg(PermitsUnit/fndex,htmt. Construction Dewatering (Discharge or Infiltration) — Discharges of water encountered during excavation or work in wet areas Permits, may require a Construction Dewatering Discharge Permit. Contact Information: For Construction Dewatering Discharge contact the CDPHE WQCD at (303) 692-3500. For Dewatering Application and instructions, see Section 3 at the CDPHE website: http: //www.cdphestate.co. us/wc/PermitsUnit/FORMSandApolications/Aoosandformanewpage. html Municipal Separate Storm Sewer System (MS4) Discharge Permit — Discharges from the storm sewer systems of larger municipalities, and from the COOT highway drainage system that Iles within those municipalities, are subject to MS4 Permits issued by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to an MS4 permit, the owner of such facility should contact the municipality regarding stormwater related clearances that may have been established under that municipality's MS4 permit. All discharges to the CDOT highway drainage system or within the Right of Way (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations Permit # COS - 000005 (http:l/www.coloradodot.info/programs/environmental/water-duality/documents/CDOT%20MS4%20Permit.doc/view) and COR-030000(¢tto:Owww.cdpheitate,co.us/wa/PermitsUnit/PERMITS/SW0ermitsrats/SWConstructionPErmit,odf). Discharges are subject to inspection by CDOT and CDHPE. Contact the CDPHE Water Quality Control Division at (303) 692-3500 for a listing of Permits, to t" ^ ^ ' ^d he. -fate .0 municipalities required to obtain MS4 or go .co General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. Allowable non-stormwater discharges can be found at http://www.cobradodot.infolprograms/environmental/water-quality/glossary.html#AllowableDischarge. Contact Information: Contact the CDOT Water Quality Program Manager at (303) 757-9343, or the Colorado Department of Public Health and Environment, Water Quality Control Division at (303) 692-3500. General Authorization - Allowable Non-Stormwater Discharges - Unless otherwise identified by CDOT or the WQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows• uncontaminated ground water Infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, uncontaminated springs, footing drains; water line flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. Contact Information: The CDOT Water Quality Program Manager or the CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements be will be specified through that permit. In those situations where a stormwater permit is not required, all reasonable measures should taken in order to minimize erosion and sedimentation according to COOT 208 specifications. In either case, the COOT Erosion Control and Stormwater Quality Guide (most recent version) should be used to design erosion controls and to restore disturbed vegetation. Contact Information: The COOT Erosion Control and Stormwater Quality Guide may be obtained from the Bid Plans Office at (303) 757-9313 or from: http://www.dot.state.co.uslenvironmental/envWaterQual/wdms4.aso Disposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges" State Highway Right or "solid wastes", and in general, should be pumped or vacuumed from the construction area, removed from the of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being --__.,, _.., �..I....,A. n-..ad,nanr .a T. .term December'10 Environmental Clearances information Summary separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained In a pit, and are not likely to pose a nuisance to future work In the area, 3) the solids are covered and the area restored as required by COOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact the COOT / CDPHE Liaison or CDOT Water Quality Program Manager. Concrete Washout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, Inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the COOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information: Contact the CDOT Water Quality Program Manager at (303) 757.9343. WebsIle: http:Owww.coloradodot.info/proorams/environmental/water- quality/revlsed•m-standards' refer to the link Revision of Sections 101, 107, 208. 213 and 620 Water Quality Control One or More Acres of Disturbance for additional guidance. Spill Reporting • Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down Into the storm drain or burled. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, Into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1.877-518-5608. About This Form - Questions or comments about this Information Summary may be directed to Alex Karam', CDOT Safety & Traffic Engineering. Utilities Unit, at (303) 757-9841, alex.karamiadot.state.co.us. Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation December '10 a a v Ev E E o e g 'S g Ep�°° q c V e e .$ c p6 : V 6 g a q aE ? 0E a °° v E- n - a A n ro�3xF"g L ,t W o 6E g0 Lo.0 = Y E e v E 'Eft s 2 c n e A E " E E« 2 2 .6"c N 2 ai a •i r I —S' vo+ 9 v v 4 N° z m a n o n '° E 3 g q a E oaf o= a.a V o•0 k% B o°. 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'J' E rn a` 1= 0 a u J Q g° • o d U 2 M 8 o W � .e ua rA:e72 C c .C q a' D 9 o.e 8 € st.la 81 S Jc a S V q C 1€ 3'4 m E a n ra a a n 2 c 3 E c c an c 2 33 ,$ i 9 ° 3 EEs v q q „ N ° A 8 ▪ a £ B o 3 E E E ' u n g v ‘O c pc g c Q c .0 3 E A '§ c rn@° n a '4 g g 3 9 c - v n n 3 _ g g 4 'a�c c - ' �' 33 LL 3 .c 2a a s c v 5 � '0 3 a 5 ° = -c A ■ ■ ■ MMM ■ MMMMMM • a e c 4 N L to O , V ° c e y n E • NaNa `o u c 3• ,4° Q ¢ c State Highway Access Permit 1 Attachment to Permit No. 412104 - Additional Terms and Conditions I. If there are any questions regarding this permit, please contact Tim Bilobran at 970-350-2163. 2. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 3. Incorporated as part of this permit are the following: Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No. 101) and its two page attachment Exhibits: "A"- Access Plan "B"- Vicinity Map 4. This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1), and is based upon the information submitted by the Permittee. This permit is only for the use and purpose stated in the Application and Permit. Any changes in traffic volumes or type, drainage, or other operation aspects may render this permit void, requiring a new permit to the be applied for based upon existing and anticipated future conditions. 5. Access construction methods for closing an access and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 6. If necessary, minor changes, corrections and/or additions to this permit may be ordered by the Department inspector, other Department representative or local authority to meet unanticipated site conditions. Changes may not be in violation of the State Highway Access Code. All major changes to the plans must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. All workers within the State Highway right-of-way shall comply with their employer's safety and health policies/procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable section of 29 CFR Part 1910- Occupations Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Cosntruction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles shall wear the following personal protective equipment: * Head protection that complies with the ANSO Z89.1-1997 standard; * At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn: * High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum, ANSI/ISEA 107-1999, Class 2). Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall apply. 7. This permit is subject to revocation due to: 1) Noncompliance with the provisions of this permit; 2) Abandonment; 3) Supersedure by new permit covering the same installation; or 4) Conflict with necessary planned highway construction and/or improvements. The Permittee shall promptly terminate occupancy State Highway Access Permit 2 Attachment to Permit No. 412104 - Additional Tenns and Conditions upon notice of cancellation of the permit from the Department, unless a new permit is applied for and granted. 8. Reconstruction may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 9. The Department retains the right to perform any necessary maintenance work in this area. 10. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the right-of-way shall be considered a violation of the terms and conditions of this access permit and may result in revocation of the permit by the Department and/or the issuing authority. 11. The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required for the removal of the access. Approval of this access permit does not constitute verification of this action by the Permittee. 12. All costs associated with the closure of this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. 13. No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authorization from the Department. The Department may also restrict work within the State Highway right-of-way during adverse weather conditions. 14. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department. 15. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. 16. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 17. No work shall be performed near a Department electronic traffic control device without coordination with Cobie Garbiso at (970) 350-2137. 18. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Linda McWilliams at the Greeley Traffic Office, (970) 350-2147, to obtain the Landscaping Permit. 19. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under the general terms and conditions of the permit. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, will require written authorization from the Department. The Department shall be given proper advance notice whenever maintenance work will affect State Highway Access Permit 3 Attachment to Permit No. 412104 - Additional Terms and Conditions the movement or safety of traffic on the State Highway. In an emergency, the Department Region Office and the State Patrol shall immediately be notified of possible hazards. 20. All work is to conform to the plans referenced by this permit on file with the Department or as modified by this permit. (If discrepancies arise, this permit shall take precedence over the plans.) The Department plan review is only for the general conformance with the Department's design and code requirements. The Department is not responsible for the accuracy and adequacy of the design, dimensions, elevations, and any other elements which shall be confirmed and correlated at the work site. The Department through the approval of this document, assumes no responsibility for the completeness and/or accuracy of the plans. 21. The State requires a Certificate of Insurance prior to commencing any work on the State Highway right- of-way. Policies shall name the State of Colorado as additional insured party. All vendors, contractors, and utility companies shall procure, at their own expense, and maintain for the duration of the work period, the following minimum insurance coverages: A. Standard workman's compensation and employer's liability, including occupational disease, covering all employees engaged in performance of the work at the site, in the amount required by State Statutes. B. Comprehensive general liability in the amount of $1,000,000 combined single limit bodily injury and property damage, each occurrence and $2,000,000 annual aggregate. C. Automobile liability in the amount of $1,000,000 combined single limit bodily injury and property damage, for each accident. Certificates of insurance showing compliance with these provisions shall be attached to and made a part of this permit and be available on the site during construction. 22. Should any excavation encounter plant or animal fossils, the remains of historic or prehistoric structures, artifacts, (pottery, stone tools, arrowheads, etc.), the work shall be stopped and the Permittee shall notify the Department inspector. 23. Survey markers or monuments must be preserved in their original positions. Notify the Department at (970) 350-2173 immediately upon damage to or discovery of any such markers or monuments at the work site. Any survey markers or monuments disturbed during the permitted work shall be repaired and/or replaced immediately at the expense of the Permittee. 24. The Permittee or the contractor shall notify Tim Bilobran at 970-350-2163 at least two working days prior to beginning any access improvements or construction of any kind within the State Highway right-of- way. Failure to comply with this requirement may result in revocation of this permit. 25. The Department inspector may suspend any work due to: 1) Noncompliance with the provisions of this permit; 2) Adverse weather or traffic conditions; 3) Concurrent highway construction or maintenance in conflict with permit work; 4) Any condition deemed unsafe for workers or the general public. The work may be resumed upon notice from the Department inspector. 26. Construction traffic devices, when not in use, shall be removed or turned away from traffic. 27. The access closure shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highway right-of-way. State Highway Access Permit 4 Attachment to Pennit No. 412104 - Additional Terms and Conditions 28. All required access closure improvements shall be installed prior to the herein authorized use of this access. 29. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. 30. The access closure shall be constructed in a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. 31. All existing drainage structures shall be extended, modified, or upgraded as necessary, to accommodate all new construction and safety standards, in accordance to the Department's standard specifications. 32. The Permittee shall request final inspection by Tim Bilobran at 970-350-2163, within 10 days following completion of access construction, and prior to authorized use. The Permittee or their representative shall be present. 33. A fully executed complete copy of this permit must be on the job site with the contractor at all times during construction. Failure to comply with this or any other construction requirement may result in the immediate suspension of work by order of the Department inspector or the issuing authority. 34. The design and closure of the access and/or development of this property shall not negatively impact adjacent nearby properties. Correction of the problem and cost resulting from damages shall be borne by the Permittee. 35. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http://www.dot.state.co.us/environmental/Forms/asp. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substance such as: wash water, paint, automotive fluids, solvents, oils or soaps. Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, State Highway Access Permit 5 Attachment to Permit No. 412104 - Additional Terms and Conditions flows from riparian habitats and wetlands, and flow from fire fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CDPHE website at: http://cdphe.state.co.us/wa/PermitsUnit/wqu. 36. Removal of this access shall include, but not limited to, the return of the highway right-of-way side slopes, ditches, and fences to match existing adjacent conditions, INCLUDING REMOVAL OF ASPHALT APRONS. Any asphalt removed from the highway shall result in a smooth finished edge. ZONE 1 Northern Loam Soil COMMON NAME BOTANICAL NAME APPLICATION RATE Pounds pls/Acre Grasses Western wheatgrass Pascopyrum smithii "Arriba" 5.0 Sideoats grama Bouteloua curtipendula "Vaughn" 3.0 Green needlegrass Nassella viridula "Lodorm" 3.0 Buffalograss Buchloe dactyloides "Texoka" 5.0 Blue grama Bouteloua gracilis "Hachita" 1.5 Little bluestem Schizachyrium scoparium "Pastura" 1.5 Prairie junegrass Koeleriamacrantha 0.2 Oats Avena sativa 3.0 Total 25.2 Forbs Prairie coneflower Ratibida columnaris 0.3 Purple prairie clover Daleapurpureum var. purpureum 0,5 Dotted gayfeather Liatrus punctata 0.5 Narrowleaf penstemon Penstemon angustifolius 0,2 Gaillardia Gaillardia aristata 1.0 Blue flax Linum Iewisii 0.5 Scarlet globemallow Sphaeralcea coccinea 0.3 Shrubs Fourwing saltbush Atriplex canescens 0.5 Winterfat Ceratoides lanata 0.5 SEEDING APPLICATION: Drill seed 0.25" to 0.50" into the topsoil. In areas that are not accessible to a drill, hand broadcast at triple the above rate and rake 0.25" to 0.50" into the topsoil. MULCHING APPLICATION: 1.5 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre. SPECIAL REQUIREMENT: Due to high failure rates hydroseeding and /or hydromulching will not be allowed. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Issuing authority application IIIcUed r Instructions: - Contact the Colorado Department of Transportation (CDOT) - Contact the issuing authority to determine what plans and - Complete this form (some questions may not apply to Please print - Submit an application for each access affected. or type - If you have any questions contact the issuing authority. - For additional information see CDOT's Access Managementwebsite or your local government to determine your issuing authority. other documents are required to be submitted with your application. you) and attach all necessary documents and Submit it to the issuing authority. at htte://www.dot.state.co.us/AccessPermits/index.htm 1) Property owner(Permittee) Randolph J. & Judy C. Cass 2) Applicant or Agent for permittee (if different from property owner) Bruce Johnson Street address 43251 HWY 392 Mailing address 801 8th St., #220 City, state & zip Briggsdale, CO 80611 Phone # 970 381-5002 City, state & zip Greeley, CO 80631 Phone # (required) 970 356-6110 E-mail address E-mail address if available 3) Address of property to be served by permit (required) 37967 HWY 14, Briggsdale, CO 80611 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? county subdivision block lot section township range Weld I N/A I N/A I N/A 120 18N I 62W 5) What State Highway are you requesting access from? 14 6) What side of the highway? ❑ E ❑ W ■ N S 7) How many feet is the proposed access from the nearest mile post? 176 How many 750+— feet is the proposed access from the nearest cross street? 77/HWY 392 0 feet ON @SUE :W) from: feet ON ASIDE _W)from: WCR 8) What is the approximate date you intend to begin construction? 9) Check here if you are requesting a: anticipated: ) improvement to existing access removal of access Qelocation of an existing access (provide detail) • new access IN temporary access (duration change in access use 10) Provide existing property use See attached letter. 11) Do you have knowledge of any State Highway access permits serving this properly, or adjacent properties In which you have a property interest? permit number(s) and provide copies: and/or, permit date: a no Il yes, if yes - what are the 12) Does the property owner own or have any interests in any adjacent property? • no Ill yes, if yes - please describe: 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? your plans and indicate the proposed and existing access points. El no NI yes, if yes - list them on 14) If you are requesting agricultural field access - how many acres will the access serve? The eastern access is ag and will serve 74.6+- Acres 15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. business/land use square footage business square footage See attached letter.I I I I 16) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units? type number of units type number of units Single Family 1 I I 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate if your counts are # of passenger cars and Pin: Pucks at peak hour volumes 76 # of multi unit trucks at peak hour volumes peak hour volumes or Q average daily volumes. # 01 single un.; vehicles in excess of 30 II 1 # or farm vehicles (field ace Proem) Total count of all vehicles 77 Previous editions are obsolete and may not be used Page 1 oft CDOT Form #137 01/10 From:ALLES Taylor and Duke, LLC 9703520128 10/24/2012 12:31 it952 P.002/003 Is) Check vdth the issuing authority to determine which of the following documents are required to complete the review of your application. a) Property map Indicating other access, bordering roads and sheets. e) Subdvieror, zoning, or development plan. b) Highway and driveway plan profile. fI Proposed access design. c) Drainage plan showing impactto the highway right-of-way. g) Parcel and ownershlp maps including easements. d) Map and letters detailing titan), locations before end after h) Traffic stales. development In end along the rght•of•way. 1) Proof or ownership. 1- It is the applicant's responsibility to contact appropriate to their activities. Such clearances may include Corps of permits, or ecological, archeological, historical or cultural Information Summary presents contact information for agencies prohibited discharges, and may be obtained from Regional COOT Ptanning/Construction-Environmental-Guidance webpage 2- All workers within the State Highway right of way shall procedures, and all applicable U.S. Occupational Safety limited to the applicable sections of 29 CFR Part 1910 - - Safety and Health Regulations for Construction. Personal protective equipment (e.g. head protection, footwear, respirators, gloves, etc.) shall be worn as appropriate for minimum, all workers in the State Highway right of way, protective equipment: High visibility apparel as specified accompanying the Notice to Proceed related to this permit that complies with the ANSI 289.1-1997 standard; and at feet, workers shall comply with OSHA's PPE requirements 1926.96. If required, such footwear shall meet the requirements Where any of the above -referenced ANSI standards have may. 3- The Pennittee is responsible for complying with the Revised under the American Disabilities Act (ADA). These guidelines use of a defined pattern of truncated domes as delectable can be found on the Design and Construction Project Support chtipU/wow,dot.state.co.ua/DeslanSu000rth., then click agencies and obtain all environmental clearances that apply Engineers 404 Permits or Colorado Discharge Permit System resource clearances. The CDOT Environmental Clearances administering certain clearances, information about CDOT Ulilily/Special Use Permit offices or accessed via the htto://vantr.det.state.co.usfenvironmentel/Forms.arm. comply wIth their employer's safety and health policies/ and Health Administration (OSHA) regulations - including, but not Occupational Safety and Health Standards and 29 CFR Part 1826 high visibility apparel, safety glasses, hearing protection, the work being performed, and as specified in regulation. At a except when in their vehicles, shall wear the following personal in the Traffic Control provisions of the documentation (at a minimum, ANSUISEA 107-1999, class 2); head protection all construction sites or whenever there Is danger of injury to for foot protection per 29 CFR 1910.136, 1926.95, and of ANSI 241-1999. been revised, the most recent version of the standard shall Guldellnes that have been adopted by the Access Board define traversable slope requirements and prescribe the warnings at street crossings. The new Standards Plans and web page at: on Design Bulletins, If an access permit Is issued to you, it will slate the terms and conditions for Its use. Any changes In the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal laws, that all Information provided on this form and submitted attachments are to the best of their knowledge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. AppliccsM OrAg 'tee '' ature i . LCv�'y' % �� PAMname A. Bruce Johnson Date 10/17/2012 �U•f If the applicant I of the owner of the property, we require this application also to be signed by the property owner or thelr legally authorized representative (or other acceptable written evidence). This signature shal constitute agreement with this application by all owners -of -interest unless stated in writing. If a permit is Issued, the property owner, in most cases, will be listed as the permlttee. Props erdginire 0"71441.- , � � Print name Randolph J. & Judy C. Can Dace 10/17/2012 L/ Previous edlUona are obsolete end may not be lead Page 2of2 COOT Form Ma) 01/10 CLINI Laza S ICC Cal mks 9 0 O3 a C i 1 "•DELORME Street Atlas USA® 2006 Vicinity Map for Access Permit #412104 "Exhibit B" Caw iiea a Data use subject to license. ® 2005 DeLorme. StreetAtlas USA® 2006. www delorme.com Scale 1 - 50,000 ai 4•q 1" = 4,188 7 ft Data Zoom 12-0 ALLES TAYLOR & DUKE, LLC 0 LICENSED PROFESSIONAL ENGINEERS LICENSED PROFESSIONAL LAND SURVEYORS October 16, 2012 Subject: Proposed Access for Lots "A" &'B" of RECX 12-0079 Randolph J. & Judy C. Cass 37967 HWY 14 Briggsdale, CO, CO 80611 Dear Madam/Sir: 3610 35TH AVE. UNIT #6 EVANS, 80634 The Mr. and Mrs. Cass are in the process of completing a recorded exemption for a parcel of ground located in Section 20, Township 8 North, Range 62West of the 6th P.M. Access to the property must be permitted before the Recorded Exemption can be completed. A drawing of the existing accesses for the parcel, Proposed Lots "A" and "B", is being attached for your information. The existing property is presently vacant. The existing buildings on the parcel (Proposed Lot "A") consist of one single family dwelling and restaurant (745 SF). There are two existing accesses to these structures, See attached drawing. There is one additional access on the eastern portion of proposed lot "A", this access is used for access to the proposed Lot "B" (Ag) and can also used for the single family dwelling as an access. The property is being sold and the new owners are reopening the restaurant or convert the restaurant to a Liquor Store (745 SF) or a combination of both. The plans of the new owner have not been set at this time. The assumed number of customers per day is 35 (35 *2 = 70 trips/day). The residential structure has an assume trip generation of 6 trips/day. The agricultural access is assumed to generate 4 trips/week. The average daily trip generation is 70 + 6 + 1 = 77 trips/day. The above access information was obtained from the present property owner. If you have any questions, please contact me at (970) 330-0308. Respectfully submitted, Mark A Taylor Colorado P.E. 46065 2012-115 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED cool 412105 sFusimp 14C / 175.993 / L Local litisdi°ti« Weld County Permittee(s): Applicant: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street Briggsdale, CO 80611 #220 Greeley, CO 80631 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. -- - — --h .. c' n59 ,rdc; ":-.:-.,°Irnn:nu D n ::ment GI=..L.ILLY 0rF:C= Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Tide Date This Notice is not valid until signed by a duly authonzed representative of the Department Colorado Department of Transportation By (X) I.Aa n n `I 1 / KAPin Tie ASS Pe! \ Arvi Date 11/20/2012 Copy disiribution Regained" - Region (original) Applicant Staff Access Section Make copies as necessary for Local Aulhaiy Inspector Tim Bilobran MICE Patrol Traffic Engineer 20 -Ault am , COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT Permit fee $100.00 Date of transmittal 11/8/2012 Region/Section/Patrol 4 / 01 /20 -Ault CDOT Permit No. 412105 State Highway No/Mp/Side 14C/ 175.993 / L Local Jurisdiction Weld County The Permittee(s); Applicant: Ref No.: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street, #220 Briggsdale, CO 80611 Greeley, CO 80631 970-381-5002 970-356-6110 is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and used in accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked by the issuing authority if at any time the permitted access and its use violate any parts of this permit. The issuing authority, the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location: This access is located on State Highway 14, a distance of 5243 east of mile post 175 on the north/left side of the road. Access to Provide Service to: (Land Use Code:) 805 - Liquor Store (Size or Count) 38 (Units) ADT Additional Information: MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Title Date ' Upon the signing of this permit the perm ttee agrees to the terms and conditions and referenced attachments contained herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to being used. The Dermittee shall notify Tim Bilobran with the Colorado Department of Transportation In Greeley, Colorado at (970) 350-2163, at least 48 hours prior to commencing construction within the State Highway right-of-way. The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to accept the permit and its terms and conditions. Per _�l I ature P nl Name O I Incort Date /7-/9-17 This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION Signature �\1„Int,1�kSC Print Name �\-1 \1M1\Ci7�Vi� Title the \ A / 1 \Gr�CIPI Date (of issue) h ,\I1I \O1 Copy Distribution: Required: 1. Region 2 Applicant Make copies as necessary for 3.Staff Access Section Local Authority Inspector 4,Central Files MTCE Patrol Traffic Engineer Previous ddltions are obsolete and may not be used Page 1 of 3 CDOT Form 0101 5/07 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the option of including within the appeal a request for a review by the Department's internal administrative review committee pursuant to [Code] subsection 2.10. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 1. A permit shall be considered expired if the access is not under construction within one year of the permit issue date or before the expiration of any authorized extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be In writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction Is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4] 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 2.14. All materials used in the construction of the access within the highway right-of-way or on permanent easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the construction according to the terms and conditions of the permit. Failure by the permittee to abide by all permit terms and conditions shall be sufficient cause for the Department or issuing authority to Initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the summary suspension of the permit. If the permittee wishes to use the access prior to completion, arrangements must be approved by the issuing authority and Department and Included in the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element fails within two years due to Improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or public or private utilities for the construction of a permitted access, the relocation, removal or repair shall be accomplished by the permittee without cost to the Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field Inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, Its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the perrnittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine If a new access permit and modifications to the access are required. 