HomeMy WebLinkAbout20080951.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: Currently(080317000024 and 080317000041)
Legal Description: 2-parcels located in SW% of, Section 17, Township 6 North, Range 65 West of the 6th PM.
Flood Plain: None Zone District:Agricultural (A) Total Acreage: 7.16 Acreage for USR: 7.16
Overlay District: None Geological Hazard:None
FEE OWNER(S) OF THE PROPERTY(If additional space is required,attach an additional sheet)
Name: Lucerne Commons, LLC
Work Phone#: (970)-381-1151
Address: 5412 Varden Way
City/State/Zip Code: Fort Collins, CO 80528
APPLICANT OR AUTHORIZED AGENT (See Below:Authorization must accompany applications signed by Authorized Agent)
Name: AgProfessionals, LLC(Dusty McCormick)
Work Phone#: (970)-535-9318-Ext-109
Cell Phone#: (303)-877-7747
Email Address: dmccormickaqpros.com
Address: 4350 Hwy 66
• City/State/Zip Code: Longmont, CO 80504
PROPOSED USE: A Special Review Permit for an Oil and Gas Support and Service facility(fracking company service
and support center);an Agricultural Service Establishment including Commercial Agricultural Commodity storage and
drying;uses allowed in the C-3(Commercial)Zone and I-1 (Industrial)Zone,including warehousing,transfer facilities,
and wholesale trade establishments for Recycling, in the A(Agricultural)Zone District.
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.
//-Y-07
Sign r wner or thorized Agent Date
EXHIBIT
• $ Z.
2008-0951
• •
AGPRO
• ■■ COMPLETE LAND & RESOURCE SOLUTIONS
May 31, 2007
To Whom It May Concern
I have contracted with AGPROfessionals, LLC to process and request records for
all land use and zoning permits, documents, and building permits to be filed in
Weld County, for Lucerne Commons LLC's property located a 19009 HWY 392
Lucerne, CO. AGPROfessionals, LLC is authorized to represent Lucerne
Commons LLC throughout this process.
Sincerely,
•
• z&L.
Lucerne Com ons LLC
• ENGINEERING, PLANNING, & CONSULTING
AGPROfessionals,LLC
4350 Highway 66 •Longmont,CO 80504
970.535.9318/office• 303.485.7838/metro•970.535.9854/fax• www.agpros.com
SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL
REVIEW(USR)QUESTIONNAIRE
• The following questions are to be answered and submitted as part of the USR application. If a question does
not pertain to your use, please respond with "not applicable", with an explanation as to why the question is not
applicable.
1. Explain, in detail, the proposed use of the property.
The historic use of this property is an agricultural storage facility, including commodity storage and
commercial operations directly related to agriculture storage. This proposal is a request for a Special
Review Permit for an Oil and Gas Support and Service facility(fracking company service and support
center); an Agricultural Service Establishment including Commercial Agricultural Commodity storage
and drying; uses allowed in the C-3 (Commercial)Zone and I-1 (Industrial)Zone, including
warehousing, transfer facilities, and wholesale trade establishments for Recycling, in the A
(Agricultural)Zone District.
The fracking business will primarily use this facility as a dispatching center for their oil and gas
support service. This will include but is not limited to outdoor parking of trucks and service
equipment, office space, and a maintenance and repair shop.
The agricultural commodity storage business will continue to use this facility as it has been historically
operated. This includes storage of potatoes, corn, wheat, and parking for commodity equipment and
trucks. These commodities may change depending on market needs.
The recycling business will primarily use this property as a transfer facility. This includes but is not
limited to storage of recyclable products, packaging, shipping and receiving, office space, outdoor
parking and staging, and wholesale trade of recyclables.
• The facility will be operated under applicable local, state and federal regulations.
2. Explain how this proposal is consistent with the intent of the Weld County Code, Chapter 22
(Comprehensive Plan).
Section 22-2-60 Agricultural Goals and Policies. 3. A.Policy 1.3 states"Allow commercial and
industrial uses, which are directly related to, or dependent upon agriculture, to locate within the A
(Agricultural)Zone District when the impact to surrounding properties is minimal, and where adequate
services and infrastructure are currently available or reasonably obtainable. Agricultural businesses
and industries will be encouraged to locate in areas that minimize the removal of agricultural land
from production."
This site and proposal has historically and currently depended on agriculture. This proposal
will have minimal additional impacts and is not removing any land from agricultural production.
Section 22-2-140 Industrial development. "Development is typically oriented toward transportation
facilities and is located where traffic, noise, air and visual pollutions conflicts with residential,
commercial, and agricultural uses are minimal.
This site and proposal is located near US highway 85, is adjacent to Colorado Hwy 392, and
is also near the railroad.
Section 22-2-170. Commercial development goals and policies. C.Policy 1.1 states "Minimize the
incompatibities that occur between uses in the A(Agriculture)Zone District and other zoned districts
that allow urban uses.
This site and proposal blends the agriculture and commercial uses together.
This site is not located within a flood hazard zone, a geologic hazard zone, or an airport
• overlay zone. The property use is necessary in Weld County to preserve and promote the diverse
economic base historically attributed to the area. The proposed use is consistent with the Weld
County Comprehensive Plan through the preservation, enhancement and growth of agriculture. The
facility is directly related to and dependent upon agriculture.
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.
• This use is allowed in the Ag Zone as a Use by Special Review as stated in Sec. 23-3-40"Uses by
Special Review" letter A"Mineral resource development facilities", letter B"Agricultural service
establishments", and letter R"Any use permitted as a Use By Right and Accessory Use, or a Use by
Special Review in the Commercial or Industrial Zone", of the Weld County Code.
Oil and Gas activities primarily occur within the A zone. Commercial agricultural commodity storage
needs to remain in the A zone. Recycling is a necessary function of today's economy that is intended
to help preserve natural resources and lands. Further, this multi-faceted facility will provide a smooth
transition form the A zone to the adjacent C zone.
4. What types of uses surround the site? Explain how the proposed use is consistent and compatible
with surrounding land uses.
Agricultural, residential, and commercial uses surround this site. Adjacent land uses are farming, and
the residential neighborhood of Lucerne. There are also several commercial uses in the immediate
area. This proposal is compatible with the surrounding agricultural uses and the Weld County
Comprehensive Plan.
5. Describe, in detail, the following:
a. How many people will use this site?
At full capacity approximately 36 employees, the owners and owners' family, sales
representatives, and supply delivery people will use this site during a typical week.
• b. How many employees are proposed to be employed at this site?
When these buildings are fully occupied under the uses being requested, this site and its
tenants will employ approximately 31 employees' total. Of that, 11 employees will work on
site and 20 employees will be truck drivers. Seasonal employees during agricultural
commodity harvests will fluctuate.
c. What are the hours of operation?
The facility will primarily operate during daylight hours. Equipment operations, trucks, and
maintenance activities, will occur primarily during business hours.
d. What type and how many structures will be erected (built)on this site?
There are currently 3 buildings, a scale, and 2 grain storage structures. Office trailers will be
used for office space, when needed. Please refer to the site plan maps for detailed drawings
of the site and structures.
e. What type and how many animals, if any, will be on this site?
Not applicable. There will be no animals involved in this USR application.
f. What kind (type, size, weight)of vehicles will access this site and how often?
Typical vehicles accessing this site include employees, equipment and sales delivery trucks,
and trucks exporting the final packaged product.
•
• •
--35 Oil and Gas Support Trucks will come and go from the site, per week, at full capacity.
--12 loads via Semi-Tractor or Tandem Truck, of Recyclable materials are estimated to be
delivered, per week, at full capacity.
• --9 Loads via Semi-Tractor, of Recycled products are estimated to be shipped, per week, at
full capacity.
Seasonal Agricultural Commodity storage transportation trucks.
Employees—Daily
g. Who will provide fire protection to the site?
The property is located in the Eaton Fire District.
h. What is the water source on the property? (Both domestic and irrigation).
The water source will be a North Weld County Water tap. There is no irrigation on the
property.
What is the sewage disposal system on the property? (Existing and proposed).
The property will be served by an Individual Sewage septic system. Self-containing office
trailers will also be used. Portable toilets will be provided when agricultural commodity
storage employees are working on site.
j. If storage or warehousing is proposed, what type of items will be stored?
