HomeMy WebLinkAbout20121650.tiff •
SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL
REVIEW (USR) APPLICATION
• FOR PLANNING DEPARTMENT USE DATE RECEIVED:
RECEIPT#/AMOUNT# /$ CASE#ASSIGNED:
APPLICATION RECEIVED BY PLANNER ASSIGNED:
Parcel Number 1 0 5 5 . 2 5 . 0 . 0 0 . 0 0 7
(12 digit number-found on Tax I.D.information,obtainable at the Weld County Assessors Office,or www.co.weld.co.us)
Legal Description Portion of South Half , Section 25 , Township 4 North, Range 65 West
Zone District:AG , Total Acreage:208.33 , Flood Plain:N/A , Geological Hazard: N/A
Airport Overlay District: N/A
FEE OWNER(S) OF THE PROPERTY:
Name:Shelton Land and Cattle, Ltd., a Colorado Corporation
Work Phone# Home Phone# Email
Address: P.O. Box 65
Address:
City/State/Zip Code Roggen, CO 80652
Name:
Work Phone# Home Phone# Email
Address:
Address:
City/State/Zip Code
Name:
• Work Phone# Home Phone# Email
Address:
Address:
City/State/Zip Code
APPLICANT OR AUTHORIZED AGENT (See Below:Authorization must accompany applications signed by Authorized Agent)
Name: Petroleum Development Corporation
Work Phone# 303-860-5800 Home Phone# Email
Address: 1775 Sherman Street
Address:
City/State/Zip Code Denver, CO 80203
PROPOSED USE:
Petroleum Development Corporation (PDC) intends to use this site as a location for a telecommunications tower
will communicate between PDC's Evans, Co office and its oil and gas wells. PDC's wells are automated and the
intent is for the wellheads to beam signals to the tower and then for the tower to beam to the Evans office.
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 authorization from all
fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be
included indicating that the signatory has to legal authority to sign for the corporation.
2A o 1 j Q
Signature: Owner or Authorized Agent Date Signature: Owner or Authorized Agent Date
• .�' P<>> h,, Pis
2012-1(p 50
•
STATE OF 00/0%'/c-1O ) CORPORATE ACKNOWLEGEMENT
V1!C I d )
COUNTY OF )
This instrument was acknowledged before me this '`$1-4 day of 7ik/rr'N , 2012,by
Ronald E.Shelton, President of Shelton Land and Cattle,Ltd.,a Colorado Corporation.
�jti J
,``lllllllllllll Notary Signature: C/ '
♦♦ G NEU,y �i C till AG ektnefi A,I
♦♦♦_r q4,i.� Printed Name of Notary:
V� �T'�*1 2/i Notary Public for the State of: LU`o 'c- d U
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1 Residing at: tnt CO
N� °i1 O 05
.9 IT My Commission Expires: 9 —1 4 O.0 14
(Affix�Atni F^,ial,4t ove)
N►►H111%
•
•
SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL
REVIEW (USR) APPLICATION
• FOR PLANNING DEPARTMENT USE DATE RECEIVED:
RECEIPT IS/AMOUNT# /$ CASE#ASSIGNED:
APPLICATION RECEIVED BY PLANNER ASSIGNED:
Parcel Number 1 0 5 5 _ 2 5 _ 0 _ 0 0 _ 0 0 7
(12 digit number-found on Tax I.D.information,obtainable at the Weld County Assessors Office,or www.co.weld.co.us)
Legal Description Portion of South Half , Section 25 , Township 4 North, Range 65 West
Zone District:AG , Total Acreage:208.33 , Flood Plain:N/A , Geological Hazard: N/A
Airport Overlay District:N/A
FEE OWNER(S)OF THE PROPERTY:
Name:Shelton Land and Cattle, Ltd., a Colorado Corporation
Work Phone# Home Phone# Email
Address:P.O. Box 65
Address:
City/State/Zip Code Roggen, CO 80652
Name:
Work Phone# Home Phone# Email
Address:
Address:
City/State/Zip Code
Name:
• Work Phone# Home Phone# Email
Address:
Address:
City/State/Zip Code
APPLICANT OR AUTHORIZED AGENT(See Below:Authorization must accompany applications signed
byAuthorized Agent)
Name: Petroleum Development Corporation — ccs<-,t Zcj .r sC'
Work Phone# 303-860-5800 Home Phone# Email
Address: 1775 Sherman Street
Address:
City/State/Zip Code Denver, CO 80203
PROPOSED USE:
Petroleum Development Corporation (PDC) intends to use this site as a location for a telecommunications tower
will communicate between PDC's Evans, Co office and its oil and gas wells. PDC's wells are automated and the
intent is for the wellheads to beam signals to the tower and then for the tower to beam to the Evans office.
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 authorization from all
fee owners must be included with the application. If a corporation is the fee owner, notarized evidence must be
included indicating that the signatory has to legal authority to sign for the corporation.
p
Signat e: Applicta Date Signature: Owner or Authorized Agent Date
• James R. Schaff
Vice President Lam
•
STATE OF COLORADO
CITY AND ) ss.
COUNTY OF DENVER
�99 n-r-
The foregoing instrument was acknowledged before me this 2 " day of February 2012, by James R.
Schaff as Vice President Land of Petroleum Development Corporation, o behalf of said corporation.
0000000000 I
CARRIE EGGLESt otarf Public
NOTARY PUBLIC )C1)*I
piw STATE OF COLORADO
My commission ex
My Commission Expires 10/12/2014
•
•
•
Use By Special Review Application
County of Weld
Proposed Construction of Telecommunication Tower
Shelton Telecommunication Tower
Township 4 North, Range 65 West, 6th P.M.