2. When an access is constructed or used In violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when Its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway Including any cattle guard and gate, and the removal or clearance of snow or ice upon the access even though deposited on the access In the course of Department snow removal operations. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is Intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility, Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing Is not all -Inclusive - additional environmental or cultural resource permits/clearances may be required In certain instances. Appropriate local, state and federal agencies should be contacted for additional Information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT — Please Review The Following Information Carefully — Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your COOT Permit, Or Enforcement Actions By Other Agencies CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following Individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website http://www.cdohe.state.co.us/0ermits.asp. • COOT Water Quality Program Manager: Rick Willard (303) 757-9343 htto://www.coioradodot.Info/programs/environmental/water- Qualit' • COOT Asbestos Project Manager: Theresa Santangelo-Drelling, (303) 512-5524 • Colorado Office of Archaeology and Historic Preservation: (303) 866-3395 • U.S. Army Corps of Engineers, District Regulatory Offices: Denver Office (303) 979-4120 http://www.nwo.usace.armv.mil/html/od-tl/tri-lakes.html Omaha District (NE Colorado), Office (970) 243-1199 htto://www,sok.usace.armv.mil/cesok-co/regulatorv/ Sacramento Dist. (Western CO), Grand Junction Pueblo Reg. Office (719)-543-6915 http://vwwtsoa.usace,armv.mil/reo/ Albuquerque District (SE Colorado), • CDOT Utilities, Special Use and Access Permitting: (303) 757-9654 :b.ffs.,1Mwkdot.state.co.us/PermiteL .dot.state.co.us/PermiteL Ecological Resources — Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or If suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species may be obtained from the CDOT website, hitp://coIoradodot.Info/programs/environmental/wildlife/auldelines or the Colorado Division of Wildlife website litto://wildlife.state.co.usNVildlifeSpecies/SoeciesOfConcern/. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources — The applicant must request a file search of the permit area through the Colorado Office of Archaeology and been identified. Inventory of Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses. all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file search at (303) 868-3395. paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder, and the Denver Museum of Nature and Science to ascertain if paleontological resources have been previously identified. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: Contact the CDOT Paleontologist at (303) 757-9632. Hazardous Materials. Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Certificate Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15.301 et al. and the Colorado Hazardous Waste Regulations (8 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the CDOT Regional Permitting Office for direction as to how to proceed. Contact Info: Andy Fiurkey, COOT Hazardous Materials Project Manager, (303) 512-5520. Asbestos Containing Materials. Asbestos Contaminated Soli — All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work done in asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's (HMWMD) Solid Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which authorization Is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information concerning clearance on COOT protects is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santangelo-Dreiling, Property Management Supervisor (303) 512-5524. Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation December'10 Transportation of Hazardous Materials - No person may otter or accept a hazardous material for transportation In commerce unless that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR, Part 171. The hazardous material must be properly classed, described, packaged, marked, labeled, and M condition for shipment as required or authorized by applicable requirements, Oran exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For authorization and more Info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT Registration (303) 969-6748. Colorado Public Utilities Commission: (303) 894-2868. Discharge of Dredged or Fill Material —404 Permits Administered By the U.S. Army Corps of Engineers. and Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 Permits are required for the discharge of dredged or fill materials Into waters of the United States, including wetlands. There are various types of 404 Permits, Including Nationwide Permits, which are issued for activities with relatively minor Impacts. For example, there is a Nationwide Permit for Utility Line Activities (NWP #12). However, depending upon the specific circumstances, it is possible that either a "General" or "Individual" 404 permit would be required. If an Individual 404 Permit is required, Section 401 water quality certification from the CDPHE WQCD is also required. Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (contact information above). Contact the CDPHE Water Quality Control Division at (303) 692-3500. Working on or in any stream or Its bank - in order to protect and preserve the state's fish and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary to obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream is defined as 1) represented by a solid blue line on USGS 7.5' quadrangle maps; and/or 2) Intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands present within 200 yards upstream or downstream of the project. The Colorado Division of Wildlife (CDOW) application, as per guidelines agreed upon by CDOT and CDOW can be accessed at bttp://www.coloradodot.info/programs/environmenta I/wlldllfelauldelines. Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from construction sites disturbing one acre or more - or certain types of industrial facilities, such as concrete batch plants - requires a CDPS Stormwater Construction Permit. Contact Information: For Utility/Special Use activities being performed In conjunction and coordination vrith a CDOT highway construction contract, please contact the CDOT Water Quality Program Manager at (303) 757- 9343. Otherwise, contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: htcdshe state co us/wOiPermitsUniUindex himl Construction Dewatering (Discharge or Infiltration) — Discharges of water encountered during excavation or work in wet areas may require a Construction Dewatering Discharge Permit. Contact Information: For Construction Dewatering Discharge Permits, contact the CDPHE WQCD at (303) 692-3500. For Dewatering Application and Instructions, see Section 3 at the CDPHE website: tt ://yvww.cdphe.slate.co.us/wq/PeggitsUnit/FORMSandApplipations/Aposandformanewnage.html Municipal Separate Storm Sewer System (MS4) Discharge Permit — Discharges from the storm sewer systems of larger municipalities, and from the CDOT highway drainage system that lies within those municipalities, are subject to MS4 Permits issued by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to an MS4 permit, the owner of such facility should contact the municipality regarding stormwater related clearances that may have been established under that municipalitys MS4 permit. All discharges to the CDOT highway drainage system or within the Right of Way (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations Permit # COS- 000005(htto:liwww.coloradodotinfo/Programs/environmental/water-auality/documents/COOTT020MS4%20PermitdocivIew) and COR-0300001htto://www.cdohestare.co.us/wa/PermitsUnit/PERMITS/SWpermitsrats/SWConstructionPErmit.odg. Discharges are subject to inspection by CDOT and CDHPE. Contact the CDPHE Water Quality Control Division at (303) 692-3500 for a listing of municipalities required to obtain MS4 Permits, or go to httD://www.cdohe.state.co.us/wo/DermitsunitLMS4/MS4Permittees.pdf. General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. Allowable non-stormwater discharges can be found at http://www.cobradodotinfo/programs/environmental/water-quality/glossary.htmlgAllowableDischarge. Contact Information: Contact the CDOT Water Quality Program Manager at (303) 757-9343, or the Colorado Department of Public Health and Environment, Water Quality Control Division at (303) 692-3500. General Authorization - Allowable Non-Stormwater Discharges • Unless otherwise identified by CDOT or the WQCD as significant sources of poiutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, uncontaminated springs, footing drains; water line flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. Contact Information: The CDOT Water Quality Program Manager or the CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements will be specified through that permit. In those situations where a stormwater permit is not required, all reasonable measures should be taken in order to minimize erosion and sedimentation according to CDOT 208 specifications. In either case, the CDOT Erosion Control and Stormwater Quality Guide (most recent version) should be used to design erosion controls and to restore disturbed vegetation. Contact Information: The CDOT Erosion Control and Stormwater Quality Guide may be obtained from the Bid Plans Office at (303) 757-9313 or from: tLttp://www.dot•$tate.co.us/environmental/envWateLQuallwgm54.a5R Disposal of Drilling Fluids - Drilling fluids used In operations such as Horizontal Directional Drilling may be classified as "discharges" or "solid wastes", and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being _ ___ _ ___ _ ..-u�.. no —hew 4n Environmental Clearances Information Summary p 9 separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact the COOT / CDPHE Liaison or CDOT Water Quality Program Manager. Concrete Washout • Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, Inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information: Contact the COOT Water Quality Program Manager at (303) 757-9343. Webslte: http://www.coloradodotlnfoioroorams/environmentaltwater- Quality/revised•m-standards; refer to the link Revision of Sections 101. 107, 208. 213 and 620 Water Quality Control One or More Acres of Disturbance for additional guidance. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or burled. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (41-120), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an Immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1-877-518-5608. About This Fornt • Questions or comments about this Information Summary may be directed to Alex Karami, CDOT Safety & Traffic Engineering, Utilities Unit, at (303) 757-9841, alex.karamit dot.state.co.us. 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Detect and remove any illicit discharges P. E a r 3" g E cy a 3 g g F vq rn ° - -,F3 k ft i{� 'a'�' € -05 n 'v �i' v_ H f c g 0 a `qo A g E5g `w rn E 3 13. F' " s2 -15 w o a E 5 E oc c',2e ov 'g a g E 1 p` a 3 E v O• n rt a • do o § ,„ d E- a p' E 3 g¢ g s 1 z 1 02 . � 3 g 8 v v `O S a G ■ MMMMMMMMM ■ ■ ■ ■ ■ ■ Y ° State Highway Access Permit 1 Attachment to Permit No. 412105 - Additional Terms and Conditions 1. If there are any questions regarding this permit, please contact Tim Bilobran at (970) 350-2163. 2. The Pennittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 3. Incorporated as part of this permit are the following: Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No. 101) and its two page attachment Exhibits: "A"- Access Plan "B"- Vicinity Map 4. This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1), and is based upon the information submitted by the Permittee. This permit is only for the use and purpose stated in the Application and Permit. Any changes in traffic volumes or type, drainage, or other operation aspects may render this permit void, requiring a new permit to the be applied for based upon existing and anticipated future conditions. 5. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 6. If necessary, minor changes, corrections and/or additions to this permit may be ordered by the Department inspector, other Department representative or local authority to meet unanticipated site conditions. Changes may not be in violation of the State Highway Access Code. All major changes to the plans must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. All workers within the State Highway right-of-way shall comply with their employer's safety and health policies/procedures, and applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment: * Head protection that complies with the ANSI Z89-1-1997 standard; * At all construction sites or whenever there is a danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn; * High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum, ANSI/ISEA 107-1999, Class 2).. Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall apply. 7. This permit is subject to revocation due to: 1) Noncompliance with the provisions of this permit; 2) Abandonment; 3) Supersedure by new permit covering the same installation; or 4) Conflict with necessary planned highway construction and/or improvements. The Permittee shall promptly terminate occupancy State Highway Access Permit 2 Attachment to Permit No. 412105 - Additional Tenns and Conditions upon notice of cancellation of the permit from the Department, unless a new permit is applied for and granted. 8. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 9. The Department retains the right to perform any necessary maintenance work in this area. 10. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the right-of-way shall be considered a violation of the terms and conditions of this access permit and may result in revocation of the permit by the Department and/or the issuing authority. 11. The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required for construction of the access. Approval of this access permit does not constitute verification of this action by the Permittee. 