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Home My WebLink About20120127 COLORADO DEPARTMENT OF TRANSPORTATION COOT Permit No. 411096 SH/S/MP STATE HIGHWAY ACCESS CODE 392 B / 106.006 / R NOTICE TO PROCEED Local Jurisdiction Weld County Permittee(s): RECEIVED Applicant: FLM Asset Management, LLC Shane McCoy JAN 0 4 2012 9500 Highway 392 P.O. Box 189 Weld County Viammng Departure j Windsor, CO 80550 GREELEY OFFICE Windsor, CO 80550 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 Title Date (X) This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By Title Date (X) H. j r 12/14/2012 ti, Ale) \c .kr`e vC.��5 \tn��.c J Copy distribution: Required: Make copies as necessary for: m m, 19Ac AM a/99 Region(original) Local Authority Inspector Lee Ireton Applicant MTCE Patrol Traffic Engineer 2012-0127 Staff Access Section 17-West Greeley cA 1, rt/ (- I(-2_Oia. PL1614t40 COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No. 411096 STATE HIGHWAY ACCESS PERMIT State Highway No/Mp/Side 392 B / 106.006 / R Permit fee Date of transmittal Region/Section/Patrol Local Jurisdiction $100.00 12/12/2011 4/ 01 /17-West Greeley Weld County The Permittee(s); Applicant: Ref No.: FLM Asset Management, LLC Shane McCoy 9500 Highway 392 P.O.Box 189 Windsor, CO 80550 Windsor, CO 80550 970-482-0690 970-539-5246 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 392,a distance of 32 feet east of mile post 106 on the south/right side. Access to Provide Service to: (Land Use Code:) (Size or Count) (Units) 818-Landscape(Wholesale) 50 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 permittee 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 permittee shall notify Lee Ireton with the Colorado Department of Transportation in Greeley, Colorado at(970) 350-2147, 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. P i Sig ure Print Name Date This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION ature i Print Name Title Date(of issue) 1. As r\,M l"H�C:\HI .kr },,g«, Mt�,.ttt ( " ( t\ Copy Distribution: Required: Make copies as necessary for Previous editions are obsolete and may no be used 1.Region 3.Staff Access Section Local Authority Inspector Page 1 of 3 CDOT Form#101 5/07 2.Applicant 4.Central Files MTCE Patrol Traffic Engineer State Highway Access Permit PERMIT EXPIRATION Form 101, Page 2 1. A permit shall be considered expired if the access is not under construction within one year of the permit issue date The following paragraphs are excerpts of the State Highway or before the expiration of any authorized extension. When Access Code. These are provided for your convenience but the permittee is unable to commence construction within one do not alleviate compliance with all sections of the Access year after the permit issue date, the permittee may request a Code. A copy of the State Highway Access Code is one year extension from the issuing authority. No more than available from your local issuing authority(local government) two one-year extensions may be granted under any or the Colorado Department of Transportation (Department). circumstances. If the access is not under construction within When this permit was issued, the issuing authority made its three years from date of issue the permit will be considered decision based in part on information submitted by the expired.Any request for an extension must be in writing and applicant, on the access category which is assigned to the submitted to the issuing authority before the permit expires. highway, what alternative access to other public roads and The request should state the reasons why the extension is streets is available, and safety and design standards. necessary, when construction is anticipated, and include a Changes in use or design not approved by the permit or the copy of page 1 (face of permit) of the access permit. issuing authority may cause the revocation or suspension of Extension approvals shall be in writing. The local issuing the permit. authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the APPEALS Department of all denied extensions within ten days. Any 1. Should the permittee or applicant object to the denial of person wishing to reestablish an access permit that has a permit application by the Department or object to any of expired may begin again with the application procedures.An the terms or conditions of a permit placed there by the approved Notice to Proceed, automatically renews the Department, the applicant and permittee (appellant) have a access permit for the period of the Notice to Proceed. right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a CONSTRUCTION request for administrative hearing to the Transportation 1. Construction may not begin until a Notice to Proceed is Commission of Colorado within 60 days of transmittal of approved. (Code subsection 2.4] notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of 2. The construction of the access and its appurtenances Colorado, 4201 East Arkansas Avenue, Denver, Colorado as required by the terms and conditions of the permit shall 80222-3400. The request shall include reasons for the be completed at the expense of the