Section 25: Part of S/2
Weld County, Colorado
Applicant:
Petroleum Development Corporation
•
1775 Sherman Street, Suite 3000
Denver, Colorado 80203
February 29, 2012
•
Table of Contents
• 1. Site Specific Development Plan and Use by Special Review(USR)Application
2. Questionnaire
2.1 Proposed Use
2.2 Weld County Code, Ch. 22 of Comprehensive Plan
2.3 Weld County Code, Ch. 23 Zoning
2.4 Uses Surrounding Site
2.5 Details of Site
2.6 Proposed Landscaping
2.7 Proposed Reclamation Procedures
2.8 Storm Water Drainage
2.9 Construction Time Frame
2.10 Storage of Waste
3. Access Permit Application
4. Title Documents
4.1 Warranty Deed
4.2 Certificate of Conveyance
5. Interest Owners Surface Estate
5.1 Affidavit of Interest Owners Surface Estate
5.2 List of Property Owners within 500 ft.
6. Additional Plans and Co-Location
6.1 Waste Handling Plan
6.2 Dust Abatement Plan
• 6.3 Co-Location
7. Maps
7.1 Special Review Plat Map(8-1/2" x 11")
7.2 Special Review Plat Map with Soil and Vicinity Maps(8-1/2" x 11")
8. Supplemental Use By Special Review Permit Application — Telecommunication
Towers
•
Shelton Telecommunication Tower
T4N-R65W-25:Pad of the S2
County of Weld, Colorado
Application
•
Site Specific Development Plan
and Use by Special Review (USR)
Application
•
•
Shelton Telecommunication Tower
T4N-R65W-25:Pail of the S/2
County of Weld, Colorado
Questionnaire
•
Questionnaire
•
•
Shelton Telecommunication Tower
T4N-R65W-25:Part of the S/2
County of Weld, Colorado
Questionnaire
• 2. Questionnaire
2.1 Explain, in detail,the proposed use of the property.
Petroleum Development Corporation intends to use this site as a location for a
150 foot telecommunication tower which will communicate between PDC's Evans
office and their oil and gas wells. PDC's oil and gas wells are automated and so
the intent is for the well heads to beam signals to the tower and then for the
tower to beam to the office in Evans as the distance between PDC's oil and gas
wells and their Evans' office is too far of a distance to send and receive signals.
The main purpose of the tower is for monitoring of PDC's oil and gas wells.
2.2 Explain how this proposal is consistent with the intent of the Weld County
Code, Chapter 22 of the Comprehensive Plan.
This proposal is consistent with the following goals and policies in the Weld
County Comprehensive Plan:
• G. A.Goal 7. County land use regulations should protect the individual
property owner's right to request a land use change.
• A.Policy 2.2. Allow commercial and industrial uses, which are directly related
to or dependent upon agriculture, to locate within agricultural areas when the
impact to surrounding areas is minimal or mitigated and where adequate
services and infrastructure are currently available or reasonably obtainable.
These commercial and industrial uses should be encouraged to locate in
areas that minimize the removal of agricultural land from production.
• A.Policy 7.1. County land use regulations should support commercial and
• industrial uses that are directly related to, or dependent upon, agriculture, to
locate within the agricultural areas, when the impact to surrounding
properties is minimal, or can be mitigated, and where adequate services are
currently available or reasonably obtainable.
Since we will be using the tower for automation, the automation does allow for
monitoring of the wells, and it also gives PDC the ability for limited remote control
of the wells/production facilities. That is PDC can shut in the wells remotely, by
closing motor valves, for example. This is a great safety factor as it is much
quicker than sending the PDC "pumper/technician"out to physically shut-in the
wells/production facilities. Also, in the unlikely event of an air emission related
leak from the wells/production facilities, since we have the shut in capability,
emissions to air quality would be minimized, especially if there was contributing
negative weather factors involved. In addition, the tower will also decrease traffic
to and from the property as PDC will be able to monitor wells from its' office. The
only service the tower will require is electricity, which will be provided by Poudre
Valley Rural Electric Association, Inc. The impact of the tower site to
surrounding properties, which is primarily agricultural and use for livestock
grazing, should be negligible as the size of the lease and area for the tower and
associated structures is only 60 feet by 60 feet and access will extend from an
existing access road to PDC oil and gas wells in the area. Therefore, the tower
site will minimize the removal of agricultural lands from petroleum.
2.3 Explain how this proposal is consistent with the intent of the Weld County
Code, Chapter 23 (Zoning) and the zone district in which it is located.
The intent of the A(Agricultural) Zone District is "to provide areas for the conduct
•
of agricultural activities and activities related to agriculture and agricultural
Shelton Telecommunication Tower
T4N-R65W-25:Part of the S/2
County of Weld, Colorado
Questionnaire
• production without the interference of other, incompatible land uses...and to
provide areas for the conduct of uses by Special Review which have been
determined to be more intense or to have a potentially greater impact than Uses
Allowed by Right." A telecommunication tower is compatible with and an
appropriate use of the land in an agricultural area. The tower will enable a more
effective monitoring system of PDC's oil and gas wells on the property, therefore
decreasing the disturbance in the surrounding areas. The proposed tower will
have a minimal impact on the surrounding areas as it will generate neither noise
nor waste and minimal dust and traffic.
2.4 What type of uses surround the site(explain how the proposed use is
consistent and compatible with surrounding land uses).
The proposed use is consistent and compatible with surrounding land uses,
which are primarily residential and agricultural. Land to the North, East and South
of PDC's tower site is being used for agricultural (primarily grazing by livestock).
Land immediately to the west is being used as a barb-wire fenced PDC oil and
gas well site. Approximately 425 feet southwest of PDC's tower site is a five acre
residential property with a metal barn/garage being some 460 feet to the
southwest, and a residence being some 580 feet to the southwest. The next
closest residence is approximately 1900 feet to the west of the tower site. A
PDC oil and gas tank battery and facility is approximately 600 feet
south/southwest of the tower site.
2.5 Describe, in detail,the following:
a. Number of people who will use this site
• The tower facility will be an unmanned site. It is anticipated that only PDC
employees involved with its oil and gas operations and related automation
will use this site. It is estimated that 1-2 employees will visit the site once or
twice per week to inspect the radio equipment inside the shelter building and
exterior tower structures and antennas.
b. Number of employees proposed to be employed at this site
There will rarely be any employees at this site as the purpose of the tower is
so that PDC can monitor their wells from their office.
c. Hours of operation
Although an unmanned facility, it will operate 24/7.
d. Type and number of structures to be erected (built)on this site
There will be one telecommunication antenna tower, an equipment shelter,
and a fence, with a gate, surrounding the tower and equipment shelter.
e. Type and number of animals, if any, to be on this site
Livestock grazing on surrounding areas.
f. Kind of vehicles (type, size,weight)that will access this site and how
often
Standard sized %ton pickup and/or 1 ton work truck, 1-2 times per week.
g. Who will provide fire protection to the site
LaSalle Fire Protection District
•
Shelton Telecommunication Tower
T4N-R65W-25:Part of the S/2
County of Weld, Colorado
Questionnaire
• h. Water source on the property (both domestic and irrigation)
Not applicable-There is no need for water service on the property as there
will seldom be any employees on the site, and when they are on the site it
will be for no longer than a few minutes.
i. Sewage disposal system on the property(existing and proposed)
Not applicable—There is no need for sewage disposal on the property as the
purpose of the tower is solely for automation and so it will be rare for
someone to be on the site at all, and if so, for no more than a few minutes.
j. If storage or warehousing is proposed,what type of items will be
stored.
