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HomeMy WebLinkAbout20100623.tiff REFERRAL LIST Name: JLW Investment, LLC Case#: AmUSR-1679 County Towns & Cities Fire Districts _Attorney _Ault _Ault F-1 X Health Department _Berthoud _Berthoud F-2 _Extension Office _Brighton _Briggsdale F-24 _Emergency Mgt Office- Ed Herring _Dacono _Brighton F-3 _Sheriffs Office Eaton F-4 _Eaton _ X Public Works _Erie _Fort Lupton F-5 _Housing Authority _Evans X Galeton F-6 _Airport Authority _Firestone _Hudson F-7 X Building Inspection _Fort Lupton _Johnstown F-8 X Code Compliance Ann _Frederick _LaSalle F-9 _Kim Ogle (Landscape Plans) _Garden City _Mountain View F-10 _Lin (Addressing Change of Zone) _Gilcrest _Milliken F-11 _Ambulance Services Nunn F-12 _Greeley _ _Grover _Pawnee F-22 State _Hudson _Platteville F-13 Div. of Water Resources _Johnstown _Platte Valley F-14 _Geological Survey Keenesburg _Poudre Valley F-15 _Department of Health _Kersey _Raymer F-2 X Department of Transportation _LaSalle _Southeast Weld F-16 _Historical Society _Lochbuie _Union Colony F-20 _Water Conservation Board _Longmont _Wiggins F-18 X Oil & Gas Conservation Commission _Mead Windsor/Severance F-17 _Milliken Division of Wildlife _New Raymer _South Hwy 66 (Loveland) _Northglenn X North Hwy 66 (Greeley) _Nunn Commissioner _Division of Minerals/Geology _Pierce X Berryman _Platteville Soil Conservation Districts _Severance _Big Thompson/ FTC _Thornton _Boulder Valley/Longmont Windsor _Brighton/SE Weld Centennial Counties _ Greeley/West Greeley _Adams _Platte Valley _Boulder West Adams _ _ Broomfield _Little Thompson _Larimer Federal Government Agencies Other US Army Corps of Engrs _School District RE- USDA-APHIS Vet Service _ _ Central Cob. Water _Federal Aviation Admin (Structures _Left Hand Water over 200 ft or w/in 20000 ft of Pub _Ditch Company Airport _Art Elmquist(MUD Area) _Federal Communications Comm EXHIBIT 13 A,huste.- WS • 2010-0623 REFERRAL LIST Name:.J( aJM/yw1JJ Case#: Ann 14x/2-/&'79 Cr -41( Towns & Cities Fire Districts Jrney _Ault _Ault F-1 X Health Department _Berthoud _Berthoud F-2 _Extension Office _Brighton _Briggsdale F-24 _Emergency Mgt Office- Ed Herring _Dacono Brighton F-3 'j( Sheriffs Office Eaton _Eaton F-4 X Public Works Erie _Fort Lupton F-5 Housing Authority _Evans )( Galeton F-6 _Airport Authority _Firestone _Hudson F-7 K Building Inspection Fort Lupton _Johnstown F-8 )CCode Compliance 1N.-Ann_S-Beth _Frederick LaSalle F-9 Kim Ogle (Landscape Plans) _Garden City _Mountain View F-10 _Lin (Addressing Change of Zone) Gilcrest _Milliken F-11 _Ambulance Services Greeley Nunn F-12 _Grover _Pawnee F-22 State Hudson Platteville F-1 3 Div. of Water Resources _Johnstown _Platte Valley F-14 _Geological Survey Keenesburg Poudre Valley F-15 _Department of Health _Kersey Raymer F-2 Department of Transportation _LaSalle _Southeast Weld F-16 Historical Society Lochbuie _Union Colony F-20 Water Conservation Board Longmont Wiggins F-18 X Oil & Gas Conservation Commission _Mead Windsor/Severance F-17 Milliken Division of Wildlife New Raymer Legal ' '.t I&—(04'3 Snuth Hwy 66 (Loveland) _Northglenn Parcel ID# tY7 f�" / g coca?" )( h Hwy 66 (Greeley) _Nunn Zone Acres? 'i'1 _Division of Minerals/Geology _Pierce USDA _Platteville Airport Soil Conservation Districts _Severance Geo Haz Big Thompson/FTC _Thornton FP? Panel# Boulder Valley/Longmont _Windsor IGA? ORD# _Brighton/SE Weld MUD? _Centennial Counties _Greeley/West Greeley _Adams _Platte Valley _Boulder West Adams Broomfield _Little Thompson _Larimer W70 L_ Federal Government Agencies Other '_ ft if US Army Corps of Engrs School District RE- _USDA-APHIS Vet Service Central Colo.Water Conservancy Dist Federal Aviation Admin (Structures _RR over 200 ft or w/in 20000 ft of Pub _Ditch Company. Airport Art Elmquist(MUD Area) 7 I:go8 Federal Communications Comm Commissioner L Ld r Kristine Ranslem From: Kristine Ranslem mt: Thursday, September 17, 2009 3:10 PM o: Ken Poncelow; Ann Siron; 'gloria.hice-idler@dot.state.co.us'; 'stuart.ellsworth@state.co.us'; 'sandra.billings@state.co.us'; 'brandon.muller@state.co.us'; 'firemanswain@gmail.com' Subject: AmUSR-1679 We have just received a case (AmUSR-1679) in which we ask that you review the material and send a referral to us by October 16, 2009. The following is a quick link to the case in question: http://www.co.weld.co.us/departments/planning/Planninq/plan current.html#AmUSR-1679 If you have any problems or have any questions, please don't hesitate to contact me at the number below. Thank you! KxistLvte RawsLevin. Planning Technician Weld