permittee except as appeal and may include changes, revisions, or conditions provided in subsection 2.14. All materials used in the that would be acceptable to the permittee or applicant. construction of the access within the highway right-of-way or on permanent easements, become public property. Any 2. Any appeal by the applicant or permittee of action by a materials removed from the highway right-of-way will be local issuing authority shall be filed with the local authority disposed of only as directed by the Department.All fencing, and be consistent with the appeal procedures of the local guard rail, traffic control devices and other equipment and authority. materials removed in the course of access construction shall be given to the Department unless otherwise instructed by 3. In submitting the request for administrative hearing, the the permit or the Department inspector. appellant has the option of including within the appeal a request for a review by the Department's internal 3. The permittee shall notify the individual or the office administrative review committee pursuant to [Code] specified on the permit or Notice to Proceed at least two subsection 2.10. When such committee review is requested, working days prior to any construction within state highway processing of the appeal for formal administrative hearing, right-of-way. Construction of the access shall not proceed 2.9(5) and(6), shall be suspended until the appellant notifies until both the access permit and the Notice to Proceed are the Commission to proceed with the administrative hearing, issued. The access shall be completed in an expeditious and or the appellant submits a request to the Commission or the safe manner and shall be finished within 45 days from administrative law judge to withdraw the appeal. The two initiation of construction within the highway right-of-way. A administrative processes, the intemal administrative review construction time extension not to exceed 30 working days committee, and the administrative hearing, may not run may be requested from the individual or office specified on concurrently. the permit. 4. Regardless of any communications, meetings, 4. The issuing authority and the Department may inspect administrative reviews or negotiations with the Department the access during construction and upon completion of the or the internal administrative review Committee regarding access to ensure that all terms and conditions of the permit revisions or objections to the permit or a denial, if the are met. Inspectors are authorized to enforce the conditions permittee or applicant wishes to appeal the Department's of the permit during construction and to halt any activities decision to the Commission for a hearing, the appeal must within state right-of-way that do not comply with the be brought to the Commission within 60 days of transmittal provisions of the permit, that conflict with concurrent of notice of denial or transmittal of the permit. highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by right-of-way or any adopted municipal system and drainage law, or the health and safety of workers or the public. plan. 5. Prior to using the access, the permittee is required to 11. By accepting the permit, permittee agrees to save, complete the construction according to the terms and indemnify, and hold harmless to the extent allowed by law, conditions of the permit. Failure by the permittee to abide by the issuing authority, the Department, its officers, and all permit terms and conditions shall be sufficient cause for employees from suits, actions, claims of any type or the Department or issuing authority to initiate action to character brought because of injuries or damage sustained suspend or revoke the permit and close the access. If in the by any person resulting from the permittee's use of the determination of the Department or issuing authority the access permit during the construction of the access. failure to comply with or complete the construction requirements of the permit create a highway safety hazard, CHANGES IN ACCESS USE AND PERMIT VIOLATIONS such shall be sufficient cause for the summary suspension 1. It is the responsibility of the property owner and of the permit. If the permittee wishes to use the access prior permittee to ensure that the use of the access to the to completion, arrangements must be approved by the property is not in violation of the Code, permit terms and issuing authority and Department and included in the permit. conditions or the Act. The terms and conditions of any permit The Department or issuing authority may order a halt to any are binding upon all assigns, successors-in-interest, heirs unauthorized use of the access pursuant to statutory and and occupants. If any significant changes are made or will regulatory powers. Reconstruction or improvement of the be made in the use of the property which will affect access access may be required when the permittee has failed to operation,traffic volume and or vehicle type, the permittee or meet required specifications of design or materials. If any property owner shall contact the local issuing authority or the construction element fails within two years due to improper Department to determine if a new access permit and construction or material specifications, the permittee shall be modifications to the access are required. responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 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. 