In the proposed equipment shelter, PDC will store emergency backup
batteries and a small amount of extra antenna mounting hardware (nuts and
bolts, etc).
2.6 Explain the proposed landscaping for the site. The landscaping shall be
separately submitted as a landscape plan map as part of the application
submittal.
There is no proposed landscaping for the site. There will be a fence installed
around the proposed tower and equipment shelter.
2.7 Explain any proposed reclamation procedures when termination of the Use
by Special Review activity occurs.
Not applicable.
2.8 Explain how the storm water drainage will be handled on the site.
• Not applicable.
2.9 Explain how long it will take to construct this site and when construction
and landscaping is scheduled to begin.
Construction is scheduled to begin as soon as the Use by Special Review is
approved. Unless winter weather conditions are encountered, it is projected that
the site will be built within 4-6 weeks.
2.10 Explain where storage and/or stockpile of wastes will occur on this site.
Not applicable.
•
Shelton Telecommunication Tower
T4N-R65W-25:Part of the S/2
County of Weld, Colorado
Access Permit Application
•
Access Permit Application
Please refer to approved Permit#AP11-00482.
•
•
Shelton Telecommunication Tower
T4N-R65 W-25:Part of the S/2
County of Weld, Colorado
Additional Plans and Co-Location
•
Additional Plans and Co-
Location
•
•
Shelton Telecommunication Tower
T4N-R65W-25:Part of the S/2
County of Weld, Colorado
•
Additional Plans, Co-Location
• 6. Additional Plans, Co-Location
6.1 Waste Handling Plan
A waste handling plan will not be required as the proposed tower will produce no waste
as its sole purpose is for automation. People will rarely be on the site, and if so, will only
be on the site for a short amount of time.
6.2 Dust Abatement Plan
If it gets dusty on the site, either water or dust suppressants will be applied. There will
very little traffic to and from the site as well as on the site; therefore, there should rarely
be dust stirred by vehicles on the site.
6.3 Co-Location
The primary reason that PDC does not want to collocate on an existing tower is that PDC
would run the risk of encountering interference from the existing frequency from the other
users on the existing tower, while using its broadband frequency. Also, there may be
limited room for PDC antennas, and the collocation cost could be expensive for long term
versus investing in its own tower. PDC has the space available on its property for the
tower. Finally, PDC has conducted "path studies"for its radio frequencies and shots for
its facilities in its geographic areas of oil and gas operations, and the proposed location
was acceptable for the purposes anticipated.
• The tower, as proposed, is designed and would be built, structurally, to accommodate
additional antenna, and associated equipment(coaxial cabling, support mounts, etc),
should the need arise in the future to install additional equipment.
• Shelton Telecommunication Tower
T4N-R65W-25:Part of the S/2
County of Weld, Colorado
VICINIT17111/117
• Part Of The South Half Of Section 25, Township 4 North, Range 65 West Of The 6th P.M.,
County Of Weld, State Of Colorado
150'
LOTS /
R&--3781
WELD COUNTY ZONING
A (Agriculture) 'PARI2" \ 'z.
/ REC.NO.241 X41
PROPOSED WELD COUNTY ZONING
TELECOMMUNICATION \
/ A (Agriculture) ,
ANTENNA TOWER SITE
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• WELD CPU IWOAD 40 - —
SCALE: 1"=200'
Supplemental Use By Special Review Permit Application
County of Weld
Proposed Construction of Telecommunication Tower
Shelton Telecommunication Tower
Township 4 North, Range 65 West, 6th P.M.
Section 25: Part of S/2
Weld County, Colorado
Applicant:
Petroleum Development Corporation
1775 Sherman Street, Suite 3000
Denver, Colorado 80203
10
February 29, 2012
Supplemental Requirements USR Permit Application
• Supplemental Use by Special Review Permit application — Telecommunication
Towers
A. Application Contents
1.0-3.0 Maps
4.0 Photo Renderings
Upon request from the Department of Planning Services, Petroleum Development
Corporation will provide photo-realistic renderings of the site after construction. Example
of similar tower and equipment shelter building is attached for your review.
5.0 Report
This requirement has already been satisfied in the Questionnaire for the USR.
6.0 FAA Response
Attached is a TOWAIR Determination for this proposed tower.As indicated, according to
the TOWAIR calculations,this tower does not need registration and/or does not require
additional lighting/painting. Please note that the measurements within the TOWAIR are
metric unless otherwise stated.
7.0 Landscaping Agreement
Since no landscaping is proposed,we do not have to address this requirement.
8.0 Landscaping Schedule
• Since no landscaping is proposed,we do not have to address this requirement.
9.0 Letter of Intent to allow Co-Location
This letter has already been provided to Dept.of Planning Services,Weld County, CO in
Petroleum Development Corporation's Zoning Permit ZPTT11-0002.
10.0 Letter of Intent which addresses removal of Tower Facility
This letter has already been provided to Dept. of Planning Services,Weld County,CO in
Petroleum Development Corporation's Zoning Permit ZPTT11-0002.
11.0 Service Area/Radius of other Towers Map
PDC Tower Map attached.
11.1 Explanatory Letter—PDC Tower
An electronic communication(email)dated November 1, 2011 has already been provided
to Dept.of Planning Services,Weld County, CO in Petroleum Development Corporation's
Zoning Permit ZPTT11-0002.
• Shelton Telecommunication Tower
T4N-R65W-25:Part of the S/2
County of Weld, Colorado
Supplemental Requirements USR Permit Application
• B. Telecommunication Facility Inventory
The reason we have difficulty with collocation of our equipment is that the signals we bring in are standard
"broad spectrum"frequency signals, and other equipment nearby drives up the signal noise, causing a loss
of data reliability for us. The reason for our own tower is an equipment issue as we have a great amount of
equipment in the field, making it difficult to change our plan to use one telecommunication antenna tower.