Storage and warehousing will be conducted on this site. The following items may be stored:
agricultural equipment, agriculture commodities, oil and gas service equipment, paper, paper
products, lumber, windows, doors, plastic products, and other recyclable products.
• 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.
Landscaping will include paved entrance aprons, decorative fences, screening fences, and decorative
rock along the unscreened portion of Highway 392 frontage. Please refer to the Landscaping Plan for
details.
7. Explain any proposed reclamation procedures when termination of the Use by Special Review activity
occurs.
Reclamation procedures include compliance with applicable state regulations. Should the facility be
permanently discontinued it would be marketed under applicable county planning and zoning
regulations to its greatest and best use.
8. Explain how the storm water drainage will be handled on the site.
Storm water drainage will be handled with one existing storm water retention pond. Please refer to
the Drainage Plan for details.
9. Explain how long it will take to construct this site and when construction and landscaping is scheduled
to begin.
There is currently no planned new construction. Any remodeling of the existing structures will be
conducted if necessary and proper building permits will be applied for. Construction of landscaping
will begin following the approval of this application.
10. Explain where storage and/or stockpile of wastes will occur on this site.
• Not applicable. There will be no need for storage or stockpile of wastes, associated with this facility.
05/18/2007 15:24 37020440 SARGENT PAGE 01
•
OPERATING AGREEMENT
OF
LUCERNE COMMONS LLC
THIS OPERATING AGREEMENT is entered into effective November 29, 2006, by
and between Wesley H.Sargent and Clayton C. Stanley(hereinafter collectively referred to as
"Members" or individually as "Member") and Lucerne Commons LLC(hereinafter referred
to as the"Company").
ARTICLE I
ORGANIZATION
1.1. Formation. The Company has been formed in compliance with the Colorado
Limited Liability Company Act("Act").
1.2 Name. The name under which the Company shall conduct its business shall be
Lucerne Commons LLC. The Company shall file the required trade name documents,if any.
1.3 Principal Office. The principal place of business of the Company shall be at 5412
Vardon Way, Fort Collins, Colorado 80528 or at such other or additional locations as the Company
may hereafter determine.
• 1.4 Term. The Company shall commence business as of the above effective date,and it
shall continue for a term of thirty (30) years unless earlier terminated pursuant to this Agreement,
the Articles of Organization of the Company ("Articles of Organization") or applicable Colorado
law.
1.5 Objects and Purposes. The Company has been formed for and has the power to
accomplish legal and lawful purposes under the Act, including but not limited to the following
objects and purposes:
a. to assume obligations and to borrow or raise money from time to time in accordance with
the negotiated provisions therefor, and secure the payment of any such obligations of the Company
by mortgage, hypothecation or pledge of all or any of the assets or properties now owned or
hereafter acquired by the Company.
b. to do and perform everything or take any action which may be necessary, advisable,
suitable or proper for the conduct of the business of the Company in carrying out the purposes,
objects and powers set forth in this Agreement,including,but not limited to,
association with others by way of joint venture,co-tenancy,partnership or corporate form.
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• ARTICLE II
CAPITAL CONTRIBUTIONS
2.1. Initial Capital Contributions. The initial capital of the Company has been
contributed by the Members as set forth in "Exhibit A" attached hereto.
2.2. Additional Capital Contributions. Farb Member shall contribute additional capital
to the Company sufficient to cover the Member's pro rata share of such other amounts as may be
unanimously agreed upon by the Members.
Any required contribution shall be made within thirty (30) days after delivery by managers
of notification that such additional contribution is required to be made.
2.3. Failure to Make Contribution. In the event a Member shall fail to make any capital
contribution as required by this Agreement, the Company or managers may take all actions
necessary to collect the contribution required of such Member, including litigation. Alternatively,at
any time after the failure of a Member to make any contribution as required by this Agreement but
before the contribution is made, voluntarily or involuntarily, the contributing Members may then
elect to (a) waive contribution by such Member and adjust the share of the profits, losses and
distributions of the non-contributing Member to compensate therefor, or (b) treat the contributions
of the contributing Members as loans to the Company. which loans shall bear interest at an annual
rate of twenty-four percent (24%), which principal and interest shall have priority over any and all
• other sums owed to or payable to the Members. In addition, the rights of the non-contributing
Member as a Member and manager, including but not limited to voting rights, shall be suspended
until such time as the required contribution is made or the contributing Members make the
foregoing election.
2.4 Return of Capital Contributions. No member shall have a right to demand the return
of the Member's capital contributions except as herein provided.
ARTICLE III
PROFITS,SURPLUS,AND LOSSES
3.1. Determination of Profits, Gains, or Losses. The profits or losses of the Company
shall be determined in accordance with the method of accounting selected by the managers. Gains
or losses from the sale of Company assets or property shall be included in such determination.
3.2 Participation in Profits, Surplus, or Losses. The Members shall initially participate
in the profits,surplus,and losses of the Company as follows:
Wesley H. Sargent 50%
Clayton C. Stanley 50%
Where property is contributed to the Company by a Member, such items shall be allocated,
pursuant to the Internal Revenue Code so as to take account of any variation between the
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• Company's adjusted tax basis of the property and the fair market value of the property at the time of
contribution.
ARTICLE IV
DEDUCTIBILITY OF EXPENSES
Each Member under the Internal Revenue Code shall be allowed to deduct expenses
incurred by that Member which may or may not be reimbursed by the Company. If such
expenses are reimbursed then the Member cannot deduct the same on an individual basis;
however, if a Member incurs business related expenses which the Company chooses not to
reimburse then in that event each individual Member shall have the right to deduct such expenses
on their individual tax returns outside of the Company.
ARTICLE V
CAPITAL AND DRAW ACCOUNTS AND DISTRIBUTIONS
4.1. Capital Accounts. An individual capital account shall be maintained for each
member. The capital of each Member shall consist of the Member's initial capital contribution,
increased by (a) additional capital contributions and (b) any credit balances transferred from the
Member's draw account to the Member's capital account and decreased by (a) distributions of
Company capital to the Member and (b) the Member's share of Company losses charged to the
capital accounts of the members.
• 4.2. Draw Accounts. An individual draw account shall be maintained for each Member
consisting of each Member's proportionate share of Company profits,gains, losses, deductions, and
credits, each such share to be allocated on the basis of the proportion of the Member's capital
account. Distributions,other than those which the Members unanimously agree shall be in reduction
of their capital accounts, shall be charged to the individual draw accounts of the Members. The
Members may determine by majority vote to distribute to Members or transfer to Company capital
all or any portion of the credit balances in the respective draw accounts of the Members. If a
Member has no credit balance in such Member's draw account, losses shall be charged to such
Member's capital account.
4.3. Distributions. At such times as agreed by majority vote among the Members, a
Member may withdraw any credit balance in such Member's draw account;provided that a Member
may not receive a distribution to the extent that, after giving effect to the distribution, all liabilities
of the Company, other than liabilities to Members on account of their membership interests,would
exceed the fair value of the Company assets. No distributions of capital may be made without the
unanimous consent of all Members.
4.4. No Interest on Capital or Draw Accounts. No interest shall accrue or be paid on a
Member's capital or draw accounts unless otherwise determined by the unanimous written consent
of the Members.
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• ARTICLE VI
MEMBERS
5.1. Additional Members. New members shall be admitted to the Company only upon
unanimous consent of the existing Members. All new members must acknowledge in writing their
agreement to be bound by this Agreement,as then amended.
5.2. Meetings and Notices. An annual meeting of the Members shall be held in the
month of December as ordered by the managers, at which time annual reports of the existing
managers shall be presented and managers for the following year shall be elected. Special meetings
may be called by a manager or Member(s) owning not less than fifty percent (50%) of the total
capital interests in the Company. Written notice of a meeting stating the date,time and place and, in
the case of a spcx.ial meeting, the purpose for which it is called, shall be delivered not less than ten
(10)nor more than fifty(50)days before the date of the meeting, either personally or by mail, at the
direction of the managers to each of the Members. When any notice is required to be given to any
Member,a waiver thereof in writing signed by the person entitled to such notice shall be equivalent
to the giving of such notice. by attending a meeting, the Member waives objection to the notice of
the meeting unless the Member, at the beginning of the meeting, objects to the holding of the
meeting or the transacting of business at the meeting. As to any Member who shall sign the minutes
of any meeting of Members, such meeting shall be deemed to have been legally and duly called,
notices, held and conducted, and the signature of any Member to the minutes shall for all purposes
and as to all persons be held to be an approval of the action thereto.