12. All costs associated with the reconstruction of this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. 13. No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authorization from the Department. The Department may also restrict work within the State Highway right-of-way during adverse weather conditions. 14. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department. 15. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 16. No work shall be performed near a Department electronic traffic control device without coordination with Cobie Garbiso at (970) 350-2137. 17. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Tim Bilobran at 970-350- 2163 to obtain the Landscaping Permit. 18. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under the general terms and conditions of the permit. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, will require written authorization from the Department. The Department shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic on the State Highway. In an emergency, the Department Region Office and the State Patrol shall immediately be notified of possible hazards. State Highway Access Permit 3 Attachment to Permit No. 412105 - Additional Terms and Conditions 19. All work is to conform to the plans referenced by this permit on file with the Department or as modified by this permit. (If discrepancies arise, this permit shall take precedence over the plans.) The Department plan review is only for the general conformance with the Department's design and code requirements. The Department is not responsible for the accuracy and adequacy of the design, dimensions, elevations, and any other elements which shall be confirmed and correlated at the work site. The Department through the approval of this document, assumes no responsibility for the completeness and/or accuracy of the plans. 20. Survey markers or monuments must be preserved in their original positions. Notify the Department at (970) 350-2173 immediately upon damage to or discovery of any such markers or monuments at the work site. Any survey markers or monuments disturbed during the permitted work shall be repaired and/or replaced immediately at the expense of the Permittee. 21. Should any excavation encounter plant or animal fossils, the remains of historic or prehistoric structures, artifacts, (pottery, stone tools, arrowheads, etc.), the work shall be stopped and the Permittee shall notify the Department inspector. 22. The Permittee or the contractor shall notify Tim Bilobran at 970-350-2163 at least two working days prior to beginning any access improvements or construction of any kind within the State Highway right-of- way. Failure to comply with this requirement may result in revocation of this permit. 23. The Department inspector may suspend any work due to: 1) Noncompliance with the provisions of this permit; 2) Adverse weather or traffic conditions; 3) Concurrent highway construction or maintenance in conflict with permit work; 4) Any condition deemed unsafe for workers or the general public. The work may be resumed upon notice from the Department inspector. 24. The access shall be reconstructed as per Exhibit "A". 25. Construction traffic devices, when not in use, shall be removed or turned away from traffic. 26. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highway right-of-way. 27. All required access improvements shall be installed prior to the herein authorized use of this access. 28. The access shall be resurfaced immediately upon completion of earthwork construction and prior to use. 29. Resurfacing of the access shall be maintained as per Exhibit "A". 30. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. 31. If frost, water or moisture is present in the subgrade, no surfacing materials shall be placed until all frost, water or moisture is gone or removed. 32. The access shall be reconstructed and maintained in a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. State Highway Access Permit 4 Attachment to Permit No. 412105 - Additional Terms and Conditions 33. The Permittee shall request final inspection by Tim Bilobran at 970-350-2163 within 10 days following completion of access construction, and prior to authorized use. The Permittee or their representative shall be present. 34. All existing drainage structures shall be extended, modified, or upgraded as necessary, to accommodate all new construction and safety standards, in accordance to the Department's standard specifications. 35. A fully executed complete copy of this permit must be on the job site with the contractor at all times during construction. Failure to comply with this or any other construction requirement may result in the immediate suspension of work by order of the Department inspector or the issuing authority. 36. The design and reconstruction of access and/or development of this property shall not negatively impact adjacent nearby properties. Correction of the problem and cost resulting from damages shall be borne by the Permittee. 37. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. 38. The State requires a Certificate of Insurance prior to commencing any work on the State Highway right- of-way. Policies shall name the State of Colorado as additional insured party. All vendors, contractors, and utility companies shall procure, at their own expense, and maintain for the duration of the work period, the following minimum insurance coverages: A. Standard workman's compensation and employer's liability, including occupational disease, covering all employees engaged in performance of the work at the site, in the amount required by State Statutes. B. Comprehensive general liability in the amount of $1,000,000 combined single limit bodily injury and property damage, each occurrence and $2,000,000 annual aggregate. C. Automobile liability in the amount of $1,000,000 combined single limit bodily injury and property damage, for each accident. Certificates of insurance showing compliance with these provisions shall be attached to and made a part of this permit and be available on the site during construction. 39. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http://www.dot.state.co.us/environmental/Forms/asp. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION Of YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substance such as: wash water, paint, automotive fluids, solvents, oils or soaps. State Highway Access Permit 5 Attachment to Permit No. 412105 - Additional Terms and Conditions Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CDPHE website at: http://cdphe.state.co.us/wq/PermitsUnit/wqu. 40. The Permittee shall extend the current 18 inch corrugated metal pipe and shall provide for proper side slopes. Culverts over 18 inches in diameter shall have end sections. ZONE 1 Northern Loam Soil COMMON NAME BOTANICAL NAME APPLICATION RATE Pounds pls/Acre Grasses Western wheatgrass Pascopyrum smithii "Arriba" 8.0 Sideoats grama Bouteloua curtipendula "Vaughn" 3.0 Green needlegrass Nassella viridula "Lodorm" 3.0 Buffalograss Buchloe dactyloides "Texoka" 5.0 Blue grama Bouteloua gracilis "Hachita" 1.5 Little bluestem Schizachyrium scoparium "Pastura" 1.5 Prairie junegrass Koeleria macrantha 0.2 Oats Avena saliva 3.0 Total 25.2 Forbs Prairie coneflower Ratibida columnaris 0.3 Purple prairie clover Dalea purpureum var. purpureum 0.5 Dotted gayfeather Liatrus punctata 0.5 Narrowleaf penstemon Penstemon angustifolius 0.2 Gaillardia Gaillardia aristata 1.0 Blue flax Linum lewisii 0.5 Scarlet globemallow Sphaeralcea coccinea 0.3 Shrubs Fourwing saltbush Atriplex canescens 0.5 Winterfat Ceratoides lanata 0.5 SEEDING APPLICATION: Drill seed 0.25" to 0.50" into the topsoil. In areas that are not accessible to a drill, hand broadcast at triple the above rate and rake 0.25" to 0.50" into the topsoil. MULCHING APPLICATION: 1.5 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre. SPECIAL REQUIREMENT: Due to high failure rates hydroseeding and /or hydromulching will not be allowed. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION RUE" ID Issuing author ty application Instructions: - Contact the Colorado Department of Transportation (CDOT) - Contact the issuing authority to determine what plans and - Complete this form (some questions may not apply to Please print - Submit an application for each access affected. Or type - If you have any questions contact the issuing authority - For additional information see CDOT's Access Management or your local government to determine your issuing authority. other documents are required to be submitted with your application. you) and attach all necessary documents and Submit it to the issuing authority. website at httD:/lwww.dot.slate.co.us/AccessPermlts/index.hlm 1) Property owner (Permittee) Randolph J. & Judy C. Cass 2) Applicant or Agent for permittee (if different from property owner) Bruce Johnson Street address 43251 HWY 392 Mailing address 801 8th St., #220 City, state & zip Briggsdale, CO 80611 Phone # 970 381-5002 City, state & zip Greeley, CO 80631 Phone # (required) 970 356-6110 E-mail address E-mail address if available 3) Address of property to be served by permit (required) 37967 HWY 14, Briggsdale, CO 80611 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? county subdivision block let section township range Weld I N/A I N/A I N/A 120 18N I 62W 5) What State Highway are you requesting access from? 14 6) What side of the highway? ❑E ❑W II OS 7) How many feet is the proposed access from the nearest mile post? 0 feet ON fSMIE qW) from: 176 How many 750+- feet is the proposed access from the nearest cross street? 77/HWY 392 feet ON DS ■E —W) from: WCR 8) What is the approximate date you intend to begin construction? 9) Check here if you are requesting a: anticipated: ) improvement to existing access removal of access Qelocatlon of an existing access (provide detail) • new access M temporary access (duration change in access use 10) Provide existing property use See attached letter. 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? permit number(s) and provide copies: and/or, permit date: Q no • yes, if yes - what are the 12) Does the property owner own or have any interests in any adjacent property? Q no 0 yes, If yes - please describe: 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? your plans and indicate the proposed and existing access points. a no fl yes, if yes - list them on 14) If you are requesting agricultural field access - how many acres will the access serve? The eastern access is ag and will serve 74.6+- Acres 15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. business/land use square footage business square footage See attached letter. I I I 16) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units? type number of units type number of units Single Family I 1 I I I 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate If your counts are it of passenger cars and light trucks at peak hour volumes 76 s of multi unit trucks al peak hour volumes peak hour volumes or O average daily volumes. s of single unit vehicles in excess of 30 ft. 1 li of farm verities (field equipment) Total count of all vehicles 77 Previous editions are obsolete and may not be used Pagel et 2 COOT Form #137 01/10 From:ALLES Taylor and Duke, LLC 9703520128 10/24/2012 12:31 1t952 P.002/003 ter) Chedt Wei the twang authority to determine which of the following documents are required to complete the review of your application. a) Property map indicating other access, bordering roads and streets. a) aubdNeion, zoning, or developmentplan. h) Highway and driveway plan profile. f) Proposed access design. c) Drainage plan showing Impact to the highway right -or -way. g) Parcel and ownership maps including easements. d) Map and letters detailing utiity locations before and alter h) Traffic erodes. development In and along the right-of-way. I) Proof of ownership. 1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances Information Summary presents contact information for agencies administering certain clearances, information about prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the COOT Planning/Construction-Environmental-Guidance webpage httedAvww.dot.state.co.us/environmental/Forms.ase. 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head protection that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there is danger of injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999. Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall may. 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be found on the Design and Construction Project Support web page at: ehttp.//www.dot.state,co.us/DeslonSupporth, then click on Design Bulletins. It an access permit is issued to you, it will state the terms and conditions for Its use. Any changes In the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal laws, that all Information provided on this form and submitted attachments ere to the best of their knowledge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work, Applicant or Agee ea abre 'ice, 4—.----"------------- Pdmname A. Bruce Johnson Date 10/17/2012 If the applicant I of the owner of the property, we require this application also to be signed by the property owner or their legally authorized representative (or other acceptable written evidence). This signature shal constitute agreement with this application by all owners -of -interest unless stated in writing. If a permit is Issued, the property owner, in most cases, will be listed as the permlttee. /// Props erdgnewre /j 44-4------..... a /vim � Plintrnme Randolph J. & Judy C. Casa Date 10/17/2012 Previous edlulens ere obsolete and nay rot be used Page 2 of 2 COOT Fora Mal 01/10 Pa Pa eit 111110211111 IMAM J C I o.d, •' 'ca ter 9 v V to V R u u .O 0 C 'a O q q g b0 y C 4.1 4. canter jive, '•DELORME Street Atlas USA® 2006 Vicinity Map for Access Permit #412105 "Exhibit B" Site Location I / Cass Field riggsdale 92 BecAWIP Ldka Data use subject to license. ® 2005 DeLorme. Street Atlas USA® 2006. www.delorme,corn Scale 1 50.000 1"a4,16676 Data Zoom 12-0 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED CDOT Permit No. 412106 SH/S/MP 14C / 176.017 / L Local Jurisdiction Weld County Permittee(s): Applicant: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street Briggsdale, CO 80611 #220 Greeley, CO 80631 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. 1 _:u Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By n (X) \RAL I/ � - C A/�� 99'(r II11..ggrr7M T le C 1 `ll.C� V rAnKjef Date 11/20/2012 Copy distribution: Required: Region (original) Applicant Staff Access Section Make copies a necessary for: r " Local Authori y Inspector Tim Bilod MTCE Patrol Traffic Engineer 20 -Ault Form 1265 8/98. 