6. The permittee shall provide construction traffic control The Department or issuing authority may summarily devices at all times during access construction, in suspend an access permit and immediately order closure of conformance with the M.U.T.C.D. as required by section 42- the access when its continued use presents an immediate 4-104, C.R.S.,as amended. threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, MAINTENANCE relocate, or repair a traffic control device or public or private 1. The permittee, his or her heirs, successors-in-interest, utilities for the construction of a permitted access, the assigns, and occupants of the property serviced by the relocation, removal or repair shall be accomplished by the access shall be responsible for meeting the terms and permittee without cost to the Department or issuing conditions of the permit, the repair and maintenance of the authority, and at the direction of the Department or utility access beyond the edge of the roadway including any cattle company. Any damage to the state highway or other public guard and gate, and the removal or clearance of snow or ice right-of-way beyond that which is allowed in the permit shall upon the access even though deposited on the access in the be repaired immediately. The permittee is responsible for the course of Department snow removal operations. Within repair of any utility damaged in the course of access unincorporated areas the Department will keep access construction, reconstruction or repair. culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for 8. In the event it becomes necessary to remove any right- the repair and replacement of any access-related culverts of-way fence, the posts on either side of the access shall be within the right-of-way. Within incorporated areas, drainage securely braced with an approved end post before the fence responsibilities for municipalities are determined by statute is cut to prevent any slacking of the remaining fence. All and local ordinance. The Department will maintain the posts and wire removed are Department property and shall roadway including auxiliary lanes and shoulders, except in be turned over to a representative of the Department. those cases where the access installation has failed due to improper access construction and/or failure to follow permit 9. The permittee shall ensure that a copy of the permit is requirements and specifications in which case the permittee available for review at the construction site at all times. The shall be responsible for such repair. Any significant repairs permit may require the contractor to notify the individual or such as culvert replacement, resurfacing, or changes in office specified on the permit at any specified phases in design or specifications, requires authorization from the construction to allow the field inspector to inspect various Department. 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 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/dearances 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 htto://www.cdvhe.state.co.usfnermits.aso. • COOT Water Quality Program Manager: Rick Willard(303)757-9343 http://www.coloradodot.info/oroorams/environmental/water- Qua itv • 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.armv.mil/html/od-tl/tri-lakes.html Sacramento Dist. (Western CO),Grand Junction Office(970)243-1199 http://www.sok.usace.armv.mil/cespk-co/reoulatorv/ Albuquerque District(SE Colorado),Pueblo Reg.Office(719)-543-6915 http://www.spa.usace.armv.mil/rea/ • COOT Utilities, Special Use and Access Permitting: (303)757-9654 h • ot.st Pm fcolooical 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 COOT prior to the continuation of work. Information about threatened or endangered species may be obtained from the CDOT website,http://coloradodot.info/txoorams/environmental/wildlife/guidelines or the Colorado Division of Wildlife website htto://wildlife.state.co.us/VVildlifeSoeciesiSoeciesOfConcem/. 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 Historic Preservation(OAHP), Denver,to ascertain if historic or archaeological resources have previously been identified. Inventory of 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 Pertaining to Solid Waste Disposal Sites and Facilities(6 CCR 1007-2),prohibit solid waste disposal without an approved Certificate 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 Soil—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 projects 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 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 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. 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 http://www.coloradodot.info/programs/environmental/wlldlife/guidelines. 