• The chairman elected from among the managers shall call the meetings of Members to order
and act as chairman of such meetings. In the absence of said chairman, any Member entitled to vote
at that meeting, or any proxy of any such Member, may call the meeting to order and a chairman
shall be elected by a majority of the Members entitled to vote at that meeting. Any person
appointed by the chairman may act as secretary of such meeting.
When a meeting is adjourned to another time or place, notice need not be given of the
adjourned meeting if the time and place thereof are announced at the meeting at which the
adjournment is taken. At the adjourned meeting the Company may transact any business which
might have been transacted at the original meeting. If the adjournment is for more than thirty (30)
days, a notice of the adjourned meeting shall be given to each Member entitled to vote at the
meeting.
5.3. Quorum and Manner of Acting. Each Member shall have a vote, in person or by
proxy, equal to its ownership percentage interest in the Company at the time of the vote. Unless
otherwise provided by law, the Articles of Organization or this Agreement, a majority of the
interests in the Company entitled to vote shall constitute a quorum. If a quorum is present,the vote
of a majority of the Membership interests present shall be the act of the Members, unless otherwise
provided by law,the Articles of Organization or this Agreement.
5.4. Action By Members Without a Meeting. Any action of the Members may be taken
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05/1B/2007 15:24 97020448 SARGENT • PAGE 05
• without a meeting if the action is evidenced by one or more written consents describing the action
taken, signed by each Member entitled to vote and delivered to the managers for inclusion in the
minutes. Action taken as provided herein is effective when all members entitled to vote have signed
the consent,unless the consent specifies a different effective date. Written consent of the Members
entitled to vote has the same force and effect as a unanimous vote of such Members and may be
stated as such in any document.
5.5. Resignation. A Member may resign from the Company at any time by delivery of
thirty (30) days prior written notice thereof to the other Members and written consent of all other
Members. Resignation without prior notice and consent shall be a violation of this Agreement.
After compliance with the preceding notice and consent requirements, the resigning Member's
interest in the Company may then be transferred or assigned by the resigning Member pursuant to
the provisions of Article X. The resigning Member shall not otherwise be entitled to receive a
distribution of the value of his interest in the Company.
5.6. Business Between Members and Company. Nothing contained herein shall prevent
a Member, or an affiliate of the Member, from loaning money to or transacting business with the
Company,and none of the other Members shall have any rights or claims as to any profits, income,
proceeds or distributions derived therefrom.
5.7 Other Ventures. This Agreement shall not preclude the right of any Member to
engage or invest in any business activity of any nature or description, including those which may be
• the same as or similar to the Company's business and in direct competition therewith. Any such
activity may be engaged in independently or with others. Neither the Company nor any Member
shall have any right, by virtue of this Agreement or the Company relationship created hereby, in or
to such other ventures or activities, or to the income or proceeds derived therefrom, and the pursuit
of such ventures, even if competitive with the business of the Company, shall not be deemed
wrongful or improper,subject to the limitations set forth herein.
ARTICLE VII
MANAGEMENT
6.1. Managers. The management and control of the Company's business and affairs shall
be vested in a manager or managers, who shall be a natural person over the age of eighteen (18)
years. Wesley H. Sargent is designated as the Manager of the Company.
6.2. Number, Election and Term. There shall be one manager. The manager shall be
elected annually by a majority of the Members at the annual meeting of the Members for a term of
one(1)year.
6.3. Removal. A manager may be removed at any time by a vote of fifty percent(50%)
of the Members then entitled to vote at a meeting called expressly for that purpose.
6.4. Resignation. A manager may resign at any time by delivery of written notice to the
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• other managers, if any, and to the Members. The resignation shall be effective without formal
acceptance but shall not be effective until the resigning manager shall deliver all Company books,
records,assets and other property in his possession or control to the other managers or Members.
6.5. Vacancies. A vacancy may be filled by written agreement of fifty percent(50%)of
the remaining manager(s);provided that a manager's position to be filled by reason of an increase in
the number of managers may be filled by written agreement of the existing managers or by election
at an annual meeting or special meeting of the Members for that purpose. A manager selected to fill
a vacancy shall hold office until the expiration of the term of his predecessor in office and the
election and qualification of a successor.
6.6. Duties. The manager shall perform the duties of a manager in good faith, in a
manner reasonably believed to be in the best interests of the Company and with such care as an
ordinarily prudent person in a like position would use under similar circumstances. A person who
so performs the duties of a manager shall not have any liability by reason of being or having been a
manager of the Company.
In performing duties for the Company, a manager shall be entitled to rely on information,
opinions, reports or statements of the following persons or groups unless the manager has
knowledge concerning the matter in question that would cause such reliance to be unwarranted:
a One or more employees or other agents of the Company whom the manager reasonably
• believes to be reliable and competent in the matters presented;
b. Any attorney, public accountant, or other person as to the matters which the manager
reasonably believes to be within such person's professional or expert competence; or
c. A committee, upon which the manager does not serve and which committee has
designated authority and the manager reasonably believes to merit confidence.
6.7. Powers. The manager is hereby specifically authorized and directed on behalf of the
Company to:
a. Acquire,own,develop,manage,use,operate and dispose of franchise development rights
and all matters connected therewith, including the acquisition, development, leasing, holding, use,
selling and otherwise dealing with real property and personal property, upon such terms as shall be
in the best interest of the Company;
b. Enter into any and all contracts or agreements in connection with the business and
properties of the Company deemed necessary and advisable by the managers, including but not
limited to the following: investment of Company funds, employment, engagement, and discharge
of any employee, agent, independent contractor, accountant, or attorney; and insurance for the
protection of the Company and the managers,for the conservation of the Company assets,or for any
purpose reasonably necessary for the conduct of the Company and its business;
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•
c. Maintain proper books and records for the Company;
d. Prepare or cause to be prepared all required tax returns and supporting schedules for the
Company and furnish copies thereof to the Members;
e. Cause the Company to make or revoke any available tax elections;
f Open accounts, deposit, disburse, and maintain funds in the name of the Company in
banks or savings and loan institutions;
g. Invest, use, and spend the capital and income of the Company in the exercise of any
rights,powers,and obligations possessed by the managers hereunder;
h. Borrow funds to conduct the business of the Company and secure payment thereof with
the acsPts or income of the Company;
i. Maintain adequate reserves from Company funds for the purpose of paying the various
obligations of the Company as they come due;
j. Execute and file for record the required trade name documents for the Company;
• k. Execute and file the Limited Liability Company reports and pay fees as required by law;
1. Do such other acts (though not expressly authorized but not expressly prohibited by this
Agreement or law) and make, execute, and deliver such instruments and documents as may be
reasonably necessary,advisable,or incidental to effectuate the foregoing.
A manager may lend money to, act as surety for, and transact other business with the
Company and, subject to other applicable law, has the same rights and obligations with respect
thereto as a person who is not a manager; except that this provision shall not be construed to relieve
a manager from any of his duties as specified hereinabove.
6.8. Limitations on Authority. No manager shall have authority to do any act in
contravention of the Articles of Organization or this Agreement. Notwithstanding the foregoing
rights,powers,authority,and obligations of the managers,without the unanimous written consent of
the Members,no manager shall on behalf of the Company:
a. Assign the Company property in trust for creditors or on the assignee's promise to pay the
debts of the Company;
b. Dispose of the goodwill of the business;
c. Do any act which would make it impossible to carry on the ordinary business of the
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05/18/2007 15:24 870204484 SARGENT • PAGE 08
• Company;or
d. Sell, exchange or otherwise dispose of all or substantially all of the assets of the
Company.
6.9. Salaries. Unless otherwise unanimously agreed in writing by the Members, no
manager shall receive any salary for services rendered to the Company.
6.10.Expenses. All expenses of the Company or expenses incurred by any manager in
connection with the conduct of Company business shall be paid or reimbursed from Company
funds. A manager desiring reimbursement for expenses chargeable to the Company shall submit a
reimbursement request along with a voucher, receipt or other appropriate supporting documentation
for such expenses.
