HomeMy WebLinkAbout20120270.tiff CHANGE OF ZONE (Z) APPLICATION
• FOR PLANNING DEPARTMENT USE DATE RECEIVED:
RECEIPT/AMOUNT# /S CASE#ASSIGNED:
APPLICATION RECEIVED BY PLANNER ASSIGNED:
Parcel Number O __O7-Ott - 3 - G CL- O 4' .
(12 digit number-found on Tax I.D. information,obtainable at the Weld County Assessor's Office.or ww:d co ye'n rn:41
(Include all lots being included in the application area.If additional space is required,attach an additional sheet)
(La-1VSZ.
Legal Description ?I Sco'f 4 {o-‘7 Lc , Section_±.Township la_North, Range('7 West
Property Address(If Applicable) Ace 3S Y9 4 ,(/lug Z07 (S of. t, $,16 Ny R67 w
Existing Zone District: PUQ Proposed Zone District: A, Total Acreage. 7o.9C Proposed#/Lots: Oac a(- 6S Me'°
Average Lot Size: Minimum Lot Size: Proposed Subdivision Name:
FEE OWNER(S)OF THE PROPERTY(If additional space is required, attach an additional sheet)
Name: C.k(.TOn_ (-(Lit:. T N A iot.JK SAN 61
Work Phone# Z$L-ZYOt Home Phone# 7t'4.944.4o4y Email Address d wo„r)s(•4i (4. . 124 r. L .(4.,
Address: ztoel AA. IeSk..• Qn...e
City/State/Zip Code ,II ,.., Co 6-o-,aT
APPLICANT OR AUTHORIZED AGENT(See Below'Authonzahon must accompany applications signed by Authonzed Agent)
Name: Pax 14OFrMM /I� Ole WorkPhone# zt5-97SZJ Home Phone# Z3? -3S-SS Email Address f,..t e SweC -cJ C (cf.
Address: 'lec 4Yt45rnn C 1. 4111/
• City/State/Zip Code re iI- MI 1K\ (0 1105 C'1
UTILITIES: Water: M erI-(-- Cite() (o.,, ty LJ. k
Sewer:
Gas:
Electric.
Phone:
DISTRICTS: School: RE Y
Fire. I. i,n.J 5.K— S€4 -rgkre
Post Office:
I (We),the undersigned, hereby request hearings before the Weld County Planning Commission and the Weld County Board
of County Commissioners concerning the proposed Change of Zone for the following described unincorporated area of Weld
County.Colorado:
I (We) hereby depose and state under penalties of perjury that all statements, proposals, and/or plans submitted with or
contained within the application are true and correct to the best of my (our)knowledge. Signatures of all fee owners of
property must sign this application. If an Authorized Agent signs, a letter of authorizat n from all fee owners must be
included with the application. If a corporation is the fee owner, notarized evide mu t b included indicating the signatory
has t gal authority to sign for the corporation.
9
Signature: net or Authorized Agent Date Signature: er o Authorized Agent D le/
EXHIBIT -4_
• 1 L 2012-0270
•._ -••• Z
O WCapital
National Bank .,
No\ember 16. 2011
Mr. Tom Parko,M.A., CFM
Planning Manager
Weld County Dept. of Planning Services
1555 N. 17th Avenue
Greeley, CO 80631
Tom,
This letter serves to let you know that Paul Hoffman is authorized to represent Capital
West National Bank in the COL process for the property for which you currently have a
rezoning application located on Hightway 257, case#COZ11-0002. Thank you.
Sincerely,
•
Douglas R. Woods
President, Capital West National Bank
SERVICE You Deserve
•
CHANGE OF ZONE/REZONING QUESTIONNAIRE:
1. How is the proposed rezoning consistent with the policies of the Weld County Code, Chapter 22? If the proposed
rezoning is not consistent with the Comprehensive Plan, explain how the proposed rezoning will correct what the
applicant perceives as faulty zoning, or how the proposed rezoning will fit with what the applicant perceives as the
changing conditions in the area.
2 How will the uses allowed by the proposed rezoning be compatible with the surrounding land uses? Include a
description of existing land uses for all properties adjacent to the subject property.
3 Will the property use a septic system or public sewer facilities?
4. Who will provide adequate water, including fire protection,to the property?
5. Does the property have soils with moderate or severe limitations for construction? If yes, the applicant shall submit
information which demonstrates that the limitations can be overcome.