•
• Shelton Telecommunication Tower
T4N-R65 W-25:Part of the S/2
County of Weld, Colorado
Th......
• HI N ler Communications, Inc.
27473 Forest Ridge Drive • Kiowa, CO 80117 • (303) 519-3136 • FAX (303) 648-3299 • www.thinaircommunications.com
Rs-land Communications Site — Sample Photo 2 (Grounds View)
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Project# 1591
By: Philip Sprouse
•
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Communications, Inc.
27473 Forest Ridge Drive • Kiowa, CO 80117 • (303) 519-3136 • FAX (303) 648-3299 • www.thinaircommunications.com
Ryland Communications Site — Sample Photo 1 (Entire Site View)
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By: Philip Sprouse
TOWAIR Determination Results
A routine check of the coordinates, heights, and structure type you provided indicates that this structure does not
require registration.
* * * NOTICE * * *
TOWAIR's findings are not definitive or binding, and we cannot guarantee that the data in TOWAIR are fully current
and accurate. In some instances, TOWAIR may yield results that differ from application of the criteria set out in 47
C.F.R. Section 17.7 and 14 C.F.R. Section 77. 13. A positive finding by TOWAIR recommending notification should be
given considerable weight. On the other hand, a finding by TOWAIR recommending either for or against notification is
not conclusive. It is the responsibility of each ASR participant to exercise due diligence to determine if it must
coordinate its structure with the FAA. TOWAIR is only one tool designed to assist ASR participants in exercising this
due diligence, and further investigation may be necessary to determine if FAA coordination is appropriate.
DETERMINATION Results
PASS SLOPE( 100:1)NO FAA REQ - 5515.0 Meters (18093.6 Feet)away & below slope by 10.0
Meters (32.8100 Feet)
Lowest Runway Length
Type C/R Latitude Longitude Name Address Elevation (m) (m)
AIRP R 40-19- 104-37- EASTON/VALLEY WELD 1469. 1 1219.2
40.00N 0.00W VIEW/ GREELEY,
CO
Your Specifications
NAD83 Coordinates
Latitude 40-16-40.0 north
• Longitude 104-36-48.3 west
Measurements ( Meters)
Overall Structure Height (AGL) 45.7
Support Structure Height (AGL) 45.7
Site Elevation (AMSL) 1469. 1
Structure Type
TOWER - Free standing or Guyed Structure used for Communications Purposes
Tower Construction Notifications
Notify Tribes and Historic Preservation Officers of your plans to build a tower.
•
Page 1 of 2
Mac Neumann
• IllflomB
From: "Mac Neumann" <macneumann@att. net>
To: "Chris Gathman" <cgathman@co.weld.co. us>
Cc: "Natalie Bell" <nbell@lonetreeenergy.com>; "Carrie Eggleston" <ceggleston@petd.com>
Sent: Tuesday, November 01 , 2011 11 :30 AM
Subject: Re: Zoning permit for Telecommunication Antenna Tower
Hi Chris.
To address your questions below:
1 . Our engineers have visited that tower site during their initial field surveys and assured me that those
towers are a light duty guyed tower option designed to accomodate the HAM radio antenna equipment.
The engineers stated that they strongly believe that none of those towers could support the PDC
microwave systems and SCADA radio equipment. In addition, the primary reason PDC has difficulty with
collocation of its equipment is that the signals we transmit and receive are standard "broad spectrum"
frequencies signals. Other equipment nearby drives up the signal "noise" causing a loss of data reliability
for us. The primary reason for the need of our own tower is an equipment issue, and the amount of
automation equipment that PDC already has in place in the field is too great to change it all out at this point
in time. The equipment proposed to be located on its proposed tower is the backbone of PDC's automation
system monitoring and controlling its oil and gas production in its entire field. If radio signal to its equipment
goes down or is interupted, PDC runs the risk of severe economic loss, monitoring and safety issues. This
is not simply a communications system, it is PDC's automation backbone. Finally, PDC needs room on its
tower for future growth of the automation system, which helps PDC maintain its environmental compliance
systems. As these environmental systems have not even been fully identified yet. the amount of future
growth could be very significant.
• 2. You may use Natalie Bell as the PDC contact person and cc Carrie Eggleston and me, concerning your
sending referrels to and in case you have any questions.
Thanks for your cooperation,
Mac Neumann, Agent to PDC
1151 Winslow Circle
Longmont, CO 80504
303-517-3010 cell
email: macneumann@att.net
Original Message From: Chris Gathman
To: Natalie Bell ; Mac Neumann
Sent: Tuesday, October 25, 2011 7:41 AM
Subject: Zoning permit for Telecommunication Antenna Tower
I am in the process of setting up your application. I will go ahead and set this up but I would like some
additional information about co-location on other towers. Since you plan to go forward with the USR at the
same time (or just after) the zoning permit I think we should address this question/issue now:
There are communication towers located directly across County Road 49 (approved under USR-854). We need
something for the file as to why co-location is or is not possible on these towers.
Also — one more question : I see PDC indicated as the applicant: Who is the contact person who I can send
• referrals to and in case I have any questions? — I will then add this to the application form .
I
2/24/2012
Page 2 of 2
Thanks!
•
Chris Gathman
Planner Ill
Weld County Department of Planning Services
1555 N. 17th Avenue,Greeley CO.80631
Ph: (970)353-6100 ext.3537
Fax:(970)304-6498
Iii . ) ] , Ii
rs
u
Confidentiality Notice:This electronic transmission and any attached documents or other writings are intended
only for the person or entity to which it is addressed and may contain information that is privileged,
confidential or otherwise protected from disclosure. If you have received this communication in error, please
immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying,
distribution or the taking of any action concerning the contents of this communication or any attachments by
anyone other than the named recipient is strictly prohibited.
•
•
2/24/2012
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Sabre Industries-
• Towers and Poles
Structural Design Report
150' S3TL Series HD1 Self-Supporting Tower
located at: Kersey, CO
II
prepared for: THIN AIR COMMUNICATIONS INC
by: Sabre Towers & Poles TM
Job Number: 49054
September 13, 2011
Tower Profile
Foundation Design Summary 2
• Maximum Leg Loads 3
Maximum Diagonal Loads 4
Maximum Foundation Loads 5
Calculations Al-A10
a Okt°L/C 1+rll
_`;0 •;gyp.HtlikN '�r't
Tower by 23`
Foundation by •
if
,/,�+'++''SS+XX��JiNAI '�
Aw.v\t.