ARTICLE VIII
INDEMNIFICATION
It is the intent of the Company and Members that the management, conduct, and operation
of the Company and its business shall be at the expense and risk of the Company and not at the
expense and risk of any manager, employee or agent. Accordingly, the indemnification provisions
of the Colorado Limited Liability Company Act, as amended from time to time, are incorporated
herein by reference thereto and shall be construed to afford any manager, employee or agent of the
• Company maximum indemnification allowable thereunder.
ARTICLE IX
FISCAL AFFAIRS
8.1. Banking. The Company shall establish and maintain bank accounts separate and
apart from any funds of the Members or managers. All Company receipts shall be deposited in and
expenses of the Company paid from these accounts. Checks drawn on these accounts shall be
signed in the manner designated from time to time by the managers. The Company may establish
as many bank accounts as deemed convenient or desirable.
8.2. Books and Records. The Company shall establish and maintain books of account
and other records, which shall be retained and kept at the principal place of business of the
Company. The books of account and records of the Company shall include but not be limited to the
following:
a. A current list of the full name and last-known business, residence, or mailing address of
each Member and manager,both past and present;
b. A copy of the Articles of Organization and all amendments thereto, together with
executed copies of any powers of attorney pursuant to which any amendment has been executed;
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• c. Copies of the Company's federal, state and local income tax returns and reports, if any,
for the three most recent years;
d. Copies of any currently effective written operating agreements, copies of any written
promise of a Member to contribute cash, property or services to the Company and copies of any
financial statements of the Company for the three most recent years;
e. Minutes of every annual and special meeting and any meeting ordered by a court of
competent jurisdiction;
f. A statement prepared and certified as accurate by a manager of the Company which
describes:
(I) The amount of cash and a description and statement of the agreed value of the
other property or services contributed by each member and which each member has agreed
to contribute in the future;
(2) The times at which or events on the happening of which any additional
contributions agreed to be made by each Member are to be made;
(3) If agreed upon, the time at which or the events on the happening of which a
Member may terminate his membership in the Limited Liability Company and the amount
• of, or the method of determining,the distribution to which he may be entitled respecting his
membership interest and the terms and conditions of the termination and distribution; and
(4) Any right of a member to receive distributions which include a return of all or
any part of a Member's contribution.
g. Any written consents obtained fion, members pursuant to provisions of the Limited
Liability Company Act pertaining to action by Members without a meeting.
8.3. Right of Inspection. The books of account and other records of the Company shall
be subject to inspection and copying at the reasonable request and expense of a Member during
ordinary business hours.
8.4. Fiscal Year. The Company books of account shall be kept on a calendar year basis.
8.5. Accounting Method. There shall be no requirement that the Company's books of
account be audited by any accounting firm. The accounting method for the Company shall be
adopted by a majority of the Members by no later than the filing of the first federal income tax
return filed by the Company.
8.6. Tax and Other Financial Information. Financial statements of the Company shall be
prepared not less often than annually. Copies of financial statements and income tax returns of the
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•
05/18/2007 15:24 9702049 SARGENT • PAGE 10
• Company shall be furnished to all Members.
The provisions of this Agreement are intended to comply with requirements under the
Internal Revenue Code and the Treasury Regulations and shall be construed accordingly.
8.7. Title. Real and personal property owned or acquired by the Company shall be held,
owned and conveyed in the Company name.
ARTICLE X
TRANSFER OR ASSIGNMENT OF COMPANY INTEREST
A Member may voluntarily transfer or assign the Member's interest in the Company only
pursuant to this Agreement. Any non-complying transfer or assignment shall be void and without
any force or effect. For purposes of this Article, "transfer or assign" includes but is not limited to
any sale, exchange, assignment (including an assignment for the benefit of creditors or a transfer to
a trustee or receiver for the benefit of creditors), gift, pledge, hypothecation, or other encumbrance
or disposition of any portion or all of a Company interest.
9.1. Right of First Refusal. The company and the other Member ("Non-assigning
Member") shall have the right of first refusal to purchase the Company interest of a Member
desiring to make a transfer or assignment ("Assigning Member"). In the event such transfer or
assignment is contemplated, the Assigning Member shall give at least thirty (30) days prior written
• notice to the Company and the Non-assigning Member of the desire to transfer or assign, which
notice shall include the type of transfer or assignment contemplated, the identity of the proposed
transferee or assignee and the terms and conditions of the transfer or assignment. Upon receipt of
the notice, the rights of the Company and the other Member shall be governed by the following
provisions of this Article.
9.2. Exercise of Right of First Refusal. The Company and the Non-assigning Member
shall exercise their rights to purchase the Assigning Member's interest as follows: If the Non-
assigning member elects, the Company shall exercise its right to purchase by giving notice of such
election to the Assigning Member within thirty (30) days after delivery of the notice of intent to
transfer or assign.
If the entire interest specified in the Assigning Member's notice is not purchased on or
before the Closing Date as defined below, the Assigning Member may proceed with the transfer or
assignment as proposed in the Assigning Member's notice, subject to the Article hereof entitled
"Members" and provided that any material change in the terms and conditions of the transfer or
assignment shall obligate the Assigning Member to again give notice and follow the procedures set
forth in this Article.
9.3. Terms and Conditions. In the case of a transfer or assignment where there is a bona
fide offer, the terms and conditions of'such transfer or assignment shall be those of the bona fide
offer. If there is no bona fide offer, the terms and conditions may be mutually agreed upon by the
- 10 -
•
05/19/2007 15:24 970204 SARGENT • PAGE 11
• Company or the Member making the purchase (the "Purchaser")and the Assigning Member. If the
Purchaser and the Assigning Member cannot agree on the purchase price, the purchase price shall
be based as follows: The Assigning Member desiring to sell its interest shall establish a price and
terms; the Non-assigning Member shall have the right to either purchase the Assigning member's
share, or, at its option, may sell its share under the same terms and conditions as was established
under the Assigning Member's offer. The Non-assigning Member shall have fifteen(15)days from
the receipt of the offer to render its decision, and if there is no decision by the Non-Assigning
Member, then it shall be construed that the Non-assigning Member will purchase the interest of the
Assigning member as specified by the Assigning Member's original offer.
9.4. Closing Date. Except as otherwise provided in this Agreement, the Closing Date
shall be determined by the mutual agreement of the Purchaser and Assigning Member, but in no
event shall the Closing date shall be later than one hundred (100) days after delivery of the
Assigning Member's original notice to transfer of assign.
9.5. Effect of Transfer or Assignment, A transfer or assignment of a Company interest
shall not dissolve the Company or entitle the assignee to become or exercise any rights of a
Member. An assignment entitles the assignee to receive, to the extent assigning, only the
distributions to which the assignor would be entitled.
9.6. Right of Assignee to Become Member. An assignee of a Company interest may
become a Member only pursuant to Article V hereof.
• ARTICLE XI
DISSOLUTION AND TERMINATION
10.1. Dissolution.
a. The Company shall be dissolved upon expiration of the agreed term of the Company;
b. The Company may be dissolved and terminated at any time by unanimous written
consent of the Members;
c. Upon the death, retirement, resignation, expulsion, bankruptcy, or dissolution of a
Member, or the occurrence of any other event which terminates the continued membership of a
Member in the Limited Liability Company, unless the business of the Limited Liability Company is
continued by the consent of all the remaining Members within ninety (90) days after the
termination, at which time the remaining Members may agree to the appointment of one or more
additional Members,managers or both.
Any one or all of the Members may act as liquidator(s). In the event none of the Members
desire to act as liquidator, the Members may hire a third party to act as liquidator. No Member shall
be entitled to any compensation for the Member's services in connection with the liquidation of the
Company,unless the other Members unanimously agree otherwise. In the event that no Member or
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•
05/18/2007 15:24 970204 SARGENT . PAGE 12
• third party is appointed to act as liquidator within sixty (60) days after the event requiring
liquidation of the Company, any Member may apply to a court of competent jurisdiction for the
appointment of a liquidator. Any liquidator, other than a court appointed liquidator, shall be liable
only for acts or omissions constituting gross negligence, willful misconduct, or fraud. A court
appointed liquidator shall be liable for any negligent act or omission.
10.3. Distribution Upon Dissolution and Termination. Upon dissolution and termination,
the assets and properties of the Company shall be used and/or distributed in the following order:
a. To pay or provide for the payment of all Company liabilities to creditors including
Members,except as to liabilities to Members for distributions of capital or profits;
b. To discharge the balance of the capital accounts of the Members and obligations to
former Members for distribution of capital and profits;
c. To discharge the balance of the draw accounts of the Members; and
d. The balance, if any, to be divided among the Members in the same proportion as they
share the profits of the Company.