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT Permit fee $0.00 Date of transmittal 11/8/2012 Region/Section/Patrol 4 / 01 /20 -Ault CDOT Permit No. 412106 State Highway No/Mp/Side 14 C / 176.017 / L Local Jurisdiction Weld County The Permittee(s); Applicant: Ref No.: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street, #220 Briggsdale, CO 80611 Greeley, CO 80631 970-381-5002 970-356-6110 is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and used in accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked by the issuing authority if at any time the permitted access and its use violate any parts of this permit. The issuing authority, the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location: This access to be closed is located on State Highway 14, a distance of 94 east of mile post 176 on the north/left side of the road. Access to Provide Service to: (Land Use Code) (Size or Count) (Units) 210 - Single -Family Detached Housing I EACH Additional Information: MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Title Date Upon the signing of this permit the perm ttee agrees to the terms and conditions and referenced attachments contained herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to being used. The oermittee shall notify Tim Bllobran with the Colorado Department of Transportation In Greeley, Colorado at (970) 350-2163, at least 48 hours prior to commencing construction within the State Highway right-of-way. The person signing as the perittee must be the owner or legal representative of the property served by the permitted access and have full authority to accept the permit and its terms and conditions. Perms :e Signature r,7 - .29-1---I Print Name _ (Sr ac e ,Y) kJ m ce94 Date // /9 -1 Z This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION iSigyature (1�' C\MW1 VAtukA D Print Namey1� 111V% 1111 Y1 Title M �(0� 1 crA-OYPi Date (of ofissue) k \ i &\I� Copy Distribution: Required: 1.Regicn 2 Applicant 3. Staff Access Section 4.Central Files Make copies as necessary for: Local Authority Inspector MTCE Patrol Traffic Engineer Previous edit are obsolete and may not be used Page 1 of 3 CDOT Form #101 5/07 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission (of Colorado). To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the option of including within the appeal a request for a review by the Department's internal administrative review committee pursuant to [Code] subsection 2.10. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (8), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 1. A permit shall be considered expired if the access is not under construction within one year of the permit issue date or before the expiration of any authorized extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4) 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 2.14. All materials used in the construction of the access within the highway right-of-way or on permanent easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the construction according to the terms and conditions of the permit. Failure by the permittee to abide by all permit terms and conditions shall be sufficient cause for the Department or issuing authority to initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the summary suspension of the permit. If the permittee wishes to use the access prior to completion, arrangements must be approved by the issuing authority and Department and included in the. permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element falls within two years due to improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or public or private utilities for the construction of a permitted access, the relocation, removal or repair shall be accomplished by the permittee without cost to the Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed In the permit shall be repaired Immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permiltee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the pern-rittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -Interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, and the removal or clearance of snow or ice upon the access even though deposited on the access In the course of Department snow removal operations. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within Incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is intended to inform entitles external to COOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility, Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not all -Inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional Information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT — Please Review The Following Information Carefully —Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website httpri/www.cdohe.state.co.us/permits.asa. • CDOT Water Quality Program Manager: Rick Willard (303) 757-9343 http://www.coioradodot.info/programs/environmental/water- quality • COOT Asbestos Project Manager: Theresa Santangelo-Dreiling, (303) 512-5524 • Colorado Office of Archaeology and Historic Preservation: (303) 866-3395 • U.S. Army Corps of Engineers, District Regulatory Offices: Denver Office (303) 979-4120 http://www.nwo.usace.armv,mil/html/od-tl/tri-lakes.html Omaha District (NE Colorado), Office 243-1199 http://www.spk.usace.armv,mil/cesok-colreoulatorv/ Sacramento Dist. (Western CO), Grand Junction (970) Albuquerque District (SE Colorado), Pueblo Reg. Office (719)-543-6915)ittp://www.spa.usace.armv.mil/rea/ • COOT Utilities, Special Use and Access Permitting: (303) 757-9654 httgl/www,clotstate.co.us/PermffsL geological Resources — Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. If any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted Immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species may from the CDOT website, http://coloradodot.info/oroarams/environmental/wlidlife/guidelines, or the Colorado Division of be obtained Wildlife website http://wildlife.state.co,us/WiidlifeSoecies/SpeclesOfConcern/. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources — The applicant must request a file search of the permit area through the Colorado Office of Archaeology and identified. Inventory of Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously been the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the Initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file search at (303) 866-3395. paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder, and the Denver Museum of Nature and Science to ascertain if paleontological resources have been previously identified. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: Contact the CDOT Paleontologist at (303) 757-9632. Hazardous Materials, Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Certificate Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25.15-301 et al, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the CDOT Regional Permitting Office for direction as to how to proceed. Contact Info: Andy Flurkey, COOT Hazardous Materials Project Manager, (303) 512.5520. Asbestos Containing Materials. Asbestos Contaminated Sol( — All work on asbestos containing materials (ACM) must comply with done in the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's (HMWMD) Solid Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information concerning clearance on COOT protects is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santangelo-Oreiling, Property Management Supervisor (303) 512-5524. Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation December '10 Transportation of Hazardous Materials • No person may offer or accept a hazardous material for transportation In commerce unless 171. The that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR, Part hazardous material must be properly classed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by applicable requirements, or an exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For authorization and more info call the Federal Motor Safety Carrier Administration, US DOT for inter- and infra -state HAZMAT Registration (303) 969-6748. Colorado Public Utilities Commission: (303) 894-2868. of Dredged or Fill Material —404 Permits Administered By the U.S. Army Corps of Engineers, and Section 401, Discharge Water Quality Certifications Issued by the CDPHE WQCD • Corps of Engineers 404 Permits are required for the discharge of dredged or fill materials into waters of the United States, Including wetlands. There are various types of 404 Permits, including Nationwide Permits, which are issued for activities with relatively minor Impacts. For example, there is a Nationwide Permit for Utility Line Activities (NWP #12). However, depending upon the specific circumstances, it is possible that either a "General" or "Individual" 404 permit would be required. If an Individual 404 Permit is required, Section 401 water quality certification from the CDPHE WQCD is also required. Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (contact Information above). Contact the CDPHE Water Quality Control Division at (303) 692-3500. Working on or in any stream or Its bank - In order to protect and preserve the state's fish and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary to obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream Is defined as 1) represented by a solid blue line on USGS 7.5' quadrangle maps; and/or 2) intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands present within 200 yards upstream or downstream of the project. The Colorado Division of Wildlife (CDOW) application, as per guidelines agreed upon by COOT and CDOW, can be accessed at blip: //www.colorado44t. infoterograJns/environmental/wild life/guide lines. Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from construction sites disturbing one acre or more - or certain types of industrial facilities, such as concrete batch plants - requires a CDPS Stormwater Construction Permit. Contact Information: For Utility/Special Use activities being performed in conjunction and coordination with a CDOT highway construction contract, please contact the COOT Water Quality Program Manager at (303) 757- 9343. Otherwise, contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: htt//www.cdpLie.state.co. us/wq(pe0nits_Unitlipd8x. html. Construction Dewaterinp (Discharge or Infiltration) — Discharges of water encountered during excavation or work in wet areas may require a Construction Dewatering Discharge Permit. Contact Information: For Construction Dewatering Discharge Permits, contact the CDPHE WQCD at (303) 692-3500. For Dewatering Application and Instructions, see Section 3 at the COPHE website: ham://www. Wphestale.co.us/wq/PermitskInitjFORMSandApg{gallons/Aposandformsnewpage.html Municipal Separate Storm Sewer System (MS41 Discharge Permit — Discharges from the storm sewer systems of larger municipalities, and from the COOT highway drainage system that Iles within those municipalities, are subject to MS4 Permits issued by the CDPHE WQCD. For facilities that Ile within the boundaries of a municipality that is subject to an MS4 permit, the owner of such facility should contact the municipality regarding stormwater related clearances that may have been established under that municipality's MS4 permit. All discharges to the COOT highway drainage system or within the Right of Way (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations Permit # COS - 000005 (htto://www.coloradodot.info/orograms/environmental/water-auality/documents/CDOT%20MS4%20Permit.doc/view) and COR-030000 (http://www.cdohestate.co.us/wo/PermitsUnil/PERMITs/SWoermitarats/SWConstructionPErmit.odn. Discharges are subject to Inspection by COOT and CDHPE. Contact the CDPHE Water Quality Control Division at (303) 692-3500 for a listing of municipalities required to obtain MS4 Permits, or go to bIto://www.cdphe.state,co.ustwaThermitsunit/f4$4/MS4Permittees.pa General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. Allowable non-stormwater discharges can be found at http://www.cobradodot.info/programs/environmental/water-quality/glossary.html#AilowableDischarge. Contact Information: Contact the CDOT Water Quality Program Manager at (303) 757-9343, or the Colorado Department of Public Health and Environment, Water Quality Control Division at (303) 692-3500. General Authorization - Allowable Non-Stormwater Discharges • Unless otherwise identified by CDOT or the WQCD as significant sources of potutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, Irrigation water, uncontaminated springs, footing drains; water line flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. Contact Information: The COOT Water Quality Program Manager or the CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements will be specified through that permit. In those situations where a stormwater permit is not required, all reasonable measures should be taken in order to minimize erosion and sedimentation according to CDOT 208 specifications. In either case, the COOT Erosion Control and Stormwater Quality Guide (most recent version) should be used to design erosion controls and to restore disturbed vegetation. Contact Information: The COOT Erosion Control and Stormwater Quality Guide may be obtained from the Bid Plans Office at (303) 757-9313 or from: http;//www,dot.state.co.us/environmental/envWater0ual/woms4.asp Disposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges" Right or "solid wastes', and in general, should be pumped or vacuumed from the construction area, removed from the State Highway of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway Is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being • -(T. �..rinn nararnhar'in age10 r' Environmental Clearances Information Summary separated from fluids or after Infiltration of the water, provided: l) the drilling fluid consists of only water and bentonite clay, or, If required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work In the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information. Contact the CDOT / CDPHE Liaison or CDOT Water Quality Program Manager. Concrete Washout • Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, dralnageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to COOT specifications and guidelines. Contact Information: Contact the CDOT Water Quality Program Manager at (303) 757-9343. Website: http://www.coloradodot.info/Droarams/environmental/water- quality/revised•m-standards; refer to the link Revision of Sections 101. 107, 208. 213 and 620 Water Quality Control One or More Acres of Disturbance for additional guidance. Spilt Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or burled. All spills shall be reported to the COOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spill In the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1.877-518-5608. About Thls Form - Questions or comments about this Information Summary may be directed to Alex Karami, COOT Safety & Traffic Engineering, Utilities Unit, at (303) 757-9841, alex.karaml(d),dot.state.co.us. 