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 CDOT Water Quality Program Manager at(303)757- 9343. Otherwise,contact the CDPHE Water Quality Control Division at(303)692-3500. Website: htto://www.cdohe.state.co.us/wg/PermitsUnit/index.html. 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 at(303)692-3500. For Dewatering Application and Instructions,see Section 3 at the CDPHE website: http://www.cdohe.state.co.us/wq/PermitsUnit/FORMSandApplications/Aoosandformsnewoage.html Municipal Separate Storm Sewer System(MS4)Dischame 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 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://www.coloradodot.info/proorams/environmental/water-quality/documents/CDOT%20MS4%20Permil.doc/view)and COR-030000(http://www.cdohe.state.co.us/wa/PermitsUnit/PERMITS/SWoermitsrats/SWConslructionPErmit.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.cdphe.state.co.us/w9/permitsunit/MS4/MS4Perm tjees.pd(. 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.coloradodot.info/programs/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 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: http://www.dot.state.co.us/environmental/envWaterQualywgms4.asp Disposal of Drillina 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 Environmental Clearances Information Summary Page 2 of 3 Colorado Department of Transportation December'10 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 COOT 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 CDOT Water Quality Program Manager at(303)757-9343. Website:htto://www.coloradodot.info/oroorams/environmental/water- ouality/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. SPIII 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 Karami, CDOT Safety&Traffic Engineering,Utilities Unit,at(303)757-9841,alex.karami@dot.state.co.us. Environmental Clearances Infommatlon Summary Page 3 of 3 Colorado Department of Transportation December'10 Industrial facilities program CDOT issues Utility Permits to those utility companies, " ' ' industry, or others wishing to install, adjust, relocate, remove, or maintain utilities in CDOT's right-of-way. CDOT issues `a Access Permits for building access from private property P (driveways) to state highways (driveways). These two permits are issued and inspections are conducted through CDOT's six regional offices located throughout Colorado. CDOT's Water Quality Program tracks and maintains a record of any permittee that ties into CDOT's storm drain system. CDOT has a program to identify and eliminate any discharge to their storm CDOT's Industrial Facilities Program is focused on educating drain system that is not composed entirely those industrial facilities that discharge stormwater into of stormwater(unless authorized by CDOT's storm drain system. Under this program, CDOT also another permit from Allowable discharges into CDOT's storm drain educates industrial facilities on the proper management of system include the following: potential pollutants that could enter the CDOT storm drain • Landscape irrigation system. ■ Diverted stream flows Industrial facilities include a site that includes any of the ■ Rising ground waters following activities for any of the following categories of industries: ■ Uncontaminated ground water infiltration to separate storm sewers • Activities • Manufacturing, processing, raw materials storage • Uncontaminated pumped ground water • Industrial plant yards • Discharges from potable water sources • Access roads/rail lines used to carry raw materials, IN Foundation drains manufactured products, waste materials, or byproducts • Air conditioning condensation • Material handling laIrrigation water • Refuse site • Springs • Application or disposal of process waste waters • Storage and maintenance of materials handling • Water from crawl space pumps equipment • Footing drains • Residual treatment, storage, or disposal II Lawn watering • Shipping and receiving areas • Manufacturing buildings • Individual residential car washing • Storage areas used (including tank farms) for raw IN Individual residential swimming pool materials and immediate and final products and hot tub discharges • Areas where industrial activity has taken place in the • Individual residential street washing past and significant materials remain and are exposed to stormwater ■ Water-line flushing • Categories of Industries ■ Flows from riparian habitats and • Manufacturing wetlands • Food and kindred products (SIC 20) • Flows from emergency fire fighting • Tobacco products (SIC 21) activities • Textile mill products (SIC 22) ■ Water incidental to street sweeping • Apparel and other textile products (SIC 23) (including associated side walks and • Lumber and wood products (SIC 24) medians)and that is not associated • Furniture and fixtures (SIC 25) with construction • Paper and allied products(SIC 26) • .;74'x^.+ ^^;a :;.,s:; . x•:e-'''.'