No member shall be entitled to anything other than cash in liquidation of the Member's
interest in the Company; provided that the Company may make such distributions in kind as may be
• considered necessary to accomplish the liquidation of the Company.
10.4. Statutory Filings. The managers shall file a statement of intent to dissolve, articles
of dissolution and such other documents as may be required by law to dissolve the Company.
ARTICLE XII
MISCELLANEOUS PROVISIONS
11.1. Choice of Law. This Agreement shall be governed by and interpreted in accordance
with the laws of the State of Colorado.
11.2. Entire Agreement and Amendment. This Agreement constitutes the entire
understanding among the Members, and it supersedes any prior understanding or agreement in
respect of the Company. This Agreement may not be amended without the unanimous consent of
all members.
11.3. Headings. Headings and subheadings contained in this Agreement shall not be
considered part of this Agreement,and the text shall control.
11.4. Severability. In the event any provision of this Agreement is found to be invalid or
unenforceable, the remaining provisions of the Agreement shall, nevertheless, be binding with the
same effect as though the invalid and unenforceable provision was deleted.
• - 12 -
05/1E/2007. 15:24 970204 SARGENT PAGE 13
•
11.5. Gender and Number. All references to gender shall include the feminine,masculine
and the neuter genders, and any reference in the singular or plural form shall include whichever
form the circumstances may require.
11.6. Nonwaiver of Rights. Failure or delay by a Member to exercise any right hereunder
shall not operate as a waiver thereof or of any other right.
11.7. Waiver of Partition Rights. Each of the Members hereby irrevocably waives any
and all rights that the Member may have to maintain any action for partition with respect to the
Member's Company interest or the Company's properties.
11.8. Inurement. This Agreement shall be binding upon and inure to the benefit of the
Members and their respective heirs,personal representatives, successors and assigns.
11.9. Notice. Any notice or other communication given or delivered pursuant to the terms
of this Agreement shall be made in writing and shall be considered as properly given or delivered if
hand delivered or mailed, postage prepaid, properly addressed to the last known address of the
addressee/Member. In the case of notification by mail, notice shall be deemed to have been
received three (3)days after the date of mailing when properly addressed to the last known address
of the addressee/Member, except for mailing of a notice of meeting, which shall be deemed
delivered as to any Member when deposited in the United States mail.
• 11.10. Attorneys' Fees. If any Member herein files an action against another Member, a
former Member or the Company to enforce the terms hereof or declare rights hereunder, the
prevailing member shall be entitled to reasonable attorneys' fees and costs of suit as well as such
other relief as the court may award.
11.11. Counterparts, This Agreement may be executed in counterparts, each of which
when taken together shall constitute one and the same Agreement binding upon all Members.
IN WITNESS WHEREOF, the Members have executed this Agreement in Fort Collins,
Colo •o,on the day , year indicated hereinabove.
esley . .argent+
C . on C. Stanle
• 13
• BUSINESS EMERGENCY INFORMATION:
Business Name: Lucerne Commons Phone: 970-217-1151
Address: 5412 Vardon Way City, ST,Zip: Fort Collins,CO 80528
Business Owner: Lucerne Commons, LLC Phone: 970-217-1151
Home Address: City, ST,Zip:
List three persons in the order to be called in the event of an emergency:
NAME TITLE ADDRESS PHONE
Wes Sargent Owner 970-217-1151
Clayton Stanley Owner 970-3810619
Business Hours: Office hours are 7:00-5:00 M-F
Type of Alarm : _None _Burglar Holdup Fire _Silent _Audible
Name and address of Alarm Company:
Location of Safe: N/A
MISCELLANEOUS INFORMATION:
Number of entry/exit doors in this building: Location(s): Please see attached map
• Is alcohol stored in building? NO Location(s):
Are drugs stored in building?NO Location(s):
Are weapons stored in building? NO Location(s):
The following programs are offered as a public service of the Weld County Sheriffs Office. Please indicate the
programs of interest. NO Physical Security Check Crime Prevention Presentation
UTILITY SHUT OFF LOCATIONS:
Main Electrical: Please see attached map
Gas Shut Off: Please see attached map
Exterior Water Shutoff: Please see attached map
Interior Water Shutoff:
•
COOT Permit No. 407141
111; COLORADO DEPARTMENT OF TRANSPORTATION
STATE HIGHWAY ACCESS CODE SH/S/MP
392B / 115.636 L
Local Jurisdiction
NOTICE TO PROCEED Weld County
Permittee(s): Applicant:
Lucerne Commons, LLC AGPROfessionals, LLC
Dusty McCormick
5412 Varden Way 4350 State Highway 66
Fort Collins, CO 80528 Longmont, CO 80504
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
!---
(y �q Title //�� Date
IX) 1 f cu_-IOC I`\rcos5 8/08
lop, istributi n: Required: Make copies as necessary for: ( I Form 1265 8/98,6/99
ks
1.Region(original) Local Authority Inspector Linda McWil I ms
2.Applicant MTCE Patrol Traffic Engineer
3.Staff Access Section 25-East Greeley
COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No. 407141
STATE HIGHWAY ACCESS PERMIT State Highway No/Mp/Side
3926 / 115.636 / L
Permit fee Date of transmittal Region/Section/Patrol Local Jurisdiction
$100.00 12/3/2007 04/ 01 /25-East Greeley Weld County
IIIIPermittee(s); Applicant: Ref No.:
Lucerne Commons, LLC AGPROfessionals, LLC
Dusty McCormick
5412 Varden Way 4350 State Highway 66
Fort Collins,CO 80528 Longmont,CO 80504
970-535-9318
is hereby granted permission to have an access to the state highway at the location noted below.The access shall be constructed,maintained and used in
accordance with this permit, including the State Highway Access Code and any attachments,terms,conditions and exhibits.This permit may be revoked
by the issuing authority if at any time the permitted access and its use violate any parts of this permit.The issuing authority,the Department and their duly
appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of
the permit.
Location:This access is located on State Highway 392, a distance of 3357 feet east of mile post 115 on the north/left side. THIS
ACCESS IS FOR EMERGENCY SERVICE VEHICLES ONLY AND MUST BE GATED AT THE ENTRANCE.
Access to Provide Service to: (Land Use Code:) (Size or Count) (Units)
996- Emergency Services Access 1 EACH
Additional Information:
•
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
Signature Print Name Title Date
Upon the signing of this permit the 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 Linda McWilliams with the Colorado Department of Transportation in
Greeley, Colorado at (970) 350-2147, at least 48 hours prior to commencing construction within the
State Highway right-of-way.
The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to
accept th permit and its term and conditions.
Per 1 e Sig lure . I Print Name Date
/1 72 d
y i Jec' / - n 54-08
This pe i u tie i is not valntil signed by a duly authorized representative of Department.
COL ADO DEPARTMENT OF TRANSPORTATION
S re t1 n Print Name Title Date(of issue)
p1,ta Tl 'I (X� GLoRtA Li ICE - IDLER_, Acc-E53 MG2 VS/OS
py Dist ibution: Required: Make copies as necessary for: Previous editions are obsolete and may not be used
1.Region 3.Staff Access Section Local Authority Inspector Page 1 of 3 CDOT Form#101 5/07
2.Applicant 4.Central Files MTCE Patrol Traffic Engineer
State Highway Access Permit PERMIT EXPIRATION
Form 101, Page 2 1. A permit shall be considered expired if the access is not
under construction within one year of the permit issue date
The following paragraphs are excerpts of the State Highway or before the expiration of any authorized extension. When
Access Code. These are provided for your convenience but the permittee is unable to commence construction within one
do not alleviate compliance with all sections of the Access year after the permit issue date, the permittee may request a
Code. A copy of the State Highway Access Code is one year extension from the issuing authority. No more than
available from your local issuing authority (local government) two one-year extensions may be granted under any
or the Colorado Department of Transportation (Department). circumstances. If the access is not under construction within
When this permit was issued, the issuing authority made its three years from date of issue the permit will be considered
decision based in part on information submitted by the expired. Any request for an extension must be in writing and
applicant, on the access category which is assigned to the submitted to the issuing authority before the permit expires.
highway, what alternative access to other public roads and The request should state the reasons why the extension is
streets is available, and safety and design standards. necessary, when construction is anticipated, and include a
Changes in use or design not approved by the permit or the copy of page 1 (face of permit) of the access permit.
issuing authority may cause the revocation or suspension of Extension approvals shall be in writing. The local issuing
the permit. authority shall obtain the concurrence of the Department
prior to the approval of an extension, and shall notify the
APPEALS Department of all denied extensions within ten days. Any
1. Should the permittee or applicant object to the denial of person wishing to reestablish an access permit that has
a permit application by the Department or object to any of expired may begin again with the application procedures.An
the terms or conditions of a permit placed there by the approved Notice to Proceed, automatically renews the
Department, the applicant and permittee (appellant) have a access permit for the period of the Notice to Proceed.
right to appeal the decision to the [Transportation]
Commission [of Colorado]. To appeal a decision, submit a CONSTRUCTION
request for administrative hearing to the Transportation 1. Construction may not begin until a Notice to Proceed is
Commission of Colorado within 60 days of transmittal of approved. (Code subsection 2.4]
notice of denial or transmittal of the permit for signature.