Approved by 7/ z
/ 3 1/
•
150.0'
• m 145.0'
v 40.0'
135.0'
M PLAN
en
2 120.0' NOTES:
1. The tower model ie S3TL Series NOI.
v^ni - 2. Transmission lines a e to be attached to
r
115.0' standard 12 hole waveguide ladders.
3. Azimuths are relative (not based on true north).
9. Foundation loads shown are maximums.
5. 141 r dla. F1559 grade 105 anchor bolts per leg.
Minimum 35.5" embedment from top of concrete to
top of nut.
6. All unequal angles are oriented with the sheet
100.0' leg vertical.
], this tower was designed for Structure Class I[,
-9 Exposure Category C and Topographic Category I.
'^ 95.0' 8. The foundation toads shown below are factored loads.
r2 _.-I « I ANTENNA LIST
NO )LEY ANTENNA TX-LINE
159.25' I1) 095e9
— 80.0' 150' (I) 3ft Sidearm 0) LOF4.5-50
149.25' (1) owed
m ra3 a. 110' (1) 30t Sidearm III LO F9.5-50
w.i 'n 75.0' 134.25' (1) DB589
130' I1) 3ft Sidearm (1) L004.5-50
124.25' (1) 085)9
120' I1) 3ft Sidearm (11 COF1.5-50
M l0' 121 2' Solid Dish (2) LDF4-50A
I 60' (2) 2' Solid Oi sM1 (2) LOF4-50A
MATERIAL LIST
•
NO TYPE
A 4.5000"x8.2370" PIPE
a 4.0000"x0.2260" PIPE
C 2.8150"xl.2030e PIPE
D t 2-1/2"x2-1/2"x3/16"
40.0' Q 1 2"x2"xl/B"
To
o;�yn.HFq' stroi.
d 20.0' •
I •
D•
•
ni ��0.0' /
TOTAL FOUNDATION LOADS IVIDUAL FDOTING LOADS
H=13.92 k H=8.36 k
a re V=24.29 k V=90.55 k
0 1072.9E k-ft U=-84.44 k
T=5.77 k-ft
11 Sabre Communications Corporation
Sa re�f1dU N�� 2101 Murray Street (P.O. Box 658), Sioux City, Iowa 51102-0658
a. To"s'sa"d PS, Fu: (712) 258-8250
"1. Phone: (712) 258-6690
0 8 x
• m g Client: THIN AIR CM44UNIGSIONN INC Job No: 49054 Date: 7 sep 2011
c '° °�"
Location: Kersey, CO Total Height: 150.00' Tower Weight: 150.00'
Standard: TIA 222-G-2005 Design Wind G Ice: 90nph 0" ice f 50nph 0.5" ice
Project: C:\Output\S3TLH01\-49054.LOD Sheet: 1
No.: 49054
Page: 2
Sabre Industries" Date: 9/13/11
Towers and Poles By: REB
is
Customer: THIN AIR COMMUNICATIONS INC
Site: Kersey, CO
150 ft. Model S3TL Series HD1 Self Supporting Tower At
90 mph Wind with no ice and 50 mph Wind with 0.5 in. Ice per ANSI/TIA-222-G-2005.
Antenna Loading per Page 1
Center of Tower
A A Notes:
/
1). Concrete shall have a minimum
\\ 0 28-day compressive strength of
4000 PSI, in accordance with
i \\ ACI 318-05.
v
0
^ b(-.1 2). Rebar to conform to ASTM specification
\ A615 Grade 60.
\ o
b 3). All rebar to have a minimum of 3"
concrete cover.
v v
4).All exposed concrete corners to be
10'-0" 10'-0" chamfered 3/4".
• 5). The foundation design is based on
20'-0" > presumptive clay soil as defined in ANSI/TIA-
PLAN VIEW 222-G-2005, using an ultimate bearing
capacity of 5 ksf. It is recommended that a
Two(2)#4 ties soil analysis of the site be performed to verify
2-6" H within top 5"of the soil parameters used in the design.
(Typical) r Grade concrete c)
b ( A
a 'Hill _������_ _��� —IIIIII A _ 6). The foundation is based on the
A _ o '4 following factored loads:
iv En "r' Factored download (kips)= 9.75
Factored overturn (kip-ft)= 1072.98
v v Factored shear(kips)= 13.92
I< 20.0 >I 7). This is a design drawing only. Please
ELEVATION VIEW see final construction drawings for all
eil`"""�i q installation details.
1Ir (24.4 Cu.Yds.) Rebar Schedule per Mat and per Pier
_w��......• s�rrr0 (1 READ.; NOT TO SCALE) (6)#7 vertical rebar w/hooks at bottom w/#4
l Si' P.HE:. ;/•,O (, Pier Rebar ties, two (2)within top 5"of pier then
% ' f tipi.. . .t? 12"C/C
y�� I �, a :W 5 (22)#8 horizontal rebar evenly spaced each
TYr
y� . /CS i Mat way top and bottom. (88 total)
' see'a ,Nat 4:. 91I5 1
•Information contained herein is the sole property of Sabre Towers&Poles,constitutes a trade secret as defined by Iowa Code Ch. 550 and shall not be
reproduced,copied or used in whole or part for any purpose whatsoever without the prior written consent of Sabre Towers&Poles.
2101 Murray St-P.O.Box 658-Sioux City, IA 51102-0658-Phone 712.258.6690-Fax 712.258.8250
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Petroleum Development Corporation
•
October 10, 2011
Weld County Colorado
Department of Planning Services
1555 North 17'h Avenue
Greeley, Colorado 80631
Re: Co-Location on Telecommunications Antenna Tower
Township 4 North,Range 65 West, 6u`P.M.
Section 25: Part of the S/2
Weld County,Colorado
Dear Planning Department:
Petroleum Development Corporation ("PDC") is planning to build a sixty foot (60')
• Telecommunications Antenna Tower (`"TAT") on the above referenced land currently leased by
PDC. Pursuant to the rules and regulations of the Weld County Codes and Zoning Permit
Application, PDC is required to submit a Letter of Intent to allow co-location on the tower. PDC
currently has no plans for allowing the co-location on or near the TAT. In the future, if PDC
considers co-location on or near the TAT, PDC will notify Weld County Planning Services and
prepare the necessary paperwork to allow that co-location on or near the TAT.