.' c. • Printing and publishing (SIC 27) • Chemicals and allied products (SIC 28) • Petroleum and coal products (SIC 29) ye ' • Rubber and miscellaneous plastics (SIC 30) • Leather and leather products (SIC 31) • Stone, clay, and glass products (SIC 32) • Primary metal industries (SIC 33) • Fabricated metal products (SIC 34) • Industrial machinery and equipment (SIC 35) - • Electronic and electric equipment (SIC 36) CDOT defines a utility or utility • Transportation equipment (SIC 37) facility as any privately, publicly, or • Instruments and related products (i.e., search/ cooperatively owned line, facility, or navigation, measuring and controlling, medical, system producing, transmitting, or photographic, watches) (SIC 38) distributing the following • Miscellaneous manufacturing industries (i.e., jewelry, • Communications silverware, musical instruments, toys, sporting goods, ■ Cable television office/ad supplies, caskets, brooms, floor coverings, signs) (SIC 39) • Power • Mining: metal, coal, oil and gas, nonmetallic minerals • Electricity (SIC 10-14) ■ Light • Oil and gas exploration, production, processing, or treatment operations is Heat gas • Transportation facilities which involve vehicle ■ Oil maintenance, equipment cleaning, and airport deicing, • Crude products including • Railroad transportation (SIC 40) ■ Water steam • Local and interurban passenger transit(SIC 41) ■ Waste • Trucking and warehousing (except farm products and • Stormwater not connected with refrigerated warehousing) (SIC 42) highway drainage • Postal service (SIC 43) Is Other similar commodity • Water transportation (SIC 44) • Air transportation (SIC 45) • Petroleum bulk stations and terminals (SIC 5171) • Hazardous waste, treatment, storage or disposal ` is • Landfills, land application sites, and open dumps that � receive industrial wastes { v j u s �I,1 �. i ' r • Recycling facilities, metal scrap yards, battery reclaimers, salvage yards, automobile junkyards for / used motor vehicle parts or scrap and waste materials ,' s • Steam electric power generating facilities including y ,-�, �. ? r, coal handling sites 1 • Wastewater treatment works for municipal and "" f domestic sewage or biosolids having a design flows of 1 MGD or more (except farm lands and domestic l, v� _ gardens) i i d, • Construction activity resulting in a disturbance of 5 acres or more, including clearing, grading, and excavation State Highway Access Permit 1 Attachment to Permit No. 411096 -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, 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.411096 -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 Lee Ireton, at the Greeley Traffic Office, (970) 350-2147 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. 411096-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 Lee Ireton at (970) 350-2147 or(970) 590-7155 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 at 25 feet wide with 25 foot radius on either side. 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. 411096-Additional Terms and Conditions 33. The Permittee shall request final inspection by Lee Ireton at (970) 350-2147 or (970) 590-7155 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. 411096-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/PermitsUnitlwqu. 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. 41. If there are any questions regarding this permit, please contact Gloria Hice-Idler at(970) 350-2148. 42. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 43. 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 44. 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. 45. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction(current edition). 46. 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) State Highway Access Permit 6 Attachment to Permit No. 411096 -Additional Terms and Conditions 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 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. 47. 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 upon notice of cancellation of the permit from the Department, unless a new permit is applied for and granted. 48. 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. 49. The Department retains the right to perform any necessary maintenance work in this area. 50. 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. 51. 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. 52. All costs associated with the installation of this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. 53. 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. 54. Traffic detours or lane closures will not be allowed, unless pre-approved by the Department. 55. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department State Highway Access Permit 7 Attachment to Permit No. 411096 -Additional Terms and Conditions 56. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 57. No work shall be performed near a Department electronic traffic control device without coordination with Cobie Garbiso at(970) 350-2137. 58. It is the responsibility of the Permittee to prevent all livestock from entering the State Highway right- of-way. Any livestock that does enter the State Highway right-of-way shall be the sole responsibility of the Permittee. 59. 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 Lee Ireton at the Greeley Traffic Office, (970) 350-2147, to obtain the Landscaping Permit. 60. 