Submit the request to the Transportation Commission of 2. The construction of the access and its appurtenances
Colorado, 4201 East Arkansas Avenue, Denver, Colorado as required by the terms and conditions of the permit shall
80222-3400. The request shall include reasons for the be completed at the expense of the permittee except as
appeal and may include changes, revisions, or conditions provided in subsection 2.14. All materials used in the
•hat 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 fled 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
aie
brought to the Commission within 60 days of transmittal provisions of the permit,that conflict with concurrent
f notice of denial or transmittal of the permit. highway construction or maintenance work, that endanger
highway property, natural or cultural resources protected by right-of-way or any adopted municipal system and drainage
law, or the health and safety of workers or the public. plan.
5. Prior to using the access, the permittee is required to 11. By accepting the permit, permittee agrees to save,
•complete the construction according to the terms and indemnify, and hold harmless to the extent allowed by law,
conditions of the permit. Failure by the permittee to abide by the issuing authority, the Department, its officers, and
all permit terms and conditions shall be sufficient cause for employees from suits, actions, claims of any type or
the Department or issuing authority to initiate action to character brought because of injuries or damage sustained
suspend or revoke the permit and close the access. If in the by any person resulting from the permittee's use of the
determination of the Department or issuing authority the access permit during the construction of the access.
failure to comply with or complete the construction
requirements of the permit create a highway safety hazard, CHANGES IN ACCESS USE AND PERMIT VIOLATIONS
such shall be sufficient cause for the summary suspension 1. It is the responsibility of the property owner and
of the permit. If the permittee wishes to use the access prior permittee to ensure that the use of the access to the
to completion, arrangements must be approved by the property is not in violation of the Code, permit terms and
issuing authority and Department and included in the permit. conditions or the Act. The terms and conditions of any permit
The Department or issuing authority may order a halt to any are binding upon all assigns, successors-in-interest, heirs
unauthorized use of the access pursuant to statutory and and occupants. If any significant changes are made or will
regulatory powers. Reconstruction or improvement of the be made in the use of the property which will affect access
access may be required when the permittee has failed to operation, traffic volume and or vehicle type, the permittee or
meet required specifications of design or materials. If any property owner shall contact the local issuing authority or the
construction element fails within two years due to improper Department to determine if a new access permit and
construction or material specifications, the permittee shall be modifications to the access are required.
responsible for all repairs. Failure to make such repairs may
result in suspension of the permit and closure of the access. 2. When an access is constructed or used in violation of
the Code, section 43-2-147(5)(c), C.R.S., of the Act applies.
6. The permittee shall provide construction traffic control The Department or issuing authority may summarily
devices at all times during access construction, in suspend an access permit and immediately order closure of
conformance with the M.U.T.C.D. as required by section 42- the access when its continued use presents an immediate
4-104, C.R.S., as amended. threat to public health, welfare or safety. Summary
suspension shall comply with article 4 of title 24, C.R.S.
7. A utility permit shall be obtained for any utility work
within highway right-of-way. Where necessary to remove, MAINTENANCE
relocate, or repair a traffic control device or public or private 1. The permittee, his or her heirs, successors-in-interest,
utilities for the construction of a permitted access, the assigns, and occupants of the property serviced by the
relocation, removal or repair shall be accomplished by the access shall be responsible for meeting the terms and
permittee without cost to the Department or issuing conditions of the permit, the repair and maintenance of the
authority, and at the direction of the Department or utility access beyond the edge of the roadway including any cattle
company. Any damage to the state highway or other public guard and gate, and the removal or clearance of snow or ice
right-of-way beyond that which is allowed in the permit shall upon the access even though deposited on the access in the
be repaired immediately. The permittee is responsible for the course of Department snow removal operations. Within
repair of any utility damaged in the course of access unincorporated areas the Department will keep access
construction, reconstruction or repair. culverts clean as part of maintenance of the highway
drainage system. However, the permittee is responsible for
8. In the event it becomes necessary to remove any right- the repair and replacement of any access-related culverts
of-way fence, the posts on either side of the access shall be within the right-of-way. Within incorporated areas, drainage
securely braced with an approved end post before the fence responsibilities for municipalities are determined by statute
is cut to prevent any slacking of the remaining fence. All and local ordinance. The Department will maintain the
posts and wire removed are Department property and shall roadway including auxiliary lanes and shoulders, except in
be turned over to a representative of the Department. those cases where the access installation has failed due to
improper access construction and/or failure to follow permit
9. The permittee shall ensure that a copy of the permit is requirements and specifications in which case the permittee
available for review at the construction site at all times. The shall be responsible for such repair. Any significant repairs
permit may require the contractor to notify the individual or such as culvert replacement, resurfacing, or changes in
office specified on the permit at any specified phases in design or specifications, requires authorization from the
construction to allow the field inspector to inspect various Department.
aspects of construction such as concrete forms, subbase,
base course compaction, and materials specifications. Minor
changes and additions may be ordered by the Department
or local authority field inspector to meet unanticipated site
•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://wvirvit.cdphastate.co.us/permits.asp.
• CDOT Water Quality Program Manager; Rick Willard (303)757.9343
• CDOT Asbestos Project Manager; Julia Horn (303)512-5519
• 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.rnilhtml/od-tl/tri-lakes.html
Sacramento Dist (1Nestern CO), Grand Junction Office(970)243-1199 http://www.spkusace.army.mil/cespk-co/reoulatory/
Albuquerque District(SE Colorado),Pueblo Reg:,Office(719)-543-6915 http://wwimspausace.armv.mil/reo/
• CDOT Utilities, Special Use and Access Permitting:(303)757-9654 http://www.dotstate.co.us/Perrnits/
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 Regional 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://www.dot.state:corus/environmental/Wildlife/Guidelines asp;or the Colorado Division of
Wildlife website http://wildlife(state.co:us/WildlifeSpecies/SpeciesOfConcern/. Additional guidance may be provided by the Regional
• Permitting Office in the Permit Special Provisions.
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 OAHP and/or CDOT. If
archaeological or historical artifacts are encountered during the progress of the permitted work,work in the subject area shall be
halted and the CDOT Regional Permitting Office and Regional Planning and Environmental Manager shall be contacted immediately.
Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional
Permitting Office in the Permit Special Provisions. Contact Information Contact the OAHP at(303)866-3395.
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 substances such as wash water,paint,automotive fluids,
solvents, oils or soaps, 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 (WQCD)at(303) 692-3500.
General Authorization-Allowable Non-Stormwater.DischargesUnless 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 groundwater infiltration to separate
storm sewers,discharges from potable water sources;'foundation drains air conditioning condensation,irrigation water 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).
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 gasoline contaminated soil,asbestos,chemicals,mine tailings;etc.)
is encountered during the performance of work,the perrnittee shall halt work in the affected area and immediately contact the CDOT
Regional Permitting Office for direction as to how to proceed Contact Info Contact the'CDOT/CDPHE Liaison at(303)757-9787.
Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation July'07
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 CDHPE 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 is available from Julia Horn, CDOT Asbestos Project Manager(3O3)512-5519.