6 Is the road and/or highway facility providing access to the property(ies) adequate to meet the requirements of the
proposed zone district? If not, the applicant shall supply information demonstrating the willingness and financial
capability to upgrade the road and highway facilities
7 Is the change of zone area located in a Flood Hazard Overlay District?
8 Is the change of zone area located in a Geologic Hazard Overlay District'?
9 Is the change of zone area located in the AP(Airport)Overlay District'?
•
-5-
•
Change of Zone Plat
•
Rezoning Questionnaire
Lot B Second Amended Recorded exemption no 0807-04-3-AMRE1452
Tract of Land located in SW 'A of section 4, Township 6 North, Range 67 West of the 6`h
PM
County of Weld, State of Colorado
October 31, 2011
1. We feel that we meet virtually every goal established for Chapter 22
Goal 1. Respects and encourages the continuation of Ag land
Goal 2. Continue the commitment to viable Ag in Weld County
Goal 4 Keep property from having unsightly refuse
Goal 5 Provide for minimum buildable lot size
Goal 6 Provides for returning the land to Ag use
Goal 7 Protects the property owners rights
Goal 8 Assured that adequate services are available
Goal 9 Reduces conflicts with various land uses
Goal 10 Right to Farm
2. The land was already zoned Ag, but had been put into a PUD estate lot zoning.
We would like to bring the zoning back to Ag
3. Property will eventually have a septic system for single family residence
• 4. Water by Northern Weld County Water.
5. We do not anticipate any unusual soil conditions
6. We have CDOT permits #411060, 411066, 411067 attached.
7. Not in Flood Hazard Overlay District
8. Not in Geological Hazard Overlay District
9. Not in Airport Overlay District
•
I
• PERMIT #411060, #411066 and
#411067
LEE IRETON (970) 350-2147
YOUR ACCESS INSPECTOR IS LEE
IRETON.
YOU MUST CONTACT THE INSPECTOR AT
LEAST 2 WORKING DAYS PRIOR TO ANY
ACCESS IMPROVEMENTS OR
CONSTRUCTION OF ANY KIND WITHIN
• THE STATE HIGHWAY RIGHT-OF-WAY.
ALL ACCESS ACTIVITY WITHIN THE
RIGHT-OF-WAY MUST BE COMPLETED IN
45 DAYS ONCE WORK BEGINS.
UPON COMPLETION OF ALL PERMIT
REQUIREMENTS, YOU MUST REQUEST A
FINAL INSPECTION BY THE ACCESS
INSPECTOR OR THEIR REPRESENTATIVE.
•
CDOT Permit No.
COLORADO DEPARTMENT OF TRANSPORTATION 411060
. STATE HIGHWAY ACCESS CODE SH/S/MP
257A / 14.035 / R
Local Jurisdiction
NOTICE TO PROCEED Weld County
Permittee(s): Applicant:
Capital West National Bank Paul Hoffman
Doug Woods
2108 Mileston Drive 405 Mason Court, Suite 111
Fort Collins,CO 80525 Fort Collins, CO 80524
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.
IIThis 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
y Title t Date
B• (X) ._ ACM*
10/12/2011
Cop, distri ution: Required: Make copies as necessary for: Form 1265 8/98,6/99
Region(original) Local Authority Inspector Lee Ireton
Applicant MTCE Patrol Traffic Engineer
Staff Access Section 17-West Greeley
r COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No. 411060
STATE HIGHWAY ACCESS PERMIT State Highway No/Mp/Side
257A / 14.035 / R
Illi Permit fee Date of transmittal • Reg ion/Section/Patrol Local Jurisdiction
$50.00 8/24/2011 4/ 01 /17-West Greeley Weld County
The Permittee(s); Applicant: Ref No.:
Capital West National Bank Paul Hoffman
Doug Woods
2108 Mileston Drive 405 Mason Court,Suite 111
Fort Collins,CO 80525 Fort Collins,CO 80524
970-282-2401 970-218-8750
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:The access is located on State Highway 257,a distance of 183 feet north of Mile Post 14 on the east/right side.
Access to Provide Service to: (Land Use Code:) (Size or Count) (Units)
210-Single-Family Detached Housing 1 EACH
Additional Information:
•
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority. 1 '
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
I 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 commendng 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 Signatur j Print Name Date
.YO — U4"25► ,e.6 ( Pm7(. u, � to-c-(I
�►- l��� N�r M IAA✓
This permit is not valid until signed by a duly authorized representative of the Department.