County Planning Services 918 10 Street, Greeley CO 80631 970-353-6100 ext. 3519 1 DEPARTMENT OF PLANNING SERVICES 918 10TH Street 1 10 CO 80631 0 t PHONE: (970) 00, Ext. 3540 FAX: (970) 304-6498 COLORADO December 10, 2009 NOTICE TO REFERRAL AGENCIES CASE NUMBER: AmUSR-1679 There will be a Public Hearing before the Weld County Planning Commission on Tuesday, January 5, 2010, at 1:30 p.m., in the Weld County Planning Department Hearing Room, 918 10'h Street, Greeley, Colorado. A subsequent hearing will be held on January 27,2010 at 10:00 a.m.,in the Chambers of the Board of County Commissioners of Weld County, Colorado, Weld County Centennial Center, 915 10'h Street, First Floor, Greeley Colorado 80631. NAME: JLW Investment, LLC FOR: A Site Specific Development Plan and Amended Use by Special Review Permit for an Oil and Gas Support Facility(install additional tanks and office trailer in an existing Class II-Oilfield Waste Disposal Facility) in the A(Agricultural) Zone District. LEGAL DESCRIPTION: Lot B RE-748; located in Part of the NE4 of Section 18, T6N, R63W of the 6th P.M., Weld County, Colorado. LOCATION: North of and adjacent to State Hwy 392 and approximately 1/4 mile east of CR 61.5. . J Weld County Planning Department MEMORANDUM a ELE, FFICE rFA 4111 TO: Chris Gathman, Planning Services DAFEq Ftebrua' S'a FROM: Heidi Hansen, P.E., Public Works Departments$ wilge SUBJECT: AmUSR-1679, JLW Investment, LLC COLORADO The Weld County Public Works Department has reviewed this proposal. This project falls under the Use by Special Review Standard, Weld County Code, Chapter 23, Article II, Division 4, Section 23. Staff comments made during this phase of the Use by Special Review process may not be all-inclusive, as other issues may arise during the remaining application process. All issues of concern and critical issues during further review must be resolved with the Public Works Department. COMMENTS: Access: 1. The Colorado Department of Transportation (CDOT) has indicated that the site access is under constructed and has provided a letter to the applicant requesting the access be constructed to CDOT standards. Please address these issues with CDOT. Site Plan: 2. A USR Site Plan showing the actual site layout has yet to be submitted. The final plat will need to show the onsite roads and layout as it has been built. An Amended USR is a new application which allows the County to review the site in full. Items can be requested that were not requested for the original USR, as such, the following comments still apply: 3. Per the CDOT Access Permit dated 4/13/2009, please place on the USR Plat Map a note stating that: A maximum of 30 trucks per day are authorized to use this site. If traffic is found to be greater, a traffic study will be required along with a new CDOT access permit. (This note is on the original USR plat as well) 4. For tracking control, the access must be paved for either a minimum of 300 feet onsite or for 100 feet with double cattle guards installed at the gate. (This is our current standard request for any facility of this type, as exhibited by other facilities that recently went through the USR process) Storm Water Drainage. On January 14, 2010, the applicant provided a "Final Drainage Report for USR 1679 &AmUSR 1679" signed and stamped by Daniel Dean Hull PE# 39337 and dated January 2010. 5. Please address all redline comments in the Final Drainage Report and associated drawings. Please return the redlined drainage report when submitting the corrected drainage report. 6. Per Weld County Code: "Weld County will not approve any detention or retention pond that does not drain in less than 72 hours, or causes injury to water rights, or is in violation of State or Federal law." Please show that the retention volume (150% of the total developed site runoff) will drain in 72 hours as a variance allowing retention cannot be granted without this information. II- 7. Please revise the calculations for the developed 100-year runoff from the site, show retention CO volume and 72 hour drain time, then analyze the major basin to show the change in volume in the K sump. W M:\PLANNING—DEVELOPMENT REVIEW\USR-Use by Special Review\AmUSR-1679-7LW Investment(Apollo)\AmUSR-1679 Drainag Report I-IQdoe saaan 8. It is unclear which sump area is being used as a retention pond. Onsite flows seem to travel to the south where there is a smaller sump area. If this is the area being utilized for retention, complete contours for this sump area will need to be shown. If the larger sump area is being used then please show how flows