If you have any questions or need additional information, please do not hesitate to give us a call
at 303-860-5800.
Sincerely,
a5tO:
EUM DE LO' ��! ' RPORATIO
` "
Landman Team Leader S J7`
• CORPORATE OFFICE:
Petroleum Development Corporation
1775 Sherman Street,Suite 3000
Denver,CO 80203
303-860-5800
S
• Petroleum Development Corporation
October 10, 2011
Weld County Colorado
Department of Planning Services
1555 North 17th Avenue
Greeley, Colorado 80631
Re: Removal of Tower Facility
Township 4 North,Range 65 West, 6th P.M.
Section 25: Part of the S/2
Weld County, Colorado
Dear Planning Department:
Petroleum Development Corporation ("PDC") is planning to build a sixty foot (60')
Telecommunications Antenna Tower ("TAT") on the above referenced land currently leased by
PDC. Pursuant to the rules and regulations of the Weld County Codes and Zoning Permit
• Application, PDC is required to submit a Letter of Intent addressing removal of the tower
facility. At the time that PDC elects to remove the TAT from the above referenced property,
PDC will be responsible for the costs associated with the removal of the TAT and reclamation of
the property as well as any notification to Weld County that may be necessary.
If you have any questions or need additional information, please do not hesitate to give us a call
at 303-860-5800.
Sincerely,
k3ETROLEUM DEVELOP i NT ! '.•": 'ATION
e Ecani estop
Landman Team Leader(DJ) •
• CORPORATE OFFICE:
Petroleum Development Corporation
1775 Sherman Street,Suite 3000
Denver,CO 80203
303-860-5800
s+--1 to
PDC
ENERGY
ger
Corporate Office RECEIVED--
1775 Sherman Street,Suite 3000
Denver,CO 80203
303-860-5800 ` 'ti ( 4 �•
www.petd.com
December 21,2011 FRONT PA NGE DISTRICT
STATE LAND BOARD
State of Colorado Shelton Land&Cattle Ltd
600 Grant Street,Suite 640 PO Box 65
Denver,Colorado 80203 Roggen,Colorado 80652
Stanley &Nancy Flippin Steven Flippin
19108 WCR 47 19108 WCR 47
LaSalle,Colorado 80645 LaSalle,Colorado 80645
Sent by Certified Mail
Return Receipt Requested
To Whom It May Concern:
Petroleum Development Corporation, d/b/a PDC Energy, ("PDC") has currently requested a Non
Exclusive License Agreement with Weld County related to a proposed telecommunication tower which
includes a proposed access off of Weld County Road 40, between Weld County Road 47 and Weld
County Road 49, for our proposed operations. This proposed road access would extend approximately
1800 feet East of Weld County Road 47 and would add additional traffic for our operations. The
• additional traffic should be very minimal; however, Weld County Public Works Department requires that
PDC notify all adjacent landowners of this increased activity.
Please acknowledge that you have received notification of PDC's proposed telecommunications tower
operations by signing and returning a copy of this letter. As a courtesy, we have included a self-addressed,
stamped envelope for your convenience. Your signature on the certified mail receipt will also serve as
acknowledge notification.
Sincerely,
PgTROLEUM DEV OPMENT CORPORATION
/D/B/A PDC EN_ Y RECEIVED
ame pi JAN 06 2012
E lesson
Landman Team Leader_
NORTH CENTRAL DISTRICT
ACKNOWLEDGEMENT:
/��,�� ��ff// STATE LAND BOARD
• / lQ4X'w ii i /%.mot Cc2:thf4 �� "'cal` vy- ,
Print 4/4 ( 04
Si azure at
cc: Weld County Public Works
. (WCR 40)Non-Exclusive License Agreement
aka) Eg RGY
Corporate Office
1775 Sherman Street,Suite 3000
Denver,CO 80203
303-860-5800
xvnxpetd.com
December 21,2011
State of Colorado Shelton Land&Cattle Ltd
600 Grant Street,Suite MO PO Box 65
Denver,Colorado 80203 Roggen,Colorado 80652
Stanley&Nancy Flippin Steven Flippin
19108 WCR 47 19108 WCR 47
LaSalle,Colorado 80645 LaSalle,Colorado 80645
Sent by Certified Mai!
Return Receipt Requested
To Whom It May Concern:
Petroleum Development Corporation, d/b/a PDC Energy, ("PDC") has currently requested a Non
Exclusive License Agreement with Weld County related to a proposed telecommunication tower which
includes a proposed access off of Weld County Road 40, between Weld County Road 47 and Weld
County Road 49, for our proposed operations. This proposed road access would extend approximately
1800 feet East of Weld County Road 47 and would add additional traffic for our operations. The
• additional traffic should be very minimal; however, Weld County Public Works Department requires that
PDC notify all adjacent landowners of this increased activity.
Please acknowledge that you have received notification of PDC's proposed telecommunications tower
operations by signing and returning a copy of this letter. As a courtesy,we have included a self-addressed,
stamped envelope for your convenience. Your signature on the certified mail receipt will also serve as
acknowledge notification.
Sincerely,
PETROLEUM DE OPMENT CORPORATION
canI
'
Landman Team Lead
ACKNOWLEDGEMENT:
Rona )≥- E -bn
Print
RIINNAR. — IIz3) 2A1z
Signature Date
cc: Weld County Public Works
• (WCR 40)Non-Exclusive License Agreement
�(1) ENERGY
Corporate Office
1775 Sherman Street,Suite 3000
Denver,CO 80203
303.860-5800
www.petd,com
December 21,2011
State of Colorado Shelton Land&Cattle Ltd
600 Grant Street,Suite 640 PO Box 65
Denver,Colorado 80203 Roggen,Colorado 80652
Stanley&Nancy Flippin Steven Flippin
19108 WCR 47 19108 WCR 47
LaSalle,Colorado 80645 LaSalle,Colorado 80645
Sent by Certified Mail
Return Receipt Requested
To Whom It May Concern:
Petroleum Development Corporation, d/b/a PDC Energy, ("PDC") has currently requested a Non
Exclusive License Agreement with Weld County related to a proposed telecommunication tower which
includes a proposed access off of Weld County Road 40, between Weld County Road 47 and Weld
County Road 49, for our proposed operations. This proposed road access would extend approximately
1800 feet East of Weld County Road 47 and would add additional traffic for our operations. The
•
additional traffic should be very minimal; however, Weld County Public Works Department requires that
PDC notify all adjacent landowners of this increased activity.