Construction Stormwater Permit; Stormwater Discharge From Industrial Facilities - Discharges of stormwater runoff from
construction sites disturbing one acre or more-or certain types of industrial facilities-requires a CDPS Stormwater 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:cdphe:state.co.us/wq/PermitsUnitlwgcdpmt:html
Construction Dewatering(Discharge or Infiltration)-Discharges of water encountered during excavation or work in wet areas
may require a Construction Dewatering Discharge Permit. Contact Information: For Construction Dewatering Discharge Permits,
contact the CDPHE WQCD at(303) 692-3500. Website:httpt//www.cdphe:state.co.us/wq/PermitsUnit/wgcdpmt.html
Minimal Industrial Discharge Permit—Discharges of small quantities of wastewater or wastewater requiring minimal treatment
such as that resulting from hydrostatic testing or certain wash waters may require a Minimal Industrial Discharge Permit('MINDI")
Contact Info:Contact the CDPHE WQCD at(303)692-3500.-..Website: htt.://www.cdphe.state.co.us/wq/PermitsUnit/wocdpmt.html
Municipal Separate Storm Sewer System (MS4) Discharge Permit—Discharges from the storm sewer systems of larger
municipalities( and from the CDOT highway drainage system that lies within those municipalities, are subject to MS4 Permits issued
by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to a 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 must comply with the applicable provisions of the
Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations and are subject to inspection by the CDOT and
the CDHPE. Contact Information: Contact the CDPHE Water Quality Control Division at(303)692-3500 for a listing of municipalities
required to obtain MS-4 Permits, or qo to http.//www,cdphe.state.co.us/wq/PermitsUnit/wgcdpmt.html#MunicipalFormsGuidance.
. 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 Information: Contact the appropriate Corps District Regulatory Office for information about what type of 404
permit may be required (information provided at top of ECIS). Contact the CDPHE Water Quality Control Division at(303)692-3500.
Erosion and Sediment Control Practices-For activities requiring a Construction Stormwater 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: to either case,the CDOT Stormwater Quality and Erosion Control Guide(2002)
should be used to design erosion controls..Contact Information:The CDOT Stormwater Quality and Erosion Control Guide may be
obtained from the Bid Plans Office at(303)757-9313 or from: httpi//www.dot.state.co.us/environmental/envWaterQual/wgms4.asp
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 cubic yard of solids)may be left on-site after either being
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.'Concrete washout shall only
be performed as specified by the CDOT Environmental Program and shall be In accordance to CDOT specifications and guidelines.
is Contact Information: Contact the CDOT Water Quality Program Manager at(303)757-9343.
Soill 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(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.
Environmental Clearances Information Summary Page 2 of 3 Colorado Department of Transportation July'07
Transportation of Hazardous Materials-No person may offer or accept a hazardous material for transportation in commerce unless
that person is registered in conformance with the United States Department of Transportation regulations at 49 CFR,Part 171. The
hazardous material must be properly classed, described, packaged marked, labeled 'and in condition for shipment as required or
authorized by applicable requirements,or an exemption,approval or registration has been issued. Vehicles requiring a placard,must
obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For
authorization and more',info call the Federal Motor Safety Carrier Administration,US DOT for inter-and intra-state HAZMAT
Registration(303)969-6748. Colorado Public Utilities Commission:`(303)894-2868. `,
Paleontology-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 COOT Regional Permitting Office and Regional Planning and
Environmental Manager shall be Contacted immediately. Authorization must be provided by CDOT prior to the continuation of work.
Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information:
Contact the CDOT Paleontologist at(303)757-9632.
Working on or in any stream or its bank-In orderto 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 CDQW,can be accessed at
www.dot.state.co.us/environmental/wild l ife/permiteoplication.asp.
About This Form •Questions or comments about this Information Summary may be directed to Dahir Egal,CDOT Safety&Traffic
Engineering, Utilities Unit,at(303)757-9344, dahlr.ecialadot.state.co.us
•
•
Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation July'07
State Highway Access Permit 1
Attachment to Permit No. 407141 -Additional Terms and Conditions
• 1. If there are any questions regarding this permit, please contact Tim Bilobran at (970) 350-2163.
2. The Permittee shall refer to all additional standard requirements included with this permit and any
enclosed additional terms, conditions, exhibits, and noted attachments.
3. Incorporated as part of this permit are the following:
Application for Access Permit (CDOT Form No. 137)
Permit(CDOT Form No. 101) and its two page attachment
Exhibits:
"A"- Access Plan
"B"- Vicinity Map
4. This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1), and is based
upon the information submitted by the Permittee. This permit is only for the use and purpose stated in the
Application and Permit. Any changes in traffic volumes or type, drainage, or other operation aspects may
render this permit void, requiring a new permit to the be applied for based upon existing and anticipated
future conditions.
5. Access construction methods and materials shall conform to the Colorado Department of Transportation
Standard Specifications for Road and Bridge Construction (current edition).
6. If necessary, minor changes, corrections and/or additions to this permit may be ordered by the
Department inspector, other Department representative or local authority to meet unanticipated site
• conditions. Changes may not be in violation of the State Highway Access Code. All major changes to the
plans must be approved in writing by the Department prior to commencement of any work on or within the
State Highway right-of-way.
All workers within the State Highway right-of-way shall comply with their employer's safety and health
policies/procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA)
regulations - including, but not limited to the applicable sections of 29 CFR Part 1910 - Occupation 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 protective equipment:
* Head protection that complies with the ANSI Z89-1-1997 standard;
* At all construction sites or whenever there is a danger of injury to feet, protective footwear that complies
with the ANSI Z41-1999 standard will be worn;
* High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum,
ANSUISEA 107-1999, Class 2).
Where any of the above-reference 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. 407141 -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. All costs associated with the maintenance of this access are the responsibility of the Permittee. This
includes design, construction, signing and striping, utility relocation, testing of materials, and inspections.
12. Landscaping and site construction shall not obstruct sight distance at any State Highway access point.
Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping
Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of
features within the right-of-way may require the Permittee to install a subsurface drain in accordance with
CDOT Standard M-605-1 or other approved system. The Permittee shall contact Linda McWilliams at the
Greeley Traffic Office, (970) 350-2147 to obtain the Landscaping Permit.
•
13. 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.
14. If highway right-of-way fence exists or is proposed, the Permittee must contact Linda McWilliams at
the Greeley Traffic Office, (970) 350-2147, prior to removal or installation.
15. The access shall be maintained at 66 feet wide with no radii.
16. Surfacing of the access shall be maintained as per Exhibit "A".
17. The access shall be 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.
18. The maintenance of the access and/or further 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.
•
State Highway Access Permit 3
Attachment to Permit No. 407141 -Additional Terms and Conditions
• 19. 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.
20. 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 firefighting activities.
ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction
sites, may require Colorado Discharge Permit System permits from
CDPHE before work begins. For additional information and forms, go to the CDPHE
website at: http://cdphe.state.co.us/wq/PermitsUnit/wqu.
•
COLORADO DEPARTMENT OF TRANSPORTATION Issuing authority application
STATE HIGHWAY ACCESS PERMIT APPLICATION acceptance date:
•nstructions: - 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 C DOT's Access Management website at htto://www.dot.state.co.usfAccessPermits/index.htm
1)Property owner(Permittee) 2)Agent for permittee(if different from property owner)
Lucerne Commons, LLC AGPROfessionals, LLC by Dusty McCormick
Street address Mailing address
5412 Varden Way 4350 HWY 66
City,state 8 zip Phone# 'City,state&zip Phone#(required)
Fort Collins, CO 80528 Longmont, CO 80504 970-535-9318
E-mail address E-mail address if available
dmccormick@agpros.com
3)Address of property to be served by permit(required)
19009 HWY 392 Lucerne, CO
4)Legal description of property:If within jurisdictional limits of Municipality,city and/or County,which one?
county subdivision block lot section township range
Weld I 117 16 North 65 West
5)What State Highway are you requesting access from? 6)What side of the highway?
HWY 392 ®N ICS DE OW
W
7)How many feet is the proposed access from the nearest mile post? How many feet is the proposed access from the nearest cross street?
feet fN❑S❑E OW)from: /9/, /9 feet ON❑S®E OW)from: LC)OP. 39
8)What is the approximate date you intend to begin construction?