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. 61. 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. 62. 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. State Highway Access Permit 8 Attachment to Permit No. 411096-Additional Terms and Conditions 63. All materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable: A. State Highway Access Code, 2 CCR 601-1 B. Roadway Design Manual C. Materials Manual D. Construction Manual E. Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M.U.T.C.D.) for Streets and Highways and the Colorado Supplement thereto H. A policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials(AASHTO), latest edition I. AASHTO Roadside Design Guide J. Institute of Transportation Engineer's Trip Gneration Manual, 6th edition Some of the reference materials listed above (A thru F)may be purchased from: Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from: The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website is: www.dot.state.co.us/business/accessmgt/ 64. 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. 65. 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. 66. The Permittee or the contractor shall notify Lee Ireton at (970) 350-2147 or (970) 590-7155 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. State Highway Access Permit 9 Attachment to Permit No. 411096-Additional Terms and Conditions 67. 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. 68. Upon completion of the work, a letter certifying that all project materials, construction, inspection and workmanship was in accordance with the plans and applicable Department Standard Specifications for Road and Bridge Construction shall be submitted to the Region Access Manager. The certification letter must be signed and stamped(sealed) by a Colorado registered professional engineer. 69. Speed change lane(s) shall be provided in accordance with Exhibit "A" and Section 4 of the State Highway Access Code, 2 CCR 601.1. 70. All final signing and pavement striping shall be done by the Permittee or the contractor in conformance with the Department's M&S Standards and the Manual for Uniform Traffic Control Devices (M.U.T.C.D.), unless otherwise agreed to by the Department and the Permittee. Two weeks prior to final pavement marking, the Permittee shall contact Art Rodriquez at (970) 304-0173 in order to review striping layout and to coordinate schedules for striping by the Permittee and inspection by the Department. No pavement marking shall be applied without the required plan review and authorization. The Permittee shall provide layout to Department striping inspection personnel. 71. The access shall be constructed as per Exhibit "A". 72. Construction traffic devices, when not in use, shall be removed or turned away from traffic. 73. 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. 74. All required access improvements shall be installed prior to the herein authorized use of this access. 75. The access shall be surfaced immediately upon completion of earthwork construction and prior to use. 76. Surfacing of the access shall be completed as per Exhibit "A". 77. Compaction of subgrade, embankments and backfill shall be in accordance with Section 203.07 of the Department's standard specifications. Test results shall be provided to the Region Access Manager. 78. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. 79. The new State Highway pavement shall slope on the same plane as the present pavement surface. 80. The existing asphalt adjacent to all new pavement shall be saw cut and removed a minimum of one foot back from the existing edge, or until an acceptable existing cross slope is achieved to assure a straight edge for the joint. 81. Longitudinal joints of the final pavement surface shall match the roadway lane lines. State Highway Access Permit 10 Attachment to Permit No. 411096-Additional Terms and Conditions 82. The top layer of plant mix bituminous pavement shall not be placed between October I and April 1, unless otherwise approved by the Department. 83. Any layer of bituminous pavement that is to have a succeeding layer placed thereon shall be completed full width, before succeeding layers are placed. 84. 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. 85. The access shall be constructed 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. 86. 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. 87. The Permittee shall request final inspection by Lee Ireton at (970) 350-2147, within 10 days following completion of access construction, and prior to authorized use. The Permittee or their representative shall be present. 88. 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. 89. The design and construction 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. 90. 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 axe 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: State Highway Access Permit 11 Attachment to Permit No.411096-Additional Terms and Conditions 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. COLORADO DEPARTMENT OF TRANSPORTATION Issuing authority application STATE HIGHWAY ACCESS PERMIT APPLICATION acceptance date: r1.