Please acknowledge that you have received notification of PDC's proposed telecommunications tower
operations by signing and returning a copy of this letter. As a courtesy, we have included a self-addressed,
stamped envelope for your convenience. Your signature on the certified mail receipt will also serve as
acknowledge notification.
Sincerely,
PETROLEUM DE OPMENT CORPORATION
f,PETROLEUM
PDC EN Y/
ro
arrie Eggleston 7
Landman Team Leader_
ACKNOWLEDGEMENT:
Print
Signature Date
cc: Weld County Public Works
•
(WCR 40)Non-Exclusive License Agreement
III
SENDER CO7iFLE�E THIS SECTION
C•M•LETE THIS SECTI•N •N •ELIVEHY
■ Complete items 1,2,and 3.Also complete A. Signature -..ent
item 4 if Restricted Delivery is desired. X - ,
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2. Article Number 7009 1410 0001 7857 5249
(Transfer from service label
PS Form 3811,February 2004 Domestic Retum Receipt 102595-02-M-1540
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(Transfer from service label)
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1500
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PS Form 3811,February 2004 Domestic Return Receipt
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•
•
NONEXCLUSIVE LICENSE AGREEMENT FOR THE UPGRADE AND
MAINTENANCE OF WELD COUNTY RIGHT-OF-WAY
THIS NONEXCLUSIVE LICENSE AGREEMENT,made and entered into this9iay of
ry-t-bt tr ,2011,by and between WELD COUNTY,COLORADO,by and through the Board
of County Commissioners of Weld County,Colorado,whose address is 915 Tenth StRzt,Greeley,
Colorado 80632,as First Party,and Pet aatorn veZ!>nrlt r*Corpot n&n
,as Second Party whose
address is I'YT 5 SIntrta n cam' 'ert 3CX?5 DeC \vtr Co ftir)27X% .
W1TNESSETH:
WHEREAS, Second Party desires to more effectively access property located at the
2 of Section 25 ,Township4 North,Range( West of the 6`s
P.M.in Veld County,Colorado,and
WHEREAS,First Party is the owner of the right-of-way known as WCRL r)for a distance of
►SOD-Feet COL,- t' !"3F WCR4"j and located as follows: tnr•±C}F Rm.)
1Y3Y L'sfi�Yl o Ci 1C D gbfl3CQU"l E QMr�K. � between Sections 2
andaa°Township 4 North,Range( West,in Weld Oaunty,Colorado,which is heremafterrefen+ed to as
"ROW," and 'sod-to
• WHEREAS,ROW is currently not being maintained by First Party,and el dOeCOU0
WHEREAS,Second Party wishes to upgrade and thereafter maintain ROW at his/her/its sole expense
in order to provide said more effective access.
NOW,THEREFORE,in consideration of the covenants contained herein and the agreements of said
Second party to be performed hereunder, and upon the conditions herein stated,First Party does gant to
Second Party,its successors and assess,a nonexclusive license to upgrade and maintain ROW without gating
or fencing across the same.
The conditions by which Second Party may upgrade and maintain ROW are as follows:
1. First Party retains the right to revoke this Nonexclusive License Agreement at anytime for any reason,
but such revocation shall not prohibit Second Party's continued use of the ROW for access to Second
Party's pr vl,..r ly,to the extent that such continued use is consistent with the right of the public to use
the ROW. First Party shall give Second Party written notice of its intent to revoke this Nonexclusive
License Agreement at least ninety(90)days prior to the intended date of revocation. Such notice shall
be sent to Second Party by Certified Mail to its address written above or served upon Second Party in
accordance with the Colorado Rules of Civil Procedure. Second Party shall have the duty of
informing First Party of Second Party's change in address from his address written above.
2. The upgrade and maintenance of ROW by Second Party shall be done in such manner as reasonably
prescribed by First Party,which manner shall include,but not be limited to,the following:
• I
a. ROW shall be constructed and maintained as a graded and drained all-weather road. The
access width requirements for emergency equipment(fire department)are a minimum of 20
feet
b. If the installation of a cross culvert is required through an existing drainage pattern or ditch,
Second Party shall be responsible to supply and install such culvert, which shall be inspected
by First Party to ensure adequacy of capacity,strength,and length. Second Party sm+a11 be
responsible to maintain the culvert after its installation, including periodically cleaning the
same.
c. If the installation of a cattle guard is required,Second Party shall be responsible to supply and
install such cattle guard, which shall meet County standards. Second Party shall be
responsible to maintain the cattle guard after its installation,including periodically cleaning
the same.
d. This Nonexclusive License Agreement does not grant the right to gate or fence ROW for
private use,but is intended to provide access to private property.
Prior to commending work within the ROW, Second Party chat',through the services of a
licensed registered surveyor hired and paid for by Second Party, mark the location of the
exterior boundaries of the ROW.
3. The upgrade and maintenance of the ROW by Second Party, including those items set forth in
• Paragraph 1.,above,or any other requirements stated by First Party,shall be at its own expense and
without the aid or use of Weld County funds. Second Party shall be responsible for snow removal
from ROW,ifrequired to gain ernes as part of the maintenance responsibilities referred to herein.
4. Except for the negligence of First Party,Second Party shall indemnify and save harmless First Party,
its successors,assigns,employees,and agents from any damage or loss sustained by them or any of
them to the extent caused by Second Party's negligence with respect to the upgrade and maintenance
of the ROW.
5. Except for the negligence of First Party,Second Party agrees to protect First Party and save and hold it
harmless from my and all third party claims and damages that said upgrade and maintenance may
directly or indirectly cause to the extent attributable to the negligence of Second Party. Second Party
hereby releases First Party,its successors,assigns,employees,and agents from any and all claims and
damages of whatsoever character to property owned by Second Party resulting from any act either on
the part of the First Party or on the part of any third party.
6. Other than assignments in connection with the mortgage or sale of all or substantially all of the Second
Party's assets or equity interests in Second Party,for which no consent shall be required. Second
Party shall not assign any or all of its rights under this Nonexclusive License Agreement without first
obtaining written consent to such assignment from First Party, which consent shall not be
unreasonably withheld.