will reach the pond. Volume calculations showing the capacity of the retention area as well as 72-hour drain time need to be provided. To ensure that neighboring properties will not be adversely impacted, developed runoff cannot leave the site undetained, Please contact Heidi Hansen, 970-304-6496 ext. 3750, for assistance if there are any questions regarding the expectations for the drainage. Flood Hazard Development Standards: This area IS NOT in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency Management Agency (FEMA). Agreements: 9. The applicant is required to enter into an Improvements Agreement with the County to ensure that all improvements are completed per the accepted design. As-built information will be required. Comments made during this stage of the review process will not be all inclusive; as revised materials are submitted, other concerns or issues may arise. All issues of concern and critical issues during further review must be resolved with the Public Works Department. pc: AmUSR-1679 M:APLANNING—DEVELOPMENT RRVIE WVUSR-Use by Special Review VAntUSR-1679-JLW Investment(Apollo)AAmUSR-1679 Drainage Report I-I0.docx Weld County Planning Department GREELEY OFFICE nu ? n?nnn (0.711 ((ii4r. Weld County Re WeEtilVED ' September 16, 2009 C, SEP 2 2 2009 COLORADO The Weld County Department of Planning Services has received the following item for review: Applicant JLW Investment, LLC Case Number AmUSR-1679 Please Reply By October 16, 2009 Planner Chris Gathman Project A Site Specific Development Plan and Amended Use by Special Review Permit for an Oil and Gas Support Facility (install additional tanks and office trailer in an existing Class II- Oilfield Waste Disposal Facility) in the A(Agricultural Zone District). Legal Lot B RE-748; located in Part of the NE4 of Section 18, T6N, R63W of the 6th P.M., Weld County, Colorado. Location North of and adjacent to State Hwy 392 and approximately 1/4 mile east of CR 61.5. Parcel Number 0799 18 000021 The application is submitted to you for review and recommendation. Any comments or recommendation you consider relevant to this request would be appreciated. Please reply by the above listed date so that we may give full consideration to your recommendation. Any response not received before or on this date may be deemed to be a positive response to the Department of Planning Services. If you have any further questions regarding the application, please call the Planner associated with the request. Please note that new information may be added to applications under review during the review process. If you desire to examine or obtain this additional information, please call the Department of Planning Services. You will be notified in writing of the Planning Commission date once the date is determined. ❑ We have reviewed the request and find that it does/does not comply with our Comprehensive Plan because ❑ We have reviewed the request and find no conflicts with our interests. 14 See attached letter. Comments: Signature „'' EL I Date I Q/i 5A) Agency P�L l� (Jo-t`k C +Weld County Planning Dept. ❖918 10th Street,Greeley, CO.80631 •(970)353-6100 ext.3540 :•(970)304-6498 fax ft MEMORANDUM TO: Chris Gathman, Planning Services DATE: October 16, 2009 FROM: Heidi Hansen, P.E., Public Works Department SUBJECT: AmUSR-1679, JLW Investment, LLC COLORADO The Weld County Public Works Department has reviewed this proposal. This project falls under the Use by Special Review Standard, Weld County Code, Chapter 23, Article II, Division 4, Section 23. Staff comments made during this phase of the Use by Special Review process may not be all-inclusive, as other issues may arise during the remaining application process. All issues of concern and critical issues during further review must be resolved with the Public Works Department. COMMENTS: Weld County Road Classification Plan (FHU): The Colorado Department of Transportation (CDOT) has jurisdiction over all accesses to the state highways. Please contact Gloria Nice-Idler at the Greeley office (970-350-2148 or 970-350-2163) to verify the access permit or for any additional requirements that may be needed to obtain or upgrade the permit. (State Highway 392) Access: Per the CDOT Access Permit dated 4/13/2009, please place on the USR Site Plan a note stating that: A maximum of 30 trucks per day are authorized to use this site. If traffic is found to be greater, a traffic study will be required along with a new CDOT access permit. The access from State Highway 52 must be paved and constructed to CDOT requirements. For tracking