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The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 3. Incorporated as part of this permit are the following: Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No. 101) and its two page attachment Exhibits: "A"- Access Plan "B"- Vicinity Map 4. This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1), and is based upon the information submitted by the Permittee. This permit is only for the use and purpose stated in the Application and Permit. Any changes in traffic volumes or type, drainage, or other operation aspects may render this permit void, requiring a new permit to the be applied for based upon existing and anticipated future conditions. 5. Access construction methods for closing an access and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 6. If necessary, minor changes, corrections and/or additions to this permit may be ordered by the Department inspector, other Department representative or local authority to meet unanticipated site conditions. Changes may not be in violation of the State Highway Access Code. All major changes to the plans must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. All workers within the State Highway right-of-way shall comply with their employer's safety and health policies/procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable section of 29 CFR Part 1910- Occupations Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Cosntruction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles shall wear the following personal protective equipment: * Head protection that complies with the ANSO Z89.1-1997 standard; * At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn: * High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum, ANSUISEA 107-1999, Class 2). Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall apply. 7. This permit is subject to revocation due to: 1) Noncompliance with the provisions of this permit; 2) Abandonment; 3) Supersedure by new permit covering the same installation; or 4) Conflict with necessary planned highway construction and/or improvements. The Permittee shall promptly terminate occupancy ZONE 1 Northern Loam Soil COMMON NAME BOTANICAL NAME APPLICATION RATE Pounds pls/Acre Grasses Western wheatgrass Pascopyrum smithii "Arriba" 8,0 Sideoats grama Bouteloua curtipendula "Vaughn" 3.0 Green needlegrass Nassella viridula "Lodorm" 3.0 Buffalograss Buchloe dactyloides "Texoka" 5.0 Blue grama Bouteloua gracilis "Hachita" 1.5 Little bluestem Schizachyrium scoparium "Pastura" 1.5 Prairie junegrass Koeleria macrantha 0.2 Oats Avena sativa 3.0 Total 25.2 Forbs Prairie coneflower Ratibida columnaris 0.3 Purple prairie clover Dalea purpureum var. purptreum 0.5 Dotted gayfeather Liatrus punclata 0.5 Narrowleaf penstemon Penstemon angustijolius 0.2 Gaillardia Gaillardia aristata 1.0 Blue flax Linum Jewish 0.5 Scarlet globemallow Sphaeralcea coccinea 0.3 Shrubs Fourwing saltbush Atriplex canescens 0.5 Winterfat Ceratoides lanata 0.5 SEEDING APPLICATION: Drill seed 0.25" to 0.50" into the topsoil. in areas that are not accessible to a drill, hand broadcast at triple the above rate and rake 0.25" to 0.50" into the topsoil. MULCHING APPLICATION: 1.5 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre. SPECIAL REQUIREMENT: Due to high failure rates hydroseeding and /or hydromulching will not be allowed. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION acceptarg Issuing authority application Instructions: - Contact the Colorado Department of Transportation (CDOT) or your local government to determine your issuing authority. - Contact the issuing authority to determine what plans and other documents are required to be submitted with your application. - Complete this form (some questions may not apply to you) and attach all necessary documents and Submit it to the issuing authority. Please print - Submit an application for each access affected. or type - If you have any questions contact the issuing authority. - For additional information see CDOT's Access Management website at http://www.dot.state.co.us/AccessPermits/index.hlm 1) Property owner (Permittee) Randolph J. & Judy C. Cass 2) Applicant or Agent for permittee (if different from property owner) Bruce Johnson Street address 43251 HWY 392 Mailing address 801 8th St., #220 City, state & zip Briggadale, CO 80611 Phone# 970 381-5002 City, state & zip Greeley, CO 80631 Phone#(required) 970 356-6110 E-mail address E-mail address if available 3) Address of property to be served by permit (required) 37967 HWY 14, Briggsdale, CO 80611 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? county subdivision block lot section township range Weld I N/A I N/A I N/A 20 18N I 62W 5) What State Highway are you requesting access from? 14 6) What side of the highway? 0 ❑S ❑E ❑W 7) How many feet is the proposed access from the nearest mile post? 0 feet ON .SOW) from: 176 How many feet is the proposed access from the nearest cross street? 750+- feet ON EIS ■E —_W) from: WCR 77/HWY 392 8) What is the approximate date you intend to begin construction? 9) Check here if you are requesting a: anticipated: ) ❑improvement to existing access removal of access Qelocation of an existing access (provide detail) • new access m temporary access (duration change in access use 10) Provide existing property use See attached letter. 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? permit number(s) and provide copies: and/or, permit date: ono • yes, if yes - what are the 12) Does the property owner own or have any interests in any adjacent property? Ei no • yes, if yes - please describe: 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? your plans and indicate the proposed and existing access points. u no t yes, if yes - list them on 14) If you are requesting agricultural field access - how many acres will the access serve? The eastern access is ag and will serve 74.6+- Acres 15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. business/land use square footage business square footage See attached letter.I I I I 16) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units? type number of units type number of units Single Family I 1 I I 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate if your counts are p of passenger cars and light trucks at peak hour volumes 76 a el multi unit trucks at peak hour volumes Speak hour volumes or CI average daily volumes. a or single unit vehicles in excess of 30 II 1 k of farm veh`clos (Veld endipmentl Total count of all vehicles 77 Previous editions are obsolete and may not be used Page 1 of 2 CDOT Form #137 01/10 From:ALLES Taylor and Duke, LLC 9703520128 10/24/2012 12:31 8952 P.002/003 1s0 Check Wth the Issuing authority to determine which of the following doamonts are required to complete the review of your epplioaton. a) Property map indicating other access, bordering roads and streets. e) 8ubdvislor, zoning, or development plan. b) Hlgtrway and driveway plan profile. t) Proposed access design. c) Drainage plen showing Impel to the highway right-of-way. g) Parcel and ownershlp maps including easements. dl Mep and letters detailing usity locations before and after h) Traffic studies. development In and along the right-of-way. I) Proof or owhersNp. 1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances Information Summary presents contact information for agencies administering certain clearances, information about prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the CDOT Planning/Construction-Environmental-Guidance webpage httoJ/www.dot.state.co,us/envlronmental/Forms.eso. 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFA Part 1926 - Safety and Health Regulations for Construction. Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head protection that compiles with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there Is danger of Injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI 241-1999. Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall appfY. 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be found on the Design and Construction Project Support web page at: ehttod/www.dot.state.co.us/DeslanSuoaorth', then click on Design Bulletins. If an access permit la issued to you, it will state the terms and conditions for its use. Any changes In the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury in the second degree, and any other applicable state or federal laws, that all Information provided on this form and submitted attachments are to the best of their knowledge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. Applicant or Agen ties stun tA. Prim name awes Johnson Date 10/17/2012 If the applicant I of the owner of the property, we require this application also to be signed by the property owner or their legally authorized representative (or other acceptable written evidence). This signature shal constitute agreement with this application by all owners -of -Interest unless slated in writing. If a permit is Issued, the property owner, In most cases, will be listed as the permlttee. Props er signature 0 �,�_------ Print name Randolph J. & Judy C. Can Date 10/17/2012 Previous editions ore obsolete end rosy not be seed Paget oft CDOT Fenn 0137 01(10 nr r: :naval -t® Latirma Cam fatn -73 M cc // a 0 o d G Vi El Pt u O .15 p R 2 U u • o aui a4w q o 4 i.�; •y CA �'..Vr fd .C~d'Q -/5 y a g s ...• ,A se C " ai �y aJ A i ag o cu at � o j..4, Ti �C4 9) W y up� d M.t- 8 w a ;F U 7 c 5t fl 1=4. o g o\^'§"a p u q DI u C •� ..q GD l, w sq 'i L R ag6'q d E u h bA i—i u k, - X y q� R • I u a+ u �, p of w o b0 •zi 'fl d y u y„ U .. y• %.� Cd R ea g a ;drb o bA4 A.E.B .9 T a ••��) Q5 XI CL d7 y V a13') lSI y' 6d • 6 u S cI d .n w.o a C c2 d C b C aJ T tdel ^ DitLORME Street Atlas USA® 2006 Vicinity Map for Access Permit #412106 "Exhibit B" &le Lacatanl Cass Field a 392 392 l riggadale • Data use subject to license. © 2005 DeLorme. Street Atlas USA® 2008. www delorme.com Scale 1 -. 5Q000 WI le.'EI 1 1" = 4,166.7 ft Data Zoom 12.0 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED COOT Permit No. 412107 SH/S/MP 14 C / 176.053 / L Local Jurisdiction Weld County Permittee(s): Applicant: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street Briggsdale, CO 80611 #220 Greeley, CO 80631 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. — Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By �} (X) % L�� T' le U`SS � ,�- (�1/1n Date 11/20/2012 Copy distribution: Required Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector Tim BiID an MTCE Patrol Traffic Engineer 20 -Ault orm l[tio anu. 1 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT CDOT Permit No. 412107 Permit fee $100.00 Date of transmittal 11/14/2012 Region/Section/Patrol 4 / 01 /20 -Ault State Highway No/Mp/Side 14C / 176.053 / L Local Jurisdiction Weld County The Permittee(s); Applicant: Ref No.: Randolph and Judy Cass Bruce Johnson 43251 County Road 392 801 8th Street, #220 Briggsdale, CO 80611 Greeley, CO 80631 970-381-5002 970-356-6110 is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and used in accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked by the issuing authority if at any time the permitted access and its use violate any parts of this permit. The issuing authority, the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location: This access is located on State Highway 14, a distance of 280 feet east of mile post 176 on the north/left side of the road. Access to Provide Service to: (Land Use Code) 805 - Liquor Store 210 - Single -Family Detached Housing (Size or Count) 38 10 (Units) ADT ADT Additional Information: MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Title Date Upon the signing of this permit the perm'ttee agrees to the terms and conditions and referenced attachments contained herein. All construction shall be completed in an expeditious and safe manner and shall be finished with'n 45 days from Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to being used. The permittee shall notify Tim Bilobran with the Colorado Department of Transportation in Greeley, Colorado at (970) 350-2163, at least 48 hours prior to commencing construction within the State Highway right-of-way. The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to accept the permit and its terms and conditions. Pe� ftee Signature LL f tGCr".(-e-13„'r--- Print Narpc Date This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION P,t Name j� \ 1w\ l tilt1VITAi \ Title 7Yc.sc Date (of issue) n lakii is Copy Distribution: Required: 1. Region 2 Applicant Make copies as necessary for 3.Staff Access Section Local Authority Inspector 4.Central Files MICE Patrol Traffic Engineer Previous • Ions are obsolete and may not be used Page 1 of 3 CDOT Form #101 5107 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission jof Colorado). To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the option of including within the appeal a request for a review by the Department's internal administrative review committee pursuant to [Code] subsection 2.10. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 1. A permit shall be considered expired if the access is not under construction within one year of the permit issue date or before the expiration of any authorized extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4j 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 2.14. All materials used in the construction of the access within the highway right-of-way or on permanent easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the construction according to the terms and conditions of the permit. Failure by the permittee to abide by all permit terms and conditions shall be sufficient cause for the Department or issuing authority to Initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the summary suspension of the permit. If the permittee wishes to use the access prior to completion, arrangements must be approved by the issuing authority and Department and Included in the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or Improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element fails within two years due to Improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or public or private utilities for the construction of a permitted access, the relocation, removal or repair shall be accomplished by the permittee without cost to the Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired Immediately. The permittee is responsible for the repair of any utility damaged In the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, Its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permrttee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, and the removal or clearance of snow or ice upon the access even though deposited on the access In the course of Department snow removal operations. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility, Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not all-inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity.. IMPORTANT — Please Review The Following Information Carefully — Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website pttp://www.cdphe.state.co.us/permits.aso. • COOT Water Quality Program Manager: Rick Willard (303) 757-9343 http://www.coloradodot.Info/proarams/environmental/water- quality • COOT Asbestos Project Manager: Theresa Santangelo-Dreiling, (303) 512-5524 • Colorado Office of Archaeology and Historic Preservation: (303) 866-3395 • U.S. Army Corps of Engineers, District Regulatory Offices: Omaha District (NE Colorado), Denver Office (303) 979-4120 http://www.nwo.usace,annv.mil/html/od-tl/tri-lakes.html 243-1199 htto://www.sok.usace.armv.mil/cesok-co/reaulatorv/ Sacramento Dist. (Western CO), Grand Junction Office (970) Pueblo Reg. Office (719)-543-6915 htt0://www spa usace armv.mil/reo/ Albuquerque District (SE Colorado), • CDOT Utilities, Special Use and Access Permitting: (303) 757-9654 http;//www.do(.stateco.us(Permits( 4I Ecological Resources — Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or from CDOT office. If any suspected threatened or endangered species habitat will require special authorization the permitting threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species may from the CDOT website, http://coloradodot.info/programs/environmental/wildlife/guidelines, or the Colorado Division of be obtained Wildlife website litto://wildlife.state.co.uslWildlifeSoecies/SoeclesOfConcern/. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources — The applicant must request a file search of the permit area through the Colorado Office of Archaeology and have been identified. Inventory of Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources previously the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file at (303) 866-3395. search Paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder, and the Denver Museum of Nature and Science to ascertain if paleontological resources have been previously identified. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work. all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact information: Contact the CDOT Paleontologist at (303) 757-9632. Hazardous Materials, Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et ai, and Regulations approved Certificate Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15-301 et al, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials etc.) is encountered during the performance of work, the permittee shall halt contaminated soil, work in the affected area and immediately contact the CDOT Regional Permitting Office for direction as to how to proceed. Contact Info: Andy Fiurkey, CDOT Hazardous Materials Project Manager, (303) 512-5520. Asbestos Containing Materials. Asbestos Contaminated Soil — All work on asbestos containing materials (ACM) must comply with Regulation 8. Disposal of ACM, and work done in the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's (HMWMD) Solid Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional Information concerning clearance on COOT Protects Is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santangelo-Dreiling, Property Management Supervisor (303) 512-5524. Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation ecember Transportation of Hazardous Materials • No person may offer or accept a hazardous material for transportation in commerce unless Part 171. The that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR, hazardous material must be properly classed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by applicable requirements, or an exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact information: For authorization and more info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT Registration (303)969-6748. Colorado Public Utilities Commission: (303) 894-2868. Administered By the U.S. Army Corps of Engineers, and Section 401 Discharge of Dredged or Fill Material — 404 Permits Water QualityCertifications issued by the CDPHE WQCD • Corps of Engineers 404 Permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 Permits, including Nationwide Permits, which are Issued for activities with relatively minor Impacts. For example, there is a Nationwide Permit for Utility Line Activities (NWP #12). However, depending upon the specific circumstances, it is possible that either a "General" or "Individual" 404 permit would be required. If an Individual 404 Permit is required, Section 401 water quality certification from the CDPHE Waco is also required. Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required (contact information above). Contact the CDPHE Water Quality Control Division at (303) 692-3500. Working on or in any stream or its bank - in order to protect and preserve the state's fish and wildlife resources from actions that to may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream is defined as 1) represented by a solid blue line on USGS 7.5' quadrangle maps; and/or 2) intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands present within 200 yards upstream or downstream of the project. The Colorado Division of Wildlife (CDOW) application, as per guidelines agreed upon by COOT and CDOW, can be accessed at http://wwwalgradodot.info/programs/environmental/wildlife/ou idelines. Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities • Discharges of stormwater runoff from construction sites disturbing one acre or more - or certain types of industrial facilities, such as concrete batch plants - requires a COPS Stormwater Construction Permit. Contact Information: For Utility/Special Use activities being performed In conjunction and coordination with a COOT highway construction contract, please contact the COOT Water Quality Program Manager at (303) 757- 9343. Otherwise, contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: us/wq(PeLmitsUnit/index. html. _http2/www.cdohe.state.co. Construction Dewaterinq (Discharge or infiltration) — Discharges of water encountered during excavation or work in wet areas may require a Construction Dewatering Discharge Permit. Contact Information: For Construction Dewatering Discharge Permits, contact the CDPHE WQCD al (303) 692-3500. For Dewatering Application and Instructions, see Section 3 at the CDPHE website: h :l/ww#.cdohe.state.co,usfwo/PermitsUnit/FORMSandApplications/Aposandformsnewnage.html Municipal Separate Storm Sewer System (MS4) Discharge Permit — Discharges from the storm sewer systems of larger municipalities. and from the COOT highway drainage system that lies within those municipalities, are subject to MS4 Permits issued by the CDPHE WQCD. For facilities that Ile within the boundaries of a municipality that is subject to an MS4 permit, the owner of such facility should contact the municipality regarding stormwater related clearances that may have been established under that municipalitVs MS4 permit. All discharges to the COOT highway drainage system or within the Right of Way (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations Permit # COS - 000005 (http://www,coloradodot.info/programs/environmentaUwater-quality/documents/COOT%20MS4%20Permil.doc/view) and COR-0300001http://www.cdohe.state.co.us/wa/PermitsUnit/PERMITs/SWoermitsrats/SWConstructionPErmlt.odf). Discharges are subject to inspection by CDOT and CDHPE. Contact the CDPHE Water Quality Control Division at (303) 692-3500 for a listing of municipalities required to obtain MS4 Permits, or go to http;//www cdDhe.stete.co.us/wolpgrmitst/_niV-MS4/MS4Permiltees.pdf. General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. Allowable non-stormwater discharges can be found at http://www.wbradodot.info/programs/environmental/water-quality/glossary.hlml#AllowableDischarge. Contact Information: Contact the COOT Water Quality Program Manager at (303) 757-9343, or the Colorado Department of Public Health and Environment, Water Quality Control Division at (303) 692-3500. General Authorization • Allowable Non-Stormwater Discharges - Unless otherwise identified by CDOT or the WQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, uncontaminated springs, footing drains; water line flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. Contact Information: The CDOT Water Quality Program Manager or the CDPHE Water Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - For activities requiring a Stormwater Construction Permit, erosion control requirements will be specified through that permit. In those situations where a stormwater permit Is not required, all seasonable measures should be taken in order to minimize erosion and sedimentation according to COOT 208 specifications. In either case, the COOT Erosion Control and Stormwater Quality Guide (most recent version) should be used to design erosion controls and to restore disturbed vegetation. Contact Information: The COOT Erosion Control and Stormwater Quality Guide may be obtained from the Bid Plans Office at (303) 757-9313 or from: hittol/www.dot.state.co.uslenvironmental/envWaterQual/woms4.aso, Disposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as "discharges" Highway Right or "solid wastes", and in general, should be pumped or vacuumed from the construction area, removed from the State of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids) may be left on -site after either being — - a- 0 t aft rtatlon nncamher '10 Environmental Clearances Information Summary Colorado epartmen o ,•„•r.. separated from fluids or after infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, If required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Contact the CDOT / CDPHE Liaison or CDOT Water Quality Program Manager. Concrete Washout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW. Concrete waste shall be placed In a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information: Contact the COOT Water Quality Program Manager at (303) 757-9343. Webslte: htlp://www.coloradodot.info/proorams/environmental/water- aualltv/revised-m-standards; refer to the link Revision of Sections 101. 107. 208, 213 and 020 Water Quality Control One or More Acres of Disturbance for additional guidance. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or burled. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4448 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, Into waterways, any spill In the highway right-of-way exceeding 25 gallons, or that may otherwise present an Immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1.877-518-5608. About This Form - Questions or comments about this Information Summary may be directed to Alex Karami, CDOT Safety & Traffic Engineering, Utilities Unit, al (303) 757-9841, alex.karami@dot.state.co.us. Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation December '10 1 | n of a facility ,!* § \ fin 4 S. S. Stin Eria A } co |/ ai na £3• - `o „ T 0 A 4'42 g E T e O ▪ O. • > F.2 O 0 0 as m c m a a E a e n E of d2 8 '° V u D e a, a v a •0 L 2 a « A _ 2 L ct i i o u 3 ■ Diverted stream flows L' 2 t 2 « c v S'° 3`I a"8 2. 2 S o 3 yb 1 u r „ m a N 9 c o9.E.t c '4 n g D = = 9 3� 0 t aas o8a°89aao= • ' 2 . 0 . 2 - o M s--2r2a A O O. a d t_ v O P Ah V t V; k A a, 3 D E E ac m o o t c E 'm m c t-gsg ��reF= oo na.€y0 goo a r0 D= 2 V u - U EO L 2 Do oE d ▪ $ N d d a Sji F. rm Y g fi A o LL Si To D L Y $ 2 e sE0 o 9 41 al CW r.. c C Track direct dischargers Detect and remove any illicit discharges N wl ■ Individual residential sweet washing ■ Water -line flushing State Highway Access Permit 1 Attachment to Pennit No. 412107 - Additional Terms and Conditions 1. If there are any questions regarding this permit, please contact Tim Bilobran at (970) 350-2163. 2. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 3. Incorporated as part of this permit are the following: Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No. 101) and its two page attachment Exhibits: "A"- Access Plan "B"- Vicinity Map 4. This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1), and is based upon the information submitted by the Permittee. This permit is only for the use and purpose stated in the Application and Permit. Any changes in traffic volumes or type, drainage, or other operation aspects may render this permit void, requiring a new permit to the be applied for based upon existing and anticipated future conditions. 5. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 6. If necessary, minor changes, corrections and/or additions to this permit may be ordered by the Department inspector, other Department representative or local authority to meet unanticipated site conditions. Changes may not be in violation of the State Highway Access Code. All major changes to the plans must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. All workers within the State Highway right-of-way shall comply with their employer's safety and health policies/procedures, and applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 - Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment: * Head protection that complies with the ANSI Z89-1-1997 standard; * At all construction sites or whenever there is a danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn; * High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum, ANSUISEA 107-1999, Class 2).. Where any of the above -referenced ANSI standards have been revised, the most recent version of the standard shall apply. 7. This permit is subject to revocation due to: 1) Noncompliance with the provisions of this permit; 2) Abandonment; 3) Supersedure by new permit covering the same installation; or 4) Conflict with necessary planned highway construction and/or improvements. The Permittee shall promptly terminate occupancy State Highway Access Permit 2 Attachment to Permit No. 412107 - Additional Terms and Conditions upon notice of cancellation of the permit from the Department, unless a new permit is applied for and granted. 8. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 9. The Department retains the right to perform any necessary maintenance work in this area. 10. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the right-of-way shall be considered a violation of the terms and conditions of this access permit and may result in revocation of the permit by the Department and/or the issuing authority. 11. The Permittee is responsible for obtaining any necessary additional federal, state, and/or City/County permits or clearances required for construction of the access. Approval of this access permit does not constitute verification of this action by the Permittee. 12. All costs associated with the reconstruction of this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. 13. No work will be allowed at night, or on Saturdays, Sundays, and legal holidays without prior authorization from the Department. The Department may also restrict work within the State Highway right-of-way during adverse weather conditions. 14. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department. 15. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 16. No work shall be performed near a Department electronic traffic control device without coordination with Cobie Garbiso at (970) 350-2137. 17. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Tim Bilobran at 970-350- 2163 to obtain the Landscaping Permit. 18. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under the general terms and conditions of the permit. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, will require written authorization from the Department. The Department shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic on the State Highway. In an emergency, the Department Region Office and the State Patrol shall immediately be notified of possible hazards. State Highway Access Permit 3 Attachment to Permit No. 412107 - Additional Terms and Conditions 19. All work is to conform to the plans referenced by this permit on file with the Department or as modified by this permit. (If discrepancies arise, this permit shall take precedence over the plans.) The Department plan review is only for the general conformance with the Department's design and code requirements. The Department is not responsible for the accuracy and adequacy of the design, dimensions, elevations, and any other elements which shall be confirmed and correlated at the work site. The Department through the approval of this document, assumes no responsibility for the completeness and/or accuracy of the plans. 20. Survey markers or monuments must be preserved in their original positions. Notify the Department at (970) 350-2173 immediately upon damage to or discovery of any such markers or monuments at the work site. Any survey markers or monuments disturbed during the permitted work shall be repaired and/or replaced immediately at the expense of the Permittee. 21. Should any excavation encounter plant or animal fossils, the remains of historic or prehistoric structures, artifacts, (pottery, stone tools, arrowheads, etc.), the work shall be stopped and the Permittee shall notify the Department inspector. 22. The Permittee or the contractor shall notify Tim Bilobran at 970-350-2163 at least two working days prior to beginning any access improvements or construction of any kind within the State Highway right-of- way. Failure to comply with this requirement may result in revocation of this permit. 23. The Department inspector may suspend any work due to: 1) Noncompliance with the provisions of this permit; 2) Adverse weather or traffic conditions; 3) Concurrent highway construction or maintenance in conflict with permit work; 4) Any condition deemed unsafe for workers or the general public. The work may be resumed upon notice from the Department inspector. 24. The access shall be reconstructed as per Exhibit "A". 25. Construction traffic devices, when not in use, shall be removed or turned away from traffic. 26. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highway right-of-way. 27. All required access improvements shall be installed prior to the herein authorized use of this access. 28. The access shall be resurfaced immediately upon completion of earthwork construction and prior to use. 29. Resurfacing of the access shall be maintained as per Exhibit "A". 30. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. 31. If frost, water or moisture is present in the subgrade, no surfacing materials shall be placed until all frost, water or moisture is gone or removed. 32. The access shall be reconstructed and maintained in a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. State Highway Access Permit 4 Attachment to Permit No. 412107 - Additional Terms and Conditions 33. The Permittee shall request final inspection by Tim Bilobran at 970-350-2163 within 10 days following completion of access construction, and prior to authorized use. The Permittee or their representative shall be present. 34. All existing drainage structures shall be extended, modified, or upgraded as necessary, to accommodate all new construction and safety standards, in accordance to the Department's standard specifications. 35. A fully executed complete copy of this permit must be on the job site with the contractor at all times during construction. Failure to comply with this or any other construction requirement may result in the immediate suspension of work by order of the Department inspector or the issuing authority. 36. The design and reconstruction of access and/or development of this property shall not negatively impact adjacent nearby properties. Correction of the problem and cost resulting from damages shall be borne by the Permittee. 37. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. 38. The State requires a Certificate of Insurance prior to commencing any work on the State Highway right- of-way. Policies shall name the State of Colorado as additional insured party. All vendors, contractors, and utility companies shall procure, at their own expense, and maintain for the duration of the work period, the following minimum insurance coverages: A. Standard workman's compensation and employer's liability, including occupational disease, covering all employees engaged in performance of the work at the site, in the amount required by State Statutes. B. Comprehensive general liability in the amount of $1,000,000 combined single limit bodily injury and property damage, each occurrence and $2,000,000 annual aggregate. C. Automobile liability in the amount of $1,000,000 combined single limit bodily injury and property damage, for each accident. Certificates of insurance showing compliance with these provisions shall be attached to and made a part of this permit and be available on the site during constriction. 39. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction-Environmental Guidance webpage at http://www.dot.state.co.us/environmental/Forms/asp. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION Of YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substance such as: wash water, paint, automotive fluids, solvents, oils or soaps. State Highway Access Permit 5 Attachment to Permit No. 412107 - Additional Terms and Conditions Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CDPHE website at: http://cdphe.state.co.us/wq/PermitsUnit/wqu. ZONE 1 Northern Loam Soil COMMON NAME BOTANICAL NAME APPLICATION RATE Pounds pls/Acre Grasses Western wheatgrass Pascopyrum smithii "Arriba" 8.0 Sideoats grama Bouteloua curtipendula "Vaughn" 3.0 Green needlegrass Nassella viridula "Lodorm" 3.0 Buffalograss Buchloe dactyloides "Texoka" 5.0 Blue grama Bouteloua gracilis "Hachita" 1.5 Little bluestem Schizachyrium scoparium "Pastura" 1.5 Prairie junegrass Koeleriamacrantha 0.2 Oats Avena sativa 3.0 Total 25.2 Fortis Prairie coneflower Ratibida columnaris 0.3 Purple prairie clover Dalea purpureum var. purpureum 0.5 Dotted gayfeather Liatrus punctata 0.5 Narrowleafpenstemon Penstemon angustifolius 0.2 Gaillardia Gaillardia aristata 1.0 Blue flax Linum lewisii 0.5 Scarlet globemallow Sphaeralcea coccinea 0.3 Shrubs Fourwing saltbush Atriplex canescens 0.5 Winterfat Ceratoides Janata 0,5 SEEDING APPLICATION: Drill seed 0.25" to 0.50" into the topsoil. In areas that are not accessible to a drill, hand broadcast at triple the above rate and rake 0.25" to 0.50" into the topsoil. MULCHING APPLICATION: 1.5 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre. SPECIAL REQUIREMENT: Due to high failure rates hydroseeding and /or hydromulching will not be allowed. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Issuing authority application iel17 ld1�y Instructions: - Contact the Colorado Department of Transportation (CDOT) or your local government to determine your issuing authority. - Contact the issuing authority to determine what plans and other documents are required to be submitted with your application. - Complete this form (some questions may not apply to you) and attach all necessary documents and Submit it to the issuing authority. Please print - Submit an application for each access affected. or type - If you have any questions contact the issuing authority. - For additional information see CDOT's Access Management website at http://www.dot.state.co.uslAccessPermlts/index.htm 1) Property owner (Permittee) Randolph J. & Judy C. Casa 2) Applicant or Agent for permittee (if different from property owner) Bruce Johnson Street address 43251 HWY 392 Mailing address 801 8th St., #220 City, state & zip Briggsdale, CO 80611 Phone it 970 381-5002 City, state & zip Greeley, CO 80631 Phone #(required) 970 356-6110 E-mail address E-mail address if available 3) Address of property to be served by permit (required) 37967 HWY 14, Briggsdale, CO 80611 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? county subdivision block lot seclion townshiprange Weld I N/A I N/A I N/A 120 I eN I 62W 5) What State Highway are you requesting access from? 14 6) What side of the hi hway? � E ❑ W ■ N �S 7) How many feet is the proposed access from the nearest mile post? 176 How many 750+- feet is the proposed access from the nearest cross street? 77/HWY 392 0 feet a llSEIRW)from: feet ON DS DE _W)from: WCR 8) What is the approximate date you intend to begin construction? 9) Check here if you are requesting a: anticipated: ) Qimprovement to existing access ❑removal of access Gelocation of an existing access (provide detail) NI new access • temporary access (duration •change in access use 10) Provide existing property use See attached letter. 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties In which you have a property interest? permit number(s) and provide copies: and/or, permit date: a no I♦ yes, if yes - what are the 12) Does the property owner own or have any interests in any adjacent property? . no / yes, if yes - please describe: 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? your plans and indicate the proposed and existing access points. gi no fa yes, if yes - list them on 14) If you are requesting agricultural field access - how many acres will the access serve? The eastern access is ag and will serve 74.6+- Acres 15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square rootage of each. business/land use square footage business square footage See attached letter. I 16) If you are requesting residential developement access, what is the type (single family, apartment, townhouse) and number of units? type number of units type number of units Single Family I 1 I I 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate if your counts are C of passenger cos and ighl vacks al peak hour volumes 76 If of muai un,i Pucks el peak Pour volumes peak hour volumes or p average daily volumes. # of sirg'e unit vehicles :n excess cr 3D rL 1 a of farm vehicles lucid equipment) Total count of all vehicles 77 Previous editions are obsolete and may not be use age 1 of 2 CDOT Form From:ALLES Taylor and Duke, LLC 9703520128 10/24/2012 12:31 #952 P.002/003 h 1e) Check w>lhthe Issuing authority to determine which of die following documents are required to complete the review of your application. a) Property map inaestlro other access, bordering roads and street e) Subdivision, zoning, or developmentplan. b) Highway and Aiveway plan profits. f) Proposed acmes design. c) Drainage plan showing Impact to the highway right-of-way. g) Parcel ardovmershlp maps including easements. d) Map and letters detailing oddly locations before and after h) Traffic etudes. development In and along the right•of•way. I) Proof at ownersHp. 1- It is the applicant's responsibility to contact appropriate to their activities. Such clearances may include Corps of permits, or ecological, archeological, historical or cultural Information Summary presents contact information for agencies prohibited discharges, and may be obtained from Regional CDOT Planning/Construction-Environmental-Guidance webpage 2- All workers within the State Highway right of way shall procedures, and all applicable U.S. Occupational Safely and limited to the applicable sections of 29 CFR Part 1910 - Occupational - Safety and Health Regulations for Construction. Personal protective equipment (e.g. head protection, footwear, respirators, gloves, etc.) shall be worn as appropriate for minimum, all workers in the State Highway right of way, except protective equipment: High visibility apparel as specified In accompanying the Notice to Proceed related to this permit that complies with the ANSI Z89.1-1997 standard; and at feet, workers shall comply with OSHA's PPE requirements 1926.96, if required, such footwear shall meet the requirements Where any of the above -referenced ANSI standards have appiY. 3- The Permittee is responsible for complying with the Revised under the American Disabilities Act (ADA). These guidelines use of a defined pattern of truncated domes as detectable can be found on the Design and Construction Project Support chttp://www.dot.state.co.us/DesienSupportb., then click agencies and obtain all environmental clearances that apply Engineers 404 Permits or Colorado Discharge Permit System resource clearances. The CDOT Environmental Clearances administering certain clearances, information about CDOT Utility/Special Use Permit offices or accessed via the http://vnirw.doletate.co.usdenvIronmentel/Forms.aeo. comply with their employer's safety and health policies/ Health Administration (OSHA) regulations - including, but not Safety and Health Standards and 29 CFR Part 1926 high visibility apparel, safety glasses, hearing protection, the work being performed, and as specified in regulation. At a when in their vehicles, shall wear the following personal the Traffic Control provisions of the documentation (at a minimum, ANSI/ISEA 107-1999, class 2); head protection all construction sites or whenever there Is danger of injury to for foot protection per 29 CFR 1910.136, 1926.95, and of ANSI Z41-1999. been revised, the most recent version of the standard shall Guidelines that have been adopted by the Access Board define traversable slope requirements and prescribe the warnings at street crossings. The new Standards Plans and web page at: on Design Bulletins. If an access permit Is issued to you, It will state the terms and conditions for its use. Any changes in the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury In the second degree, and any other applicable state or federal laws, that all information provided on this form and submitted attachments are to the best of their knowledge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. Applicant or ature Pent name A, Bruce Johnson Data 10/17/2012 ' Yapplicant -f If the I of the owner of the property, we require this application also to be signed by the property owner or their legally authorized representative (or other acceptable written evidence). This signature that constitute agreement with this application by all owners -of -interest unless stated in writing. If a permit is Issued, the property owner, in most cases, will be listed as the permlttee. Drennan a,,a) yf (ft :%<..A._____,.Randolph Printrame J. & Judy. C. Cass Date 10/17/2012 Pnvteaa salaam are obsolete aid say not be ,sad Page 2of2 CPo7 Fame 0127 01/10 Lzaj cas) ces$03 ort.-03 V W CID U U W ciD 9 6 'DELORME Street Atlas USA® 2006 Vicinity Map for Access Permit #412107 "Exhibit B" al she Lctetian� Cass Flew a rlggsdale 1 392 ti Data use subject to license. © 2005 DeLorme. Street Atlas USA® 2006. ww.v.delorme corn Scale 1.50,000 IM I. rEl 1" = 4,166.7 ft Data Zoom 12-0 Hello