COLORADO DEPARTMENT OF TRANSPORTATION
f Signgtere q P tt{Name l j Tit}e t` Date(of issue)
Y. . 'fLC-12- - 0-- 'iCr-iCirtIGe- — ILI ( t-tr- Itzv iii' lf` 4 l' I- ! f/!7 ii
Copy Dis rtbutton: Required: Make copies as necessary for: Previous a tt s are obsolete and ay not be usec
1.Region 3.Staff Access Section Local Authority inspector Page 1 of 3 CDOT Form#101 5101
2Applicant 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
,e following paragraphs are excerpts of the State Highway or before the expiration of any authorized extension. When
cess 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
peal and may include changes, revisions, or conditions provided in subsection 2.14. All materials used in the
t 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 internal 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
• brought to the Commission within 60 days of transmittal provisions of the permit, that conflict with concurrent
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.
Prior to using the access, the permittee is required to�omplete the construction according to the terms and 11. By accepting the permit, permittee agrees to save,
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
ithin highway right-of-way. Where necessary to remove, MAINTENANCE
elocate, 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
cr local authority field inspector to meet unanticipated site
onditions.
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/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.cdphe.state.co.us/permits.asp.
• CDOT Water Quality Program Manager: Rick Willard(303)757-9343 http://www.coloradodot.info/proqrams/environmental/water-
quality
• CDOT 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.spk.usace.armv.mil/cespk-co/requlatorv/
Albuquerque District(SE Colorado), Pueblo Reg.Office(719)-543-6915 http://www.spa.usace.armv.mil/ren/
• CDOT Utilities,Special Use and Access Permitting:(303)757-9654 http://www.dot.state.co.us/Permits/
Ecological 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
be obtained from the CDOT website, http://coloradodot.info/proarams/environmental/wildlife/guidelines,or the Colorado Division of
Wildlife website http://wildlife.state.co.us/WildlifeSpecies/SpeciesOfConcern/. 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 COOT 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 infra-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/pros ra ms/envi ron manta I/wi Idl ife/auidel Ines.
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:
http://www.cdohe.state.co.us/wq/PermitsUniVindex.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.cdphe.state.co.us/wa/PermitsUnit/FORMSandApplications/Appsandforms newpage.htm I
• 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
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.coloradodainfoftprograms/environmental/water-aualitv/documents/CDOT%20MS4%20Permit.doc/view)and
COR-030000(http://www.cdphe.state.co.us/wa/PermitsUnit/PERMITS/SWoermitsrats/SWConstructionPErmit.pdf). 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.cdohe.state.co.us/wapermitsunit/MS4/MS4Permittees.odf.
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/envWaterQual/wams4.ase
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
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 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 CDOT
Water Quality Program Manager at(303)757-9343. Website:httb://www.coloradodot.info/programs/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.
_
Spill Reporting-Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm
drain or buried. 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 Information Summary Page 3 of 3 Colorado Department of Transportation December'10
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•
State Highway Access Permit 1
Attachment to Permit No. 411060-Additional Terms and Conditions
• 1. If there are any questions regarding this permit, please contact Gloria Hice-Idler at (970) 350-2148.
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 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.
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,
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. 411060 -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 southmost access to the property shall be removed immediately. Removal 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.
12. 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.
• 13. 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.
14. 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.
15. Traffic detours or lane closures will not be allowed, unless pre-approved by the Department.
16. Two-way traffic shall be maintained throughout the work area at all times unless specific written
authorization is obtained from the Department
17. No construction vehicles shall be parked, or construction materials/equipment stored, on the State
Highway right-of-way overnight.
18. 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.
19. 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
State Highway Access Permit •
S3
Attachment to Permit No. 411060 - Additional Terms and Conditions
• CDOT Standard M-605-1 or other approved system. The Permittee shall contact Gloria Hice-Idler at the
Greeley Traffic Office, (970) 350-2148, to obtain the Landscaping Permit.
20. 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.
21. 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.
22. 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
State Highway Access Permit •
S4
Attachment to Permit No. 411060 -Additional Terms and Conditions
• The website is:
www.dot.state.co.us/business/accessmgt/
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. 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.
25. 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.
26. 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.
• 27. If highway right-of-way fence exists or is proposed, the Permittee must contact Gloria Hice-Idler at the
Greeley Traffic Office, (970) 350-2148, prior to removal or installation.
28. The access shall be constructed as per Exhibit "A".
29. Construction traffic devices, when not in use, shall be removed or turned away from traffic.
30. The access shall be constructed perpendicular to the travel lanes of the State Highway for a minimum
distance of 40 feet, and shall slope down and away from the adjacent pavement edge at a rate of 2% grade
for a minimum of 20 feet.