control, the access must be paved for either a minimum of 300 feet onsite or for 100 feet with double cattle guards installed at the gate. Storm Water Drainage: Please provide a Final Drainage Report showing that the existing pond has the capacity to hold the increased runoff due to the additional tanks and office with one foot of freeboard. Retention is not allowed by Weld County Code. A variance must be requested and approved before retention will be accepted for this project. The provided on-site contours at 2 foot intervals do not show the existing pond(s); on the drainage plan, 1 foot contours may be necessary. The existing on-site contours provided on the site plan do not define the drainage basin boundary shown in the preliminary drainage report for the original USR. Please revise the basin if needed. Please show the existing detention areas with the 10 year and 100 year water surface elevations contained in drainage easements. Please show contours for 200 feet offsite and account for offsite flows in your detention/retention calculations. Please contact Heidi Hansen, 970-304-6496 ext. 3750, for assistance if there are any questions regarding the expectations for the drainage. M\PLANNING—DEVELOPMENT REVIEW VUSR-Usc by Special Review VAmUSR-1679-]LW Investment(Apollo)AAmUSR-1679.docs Flood Hazard Development Standards: This area IS NOT in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency Management Agency (FEMA). Agreements: The applicant is required to enter into an Improvements Agreement with the County to ensure that all improvements are completed per the accepted design. This was required as a condition of approval under the original USR condition 1, H but was never completed: The applicant shall enter into on-site (private) road maintenance agreement and post adequate collateral for access, drainage and landscape/screening improvements. The agreement and form of collateral shall be submitted for and reviewed by the Departments of Planning Services and Public Works and accepted by the Board of County Commissioners prior to recording the Use by Special Review plat. Or the applicant may submit evidence that all work has been completed and approved by the Departments of Public Works and Planning Services. (Departments of Public Works and Planning Services). At this time we are unable to conduct a full review of the USR application due to the missing items described above. Public Works will require sufficient time to review the additional materials and depending on the submittal date as well as the content, we may request the hearing for this project to be continued to a later date. Comments made during this stage of the review process will not be all inclusive; as revised materials are submitted, other concerns or issues may arise. All issues of concern and critical issues during further review must be resolved with the Public Works Department. pc: AmUSR-1679 M\PLANNING—DEVELOPMENT REVIEW\USR-Use by Special Review\AmUSR-1679-JLW Investment(Apollo)\AmUSR-1679.docx MEMORANDUM ' TO: CHRIS GATHMAN, PLANNING SERVICES FROM: TROY SWAIN,C� SUBJECT: AM SR`1 ENVIRONMENTAL HEALTH 679 JLW INVE TMENT, LLC COLORADO DATE: DECEMBER 16, 2009 Environmental Health Services has reviewed this proposal to install additional tanks and an office trailer at an existing oil and gas support operation Class II Oilfield Waste Injection Disposal Well facility. We have no objections to the proposal, however, we do recommend that the following conditions be part of any approval: We recommend that the following requirements be met prior to allowing the plat to be recorded: 1. The applicant shall file an amended Air Pollution Emission Notice with the Colorado Department of Health and Environment's (CDPHE) Air Pollution Control Division. 2. If appropriate, Stormwater Discharge Permit coverage shall be obtained from the CDPHE Water Quality Control Division for construction activities. 3. The applicant shall submit evidence to the Weld County Department of Public Health and Environment and the Department of Planning Services, from the Colorado Division of Water Resources, demonstrating that the water supply well is appropriately permitted for the commercial use. 4. A concrete secondary containment structure (floor and walls) surrounding each tank or battery of tanks shall be constructed. The volume retained by the structure shall be 150% greater than the volume of the largest tank inside this structure. A registered professional engineer shall design the structure. The structure shall prevent any release from the tank system from reaching land or waters outside of the containment area. The operator shall provide evidence from the engineer to the Weld County Dept. of Public Health and Environment (WCDPHE) indicating that the structure has been constructed to meet this criterion. 