• 2
7. The parties hereby agree that neither has made or authorized any agreement with respect to the subject
matter of this instrument other than expressly set forth herein,and no oral representation,promise,or
consideration different from the terms herein contained shall be binding on either party hereto,or its
agents or employees. This Nonexclusive License Agreement embodies all agreements between the
parties hereto and there are no promises, terms, conditions, or obligations re err ug to the subject
matter whereof other than as contained herein.
8. If any term or provision of this Nonexclusive License Agreement,or the application thereof to any
person or circumstances shalt to any extent,be held invalid or unenforceable,the remainder of this
Nonexclusive.License Agreement, or the application of such terms or provisions,to a person or
circumstances other than those as to which it is held invalid or unenforceable,shall not be affected,
and every other term and provision of this Nonexclusive License Agreement shall be deemed valid and
enforceable to the permitted by law.
9. No portion of this Nonexclusive License Agreement shall be deemed to constitute a waiver of any
immunities the parties or their officers or employees may possess, nor shall any portion of this
Nonexclusive License Agreement be deemed to have created a duty of care which did not previously
exist with respect to any person not a party to this Nonexclusive License Agreement
10. It is expressly umd..atuud and agreed that the enforcement of the terms and conditions of this
Nonexclusive License Agreement, and all rights of action relating to such enforcement shall be
strictly reserved to the undersigned parties and nothing in this Nonexclusive License Agreement shall
• give or allow any claim or right of action whatsoever by any other person not included in this
Nonexclusive License Agreement It is the express intention ofthe undersigned parties that any entity
other than the undersigned parties receiving services or benefits under this Nonexclusive License
Agreement shall be an incidental beneficiary only.
11. There shall be a$150 fee for the fabrication and installation of blue and white cress roads signs
identifying the section line road intersection for the use of addressing and emergency response.The
blue and white signs identify a non-maintained County right-of-way. Distance and location from the
nearest maintained County road may require additional information signs. If existing signs are in
place,the fee may be waived.
12. There shall be a$100.00 fee for the Nonexclusive License Agreement
•
It is mutually understood and agreed that this Nonexclusive License Agreement and all the terms and
conditions hereof shall extend to and be binding upon the parties hereto,their successors,and assigns.
• 3
•
EXECUTED IN DUPLICATE the day and year rust above written.
FIRST PARTY:
WELD COUNTY,COLORADO,by and through the BOARD OF COUNTY COMMISSIONERS OF
WELD COUNTY,COLORADO
ATTEST:
Clerk to the Board
By: By:
Deputy Clerk , Chair
SECOND PARTY:
NAME AFR,otiloCf ‘ogrertt NAME
CCepteClaiorl
• BY: awe/C By
. +-4-14-14
SUBSC MED AND SWORN to before me this H Thday of Wo ,20j
BY c- I-AilnFS fC - OCI-LAer 4S V\CL P PeskD&1T1Akic) aC (t.TC0LCIA rn
(J�uf.A-iPrnpfiT C:.O A_ efif9YM} RneorriGN.
WITNESS my hand and official seal
CARR LEST0N
Notary ub ' NOTARY PUBLIC
STATE OF COLORADO
My commission expires: - My Commission Expires 10/12/2014
MAAGREFMENrsNoncalusiseUGR EMENf FORM.doc
• .4
ENERGY
District Office
3801 Carson Avenue
Evans,CO 80620
970-506-9272
www.petd.com
February 27,2012
LaSalle Fire Protection District VIA Hand D ive
Attti: Benjamin"Bear"Hulsey
118 Main Street Received by:
LaSalle,CO 80645
2 . 2g - tt
Date:
RE: Fire District Notification
Proposed 150' Telecommunications tower
and Equipment Shelter Bldg
Township 4 North,Range 65 West,6th P.M.
Section 25: Part of S/2
Weld County,Colorado
Dear Mr. Hulsey:
Reference is made to our meeting today. Petroleum Development Corporation d/b/a PDC Energy(PDC)is the in the
• process of working on a USR Application with Weld County Planning for the purposes of constructing the captioned
tower, which we will use for oil and gas well automation.
Per your request, I have enclosed hard copies of maps depicting the lands on which the tower will be located. I have
also attached copies of the tower and equipment shelter building drawings, for your review.
I have also attached a copy of the Weld County provided"Fire District Notification"form, for your review and
completion, including comments,signature and date.
Should you have any questions regarding this request,please feel free to contact me at contact me at(303)517-
3010.
Sincerely,
PDC En- 14er
Mac Neumann,Agent
cc: Carrie Eggleston
•
DEPARTMENT OF PLANNING SERVICES
-r , _ BUILDING INSPECTION DIVISION
W Li! r 1555 N 17TH AVENUE, GREELEY, CO 80631
,. ('
-- T Y - (970) 353-6100 X3540
c o ,1 (970) 304-6498 FAX
FIRE DISTRICT NOTIFICATION
PERMIT NUMBER PLEASE MAIL OR FAX BEFORE ISSUANCE
I Q
OWNER (to Lcc� tie (vyavr�acAl— C cTjari-1 l 0 N
CONTRACTOR Th i•v �i� Couv» v"(t NO C �f( 6r S , �� C , 1A
SITE ADDRESS cc c0 - 2 -pIh- t 6rfS` Z ( cf —r���Lv L (/lhlA CY.
DESCRIPTION OF WORK �{ na 7�R1 iA tc o-tC I t feComYw.f,tc. cv S
•
FIRE DISTRICT COMPLETE BELOW i(8 MANS S• C.ISAc« Pa Soo YS
FIRE DISTRICT NAME Ga5Ac.c.d .2� 2.2ZE Griv�.) (N ' Sire Sfr eot
ADDRESS .o1 "� a ff p `rob o� `SiZ
owt6�sr 4 Nor?L P.a.")(Ng:-4S L.1 CITY STATE ZIP
PHONE NUMBER '1 2°- Z 8V -‘33 Cc FAX NUMBER ? 9 " Z ey - G 6 q ?-
SPRINKLERS YES D` IVO r
�q �tN1 A /N CCss cror } •r c..
COMMENTS / v' ��-
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SIGNATURE ` DATE a 2 - 2&- I
PRINTED NAME c ry d SGST
• /
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