31. 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.
32. Any access gate shall be set back so that the longest vehicle using the access can completely clear the
traveled way when the gate is closed.
33. All required access improvements shall be installed prior to the herein authorized use of this access.
34. The access shall be surfaced immediately upon completion of earthwork construction and prior to use.
35. Surfacing of the access shall be completed as per Exhibit "A".
• 36. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to
assure a straight edge for patching.
State Highway Access Permit • 5
Attachment to Permit No. 411060-Additional Terms and Conditions
• 37. 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.
38. If necessary, the Permittee shall install a new 18 inch corrugated metal pipe and shall provide for proper
side slopes. Culverts over 18 inches in diameter shall have end sections.
39. 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.
40. 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.
41. 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.
42. 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.
• 43. 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.
44. 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, flows from riparian habitats and
wetlands, and flow from fire fighting activities.
•
State Highway Access Permit 6
Attachment to Permit No. 411060-Additional Terms and Conditions
• 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: Qi //
�structions: - 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 websito at h_t_tp://www.dot.state.co.usrAccessPerrnitsiindex.htm
1)Property owner(Pormiflee) 2)Applicant or Agent for permitlee (if different from properly owner)
Capital West National Bank Paul Hoffman
Street address Mailing address
2108 Milestone Drive 405 Mason Court, Suite 111 —
City.state& zip Phone# City.state&zip phone a(required)
Fort Collins, CO 80525 970-282-2401 Fort Collins, CO 805024 970-218-8750
E•mai address! E-mail address if available
dwoods@cwnbank.com paul@sweetwaterlimited.com
3)Address of property to be served by permit(required) —
35496 HWY 257, Weld County
4)Legal description of property:If within jurisdictional units of Municipality,city and/or County,which one?
:r._r— l 1..-!.-0,-.,;,e, ICI stlC l6+.n canoe .-_.._
Weld -1 j B I SW N 1/4 of 4 16 North I 67 West
5)What State Highway are you requesting access from? le)
What side of the to hway?
257 FIN S 0 E El w ._.—...._
7)How many feet is the proposed access from the nearest mile post? How many feet is the proposed access frorn the nearest cross street?
--=__-.L-_(�J,__._.._.._.feel kiN ns 0 E DWI from:,....... .....l.np.._.I4 feet IN S E a w,from WCR__.. .. '\...-
8)What is the approximate date you intend to begin construction?
5/1/2012 __
9)Check here if you are requesting a:new.access []temporary access(duration anticipated: ) 1nrovement to existing access
-t•rme1pcatron of an existing access(provide detail)
flange in access use nrernoval of access L rt
10)Provide existing property use
vacant Field --
i i)Do you have knowledge of any State Highway access permits serving this property.or adjacent properties in which you have
arproperty permit date:
Ono Dyes.if yes•what are the permit number(s)and provide copies: v
—
12)Does the property owner own or have any interests in any adjacent property?
Eno Dyes,if yes •please describe:
13)Are there other existing or dedicated public streets,roads,highways or access easements bordering or within the property'?
Dno a yes,it yes•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?
15)If you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage u of each.
business.tand use square footage business
are fotage
16i It you are requesting residential development access.what is the type(single family.apartment.townhouse)and number of units? number o!units
type number of units tYPe..___ ,u _.
Single Family j One 1 .
17)Provide the following vehicle count estimates for vehicles that will use the access.Leaving the property then returning is two counts.
s C!nIu7t:and Irycks,l!peak h?,.e vplwroy .
R of OJ nq`,�lrs and t�•hC!Nat':,1 pdak howvOtum85
-ate if your counts are L U
eak hour volumes or p average daily volumes.
r at yrVo umt vend/,.n cievsr.of 30 t1. 'a 01 lam:vvn:4os i!<47 cQ...amo:li
Total count of all vehicles c-1
1 of 2 'DOT m A177 0trl(
Previous editions ore obsolete and may not be used Page
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 and driveway plan profile. t) 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 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 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.
II3- The Perrnittee 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:
<http://www.dot.state,co.us/DesignSupport/>, 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 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 Ag or Pr t e signature I Pr n Warne Date
! Paul Hoffman 7/27/11
Cam\
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 Date
VC. {/ J �. ,2%9- Doug Woods, Pres, CWNB 7/27/11
•
Previous editions are obsolete end may not be used Page 2 012 COOT Form 0137 01/10
FINIEWIENI Ire.
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