5. The applicant shall submit evidence to the WCDPHE, Weld County Planning Services and the Colorado Oil and Gas Conservation Commission (COGCC) that the facility was constructed in accordance with application materials. 6. The applicant shall install the approved individual sewage disposal system (I.S.D.S.) for sewage flow from the proposed office trailer (SP-0800131). 7. Financial Assurance posted with COGCC shall be adequate to cover a third- party closure of the facility, including the plugging and abandonment of the well, in accordance with industry standards, and the removal of all structures (including concrete) on the facility. The site shall be returned to its original grade. The facility shall submit evidence, in writing, to the WCDPHE that the appropriate financial assurance has been obtained. We recommend that the following requirements be incorporated into the permit as development standards: 1. The facility shall be constructed and operated to ensure that contamination of soil and groundwater does not occur. 2. A manager, knowledgeable in operating an injection well, shall be on site when the facility is receiving waste. 3. No disposal of waste, other than Class II, as defined by the Environmental Protection Agency, is permitted. Any changes from the approved Class II use would require an amendment to this Special Use Permit. 4. Any wastes generated on the facility shall be disposed of in accordance with the Colorado Solid Waste Act, Section 30-20-100.5, C.R.S., or other appropriate rule, regulation or law. 5. This facility shall adhere to the maximum permissible noise level of 70 dBA as allowed in the industrial Zone as delineated in 25-12-103 C.R.S. 6. Fugitive dust and fugitive particulate emissions shall be controlled on this site. 7. All chemicals must be stored secure, on an impervious surface, and in accordance with manufacturer's recommendations. 8. The facility shall comply with Colorado Air Quality Control Commission Regulations and any air permits issued by the CDPHE Air Pollution Control Division. 9. All liquid wastes received at the facility shall be unloaded on the unloading pad. The concrete unloading pad shall be cleaned at a frequency that prevents oils 2 and other wastes from building up on the pad. During winter months, the facility shall maintain the unloading pad free of ice. 10.Any analysis of waste shall be forwarded to the WCDPHE, who reserves the right to require additional, more extensive monitoring at a later date. 11.All liquid and solid wastes (as defined in the Solid Wastes Disposal Sites and Facilities Act, 30-20-100.5, C.R.S.) shall be stored and removed for final disposal in a manner that protects against surface and groundwater contamination. 12.Any petroleum contaminated soils on the facility shall be stored on an impervious surface where any stormwater that comes into contact with the soils would be contained. These wastes shall be stored, removed, treated, and disposed of in accordance with all applicable rules and regulations. 13.The property owner or operator shall be responsible for complying with all of the Development Standards. Noncompliance with any of the Development Standards may be reason for revocation of the Permit by the Weld County Board of County Commissioners. 14.The facility shall comply with the approved groundwater monitoring plan. 15.All storm water, which has come into contact with waste materials on the site, shall be confined on the site. In the event that storm water is not adequately controlled on the site, upon written notification from the WCDPHE or CDPHE, a comprehensive site-wide storm water plan shall be developed and implemented. The plan must be approved, in writing, prior to implementation by WCDPHE and CDPHE. 16.Adequate drinking water, hand washing, and toilet facilities shall be provided. 17.Any individual sewage disposal system (I.S.D.S.) on the property shall be permitted, installed, maintained and operated in compliance with all provisions of the Weld County Code, pertaining to I.S.D.S. 18. The facility shall operate in compliance with the rules and regulations of the Colorado Oil and Gas Conservation Commission. 