(A -\»CTh Instructions: - Contact the Colorado Department of Transportation(COOT)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 apptcaflon. - 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 jtttflJ/rrww_dat.state.co.ua/Acce Permute ndez.htrn 1)Property yowner(Perm ittee) 2) Heard or Agent for permlttee(if different from property owner) Streeta / 1 A6 SCi' girt_t��11 cro, L L(cfress Ma;l adhd d/L ,Ati 4 i c ess 45b0 �• h,� 3 PO aox /F9 `� City,state&zip J Ph2ne# City,state&zip Phone#(required) We s_o1' 00 ? ThD 970-4 7z-0(A 90 W011 t, 36 470 -639--5,2€14. E- fl address E-mail address if available ? 3)Address of property to be served by it(required) 9 0 Ili, ackt Will 4V OI 0 Oti galssa 4)Legal description of 0.: :If writ it rlsdictional limits of Municipality,city and/or County,which one? ca a I subdivision I blocklot l section .2.2 township 04 I raga t, 7 5)What State Highway are you requesting access from? 6)What side ofN the hay?DE ❑W 91.7)How many feel is the proposed access from the nearest mile post? How many feet is the proposed access from the nearest cross street? feet N j]SgE❑w)from: A' feet pN DS®E[ from: 8)What is the approximate date you intend to begin construction? (U 071 40 tit/Pt t a 0pr1?1/a.l�" D€ foil,/ - trat.•-L �o/ ./Nyiel 9)Check he it you are uestng a: new access ('temporary access(duration anticipated: } improvement to existing access change in access use nremoval of access elocation of an existing access(provide detail) 10)Provide existing property use _ ,�Q.zo�se_o1{O� /�2a.��Z ta�tP.e� CQ�� -y �P!' v�2� 11)Do you have knowledge of ally State Highway access permits serving this property,or adjaca propertiesYwhich you have a property interest? ®na eyes,if yes-what are the permit number(s)and provide copies: and/or,permit date: 12)Does the property owner own or have any interests In any adjacent property? ®no oyes,if yes-please describe: 13)Are there other existing or dedicated public streets,roads,highways or access easements bordering or wlttlin the property? vino Oyes,dyes-list them on your plans and Indicate the proposed and existing access points. 14)If you are requesting agricultural field access-how many acres will the access serve? nja 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 business square footage �(/jt / L.[ O, I I 16)II you are requesting residential developement access,what is the type(single family,apartment,townhouse)and number of units? i type number of units type number of units I I I 1 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 s or passenger cars and tight trucks at hour vdumae sot Mufti unit trucks al peak hour volumes i Deak hour volumes ord verage daily volumes. a of single unh men vehicles in en 30 R. s or term vehicles(fend equipment) Total count o$2 vehicles t ib Previous editions are obsolete and may not be used Page 1 of 2 COOT Form#137 01110 ` i l I l I f 18)Check with 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 streets. e) Subdivision,zoning,or development plan. b) Highway andddveway plan profile f) Proposed access design. c) Drainage plan showing impact to the highway right-of-way, g) Parcel and ownership maps including easements. d) Map and letters detailing utility locations before and after h) Traffic studies. development in and along the right-of-way. i) Proof of ownership. 1- It is the applicants 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 htto/Nrww.dot.state.co.us/environmental/Forms.aso. 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, ANSVISEA 107-1999, class 2); head protection that complies with the ANSI 289.1-1997 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: <htWWJ/www.dot.state.co.us/DeslgnSupoort/> then click 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 fisted 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 P rmittee signature Print le name Date 7 U.nnpant. /VIC l!/.29l1/ th licant is not the owner of the property,we require this application also to be ned by the property owner or it 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 nature Print name Date — k "72 7 d%ctt-Le_d d0,Y , 11Av9�!/ /'2 R/' tarFGMAaath,/ /t'ta�a'l,agtottdtt7, Las Previous editions are obsolete and may not be used Page 2 on 2 C x127 01/10 csinliMilal r -_-.'v! I I ff —one M pep�.� is+'.a� J ® Ly �� C n 3 1 J Irilr g Y La c • c n. „0 b Cd O 4.1 R O .1 'o al' h. Ln o z d ( `( °u c wry, �r w q q .. OD w ° A 1 r - to .� b v� " w � 8 � J5 W .�eti a � q („�`� 1_2.--) p ir CU o y c '5 a 0. g �O S 1/4--D-ccu • okb,01 ! " s `,/-,I1 H a o q .4 u a� UL41II4 o a) G )' 4 T ,� 'd '17 O OD A .P .0 .5 el O A r.el •S k FL CI h V CI.'C7 r izi �a Li- °' S .. cs 5 .t w. o R a 1 DELO R M E Street Atlas USA®2006 ID illapait Vicinity Map for Access Permit #411096 ---43 "Exhibit B" EPR0SPECTRD R Windsor _... �I ` ® Reservoir 7lmnath ♦ Severance 38 es ! Woods i Lake 1 I ., Bruce i Windsor CF 392 - fie ,•:'• 392 68 392 are n°^ Corner i Bracewell Farmers_.. - 29 1 III; 31 34 II"11,, 1 0. Officer 257 , Koenigi I ® I I I I +a Scale 1 :100,000 Data use subject to license. fififi _ ®2005 DeLorme.Street Atlas USA®2006 v«e.rEl o I 3 'I www.deIorme.com 1"=1.58 mi Data Zoom 11-0 Hello