19.The operation shall comply with all applicable rules and regulations of the State and Federal agencies and the Weld County Code. 3 Chris Gathman r•om: Bilobran, Timothy[Timothy.Bilobran@DOT.STATE.CO.US] ,nt: Tuesday, October 13, 2009 3:10 PM To: Chris Gathman Subject: CDOT Comment for two referrals Attachments: 408023.pdf; 409022.pdf Afternoon Chris, Here are the CDOT comments for a few referrals which are due in a few days. AmUSR-1679 (JLW Investment, LLC) : This Permittee has already completed their CDOT access permit which is attached to this e- mail. There is a clause attached to the permit which reads: THIS PERMIT AUTHORIZES A MAXIMUM OF 30 TRUCKS PER DAY USING THIS SITE. IF TRAFFIC IS FOUND TO BE GREATER, A TRAFFIC STUDY WILL BE REQUESTED FROM THE PERMITTEE, ALONG WITH A NEW CDOT ACCESS PERMIT. Any help the county can give with monitoring the parcel to check for compliance with our traffic requirement will be greatly appreciated. The right-of-way request for this parcel is 75 feet from centerline of the roadway. USR-1719 (Mary Plonka) This Permittee has already obtained a CDOT permit for this proposal as well, which is also '-tached to this e-mail. Aside from a ROW request of 75 feet from centerline, CDOT has no .urther comment for this referral. Thanks and give me a call if you have any questions. Tim Tim Bilobran CDOT Region 4 Assistant Access Manager, Utility Permits, and Outdoor Advertising Office- (970) 350-2163 Mobile- (970) 302-4022 Fax- (970) 350-2207 Timothy.BilobranOdot.state.co.us 1 CDOT Permit No. 409022 COLORADO DEPARTMENT OF TRANSPORTATION srf 392 STATE HIGHWAY ACCESS CODE 392B / 127.536 / L Local Jurisdiction NOTICE TO PROCEED Weld County Permittee(s): Applicant: JLW Investments,L.L.C. Lamp,Rynearson, &Associates Jesse L.White Omar R.Herrera 351 Glencoe Street 808 8th Street Denver,CO 80220 Greeley,CO 80631 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By Title -Date (X) This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation BY , ` Title Date (00 t t.cn PQX m s Nk 4/28/2009 Co•, distri ution: Required: Make copies as necessary for Form 1266 8/98,6/99 Region(original) Local Authority Inspector Lee Ireton Applicant MTCE Patrol Traffic Engineer Staff Access Section 25-East Greeley COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No. 409022 STATE HIGHWAY ACCESS PERMIT State Highway No/Mp/Side 392 8 / 127.536 / L Permit fee Date of transmittal Region/Section/Patrol Local Jurisdiction $100.00 4/13/2009 4 / 01 /25-East creeley Weld County The Permittee(s); Applicant: Ref No.; JLW Investments,L.L.C. Lamp,Rynearson,&Associates Jesse L.White Omar R Herrera 351 Glencoe Street 808 8th Street Denver,CO 80220 Greeley,CO 80631 303-830-0888 970-356-6362 is hereby granted pennisslon to have an access to the state highway at the location noted below.The access shall be constructed,maintained and used in accordance with this permit,including the State Highway Access Code and any attachments,terms,conditions and exhibits.This permit may be revoked by the issuing authority if at any time the permitted access and its use violate any parts of this permit The issuing authority,the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location:This access is located on State Highway 392,a distance of 2830 feet east of mile post 127 on the north/left side. Access to Provide Service to: (Land Use Code) (Size or Count) (Units) 988-Oil/Gas Disposal 92 ADT Additional Information: THIS PERMIT AUTHORIZES A MAXIMUM OF 30 TRUCKS PER DAY USING THIS SITE.IF TRAFFIC IS FOUND TO BE GREATER,A TRAFFIC STUDY WILL BE REQUESTED FROM THE FERMI 11 hE,ALONG WITH A NEW CDOT ACCESS PERMIT. MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Title Date Upon the signing of this permit the permittee agrees to the terms and conditions and referenced attachments contained herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to being used. The permittee shall notify Lee Ireton with the Colorado Department of Transportation in Greeley, Colorado at(970) 350-2147, at least 48 hours prior to commencing construction within the State Highway right-of-way. The person signing as the pennittee 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. Penn SI ..ittee Print Name Date 6 5e tr. e'er >_, wh it- WaV09 This permit is not valid until signed by a duly authorized representative of the Department COLORADO DEPARTMENT OF TRANSPORTATION Signa P jnt Name Title 1� 1 Date(of issue) � . 4,4s -,� �on a N��,- (A l¢/ pr�rlm i-F �"�C7CJ1� .I/(_z47,//oq Copy Iatrl• 'on: Required: Make copies as necessary for Previous editions are obsolete and may not be user 1.Reglon 3.Staff Access Section Local Authority Inspector Page 1 of 3 CDOT Form#101 5d0% 2.Applicent 4.Central Files MICE Patrol Traffic Engineer Hello