�7°�heck ac here if you are requesting a:
ew access ntemporary access(duration anticipated:
) Elimprovement to existing access
hange in access use EY1'12 !X1 removal of access jelocation of an existing access(provide detail)
10)Provide existing property use 1 removal oOn(9
Commercial Agriculture commodity storage
11)Do you have knowledge of any State Highway access permits serving this property,or adjacent properties in which you have a property interest?
liai no ❑yes,if yes-what are the permit number(s)and provide copies: and/or,permit date:
12)Does the property owner own or have any interests in any adjacent property?
®no ❑yes,if yes-please describe:
13)Are there other existing or dedicated public streets,roads,highways or access easements bordering or within the property?
O no ®yes,if 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 of each.
business/land use square footage business square footage
'E.bmmere4al-Ag odit Sior�e I X7-3, 86- Recycling j •
1 \/ �, I \/ '34;-1 0
Cvi-l--errrct-GarLl'qtrip-.—Maimt/Storage I—LB-rttr t 4 E P.6E•Nt C ] ON V L-7
16)If you are requesting residential developement access,what is the type(single family,apartment,townhouse)and number of units?
type number of units type nuLi of units
I
lIovide the following vehicle count estimates for vehicles that will use the access.Leaving the property then returning is two counts.
ate if your counts are p of passenger cars and light trucks at peak hour volumes b of multi unit trucks at peak hour volumes
'}peak hour volumes or$average daily volumes. O xrnn, _ O
n of single unit vehicles in excess of 30 ft. A of farm vehicles(field equipment) Total count of all vehicles
O 42_5 O
Previous editions are obsolete and may not be used Page 1 of 2 C T F rm#137 12/04
•
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. f) Proposed access design.
c) Drainage plan showing impact to the highway right-of-way. g) Parcel and ownership maps including easements.
d) Map and letters detailing utility locations before and after h) Traffic studies.
development in and along the right-of-way. i) Proof of ownership.
1- It is the applicant's responsibility to contact appropriate agencies and obtain all environmental clearances that apply
to their activities. Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System
permits, or ecological, archeological, historical or cultural resource clearances. The CDOT Environmental Clearances
Information Summary presents contact information for agencies administering certain clearances, information about
prohibited discharges, and may be obtained from Regional CDOT Utility/Special Use Permit offices or accessed via the
CDOT Planning/Construction-Environmental-Guidance webpage http://www.dot.state.co.us/environmental/Forms.asp.
2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/
procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not
limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926
- Safety and Health Regulations for Construction.
Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection,
respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a
minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal
protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation
accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head
protection that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there is danger of
injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95,
and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999.
Where any of the above-referenced ANSI standards have been revised, the most recent version of the standard shall
*ply.
3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board
under the American Disabilities Act(ADA). These guidelines define traversable slope requirements and prescribe the
use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and
can be found on the Design and Construction Project Support web page at:
chttp://www.dot.state.co.us/DesignSu000rtl>, 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.
Appr 's signature Print name Date
ecc Ousl `lr nid // -/S-C7
If the tic t is not the owner of the property, we require this application also to be signed by the property owner or
their legs 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 t e permittee.
Pro o)ner gnature Print name Date
A.() C 1 9aleceal fir- iy-67
/ /
t/// Previous editions are obsolete and may not be used Page 2 of 2 CDOT Form#137 12/04
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COMPLETE LAND&RESOURCE SOLUTIONS 1 OF
4111 COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No. 407142
STATE HIGHWAY ACCESS CODE S /5/MP
392 B / 115.687 / L
NOTICE TO PROCEED Lo`aliurisdi`tion
Weld County
Permittee(s): Applicant:
Lucerne Commons, LLC AGPROfessionals, LLC
Dusty McCormick
5412 Varden Way 4350 State Highway 66
Fort Collins, CO 80528 Longmont, CO 80504
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.41;This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as
appropriate.
Municipality or County Approval (When the appropriate local authority retains issuing authority)
By Title Date
(X)
This Notice is not valid until signed by a duly authorized representative of the Department
Colorado Department of Transportation
By Title Date
(X) • , -[ ncvl 5 M l a o
8
Illiopy .stribut i n: Required: Make copies as necessary for: / \,1,•/ Form 1265 8/98,6/99
1.Region(original) Local Authority Inspector Linda McWillia
2.Applicant MTCE Patrol Traffic Engineer
3.Staff Access Section 25-East Greeley
COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No. 40714;
STATE HIGHWAY ACCESS PERMIT State Highway No/Mp/Side
3926 / 115.687 / L
Permit fee Date of transmittal Region/Section/Patrol Local Jurisdiction
$100.00 12/3/2007 4/ 01 /25-East Greeley Weld County
The Permittee(s); Applicant: Ref No.:
Lucerne Commons, LLC AGPROfessionals, LLC
Dusty McCormick
5412 Varden Way 4350 State Highway 66
Fort Collins,CO 80528 Longmont, CO 80504
970-535-9318
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 it
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 3625 feet east of mile post 115 on the north/left side.
Access to Provide Service to: (Land Use Code:) (Size or Count) (Units)
147- Storage Yard(Commercial Ag. Storage) 32 ADT
147-Storage Yard(Oil and Gas Storage) 32 ADT
1000-Recycling 32 ADT
Additional Information:
•
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
Signature Print Name Title Date
Upon the signing of this permit the permittee agrees to the terms and conditions and referenced attachments contained
herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from
Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to
being used.
The permittee shall notify Linda McWilliams with the Colorado Department of Transportation in
Greeley, Colorado at(970) 350-2147, at least 48 hours prior to commencing construction within the
State Highway right-of-way.
The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to
accep the permit and its terms and conditions.
P ee ignatu e.sL
Print Name Date
CJLst�L, NSae i vy3'
Cry �/a Sr;i1e7 / -vim Oc
This er ' t is not lid until signed by a duly authorized representative of the Department.
LORADO DEPARTMENT OF TRANSPORTATION
tur '� _ � /I Pint Name Title �G� Date(of issue)
f—C l�{�/ Owwa N lcE-lot-Et Access 1J/8(/08
opy Di ribution: Required: Make copies as necessary for: Previous editions are obsolete and may not be used
1.Region 3.Staff Access Section Local Authority Inspector Page 1 of 3 COOT Form ft101 5/07
2 Applicant 4 Central Files MTCE Patrol Traffic Engineer
State Highway Access Permit PERMIT EXPIRATION
Form 101, Page 2 1. A permit shall be considered expired if the access is not
under construction within one year of the permit issue date
The following paragraphs are excerpts of the State Highway or before the expiration of any authorized extension. When
cess Code. These are provided for your convenience but the permittee is unable to commence construction within one
not alleviate compliance with all sections of the Access year after the permit issue date, the permittee may request a
ode. A copy of the State Highway Access Code is one year extension from the issuing authority. No more than
available from your local issuing authority (local government) two one-year extensions may be granted under any
or the Colorado Department of Transportation (Department). circumstances. If the access is not under construction within
When this permit was issued, the issuing authority made its three years from date of issue the permit will be considered
decision based in part on information submitted by the expired. Any request for an extension must be in writing and
applicant, on the access category which is assigned to the submitted to the issuing authority before the permit expires.
highway, what alternative access to other public roads and The request should state the reasons why the extension is
streets is available, and safety and design standards. necessary, when construction is anticipated, and include a
Changes in use or design not approved by the permit or the copy of page 1 (face of permit) of the access permit.
issuing authority may cause the revocation or suspension of Extension approvals shall be in writing. The local issuing
the permit. authority shall obtain the concurrence of the Department
prior to the approval of an extension, and shall notify the
APPEALS Department of all denied extensions within ten days. Any
1. Should the permittee or applicant object to the denial of person wishing to reestablish an access permit that has
a permit application by the Department or object to any of expired may begin again with the application procedures.An
the terms or conditions of a permit placed there by the approved Notice to Proceed, automatically renews the
Department, the applicant and permittee (appellant) have a access permit for the period of the Notice to Proceed.
right to appeal the decision to the [Transportation]
Commission [of Colorado]. To appeal a decision, submit a CONSTRUCTION
request for administrative hearing to the Transportation 1. Construction may not begin until a Notice to Proceed is
Commission of Colorado within 60 days of transmittal of approved. (Code subsection 2.4]
notice of denial or transmittal of the permit for signature.
Submit the request to the Transportation Commission of 2. The construction of the access and its appurtenances
Colorado, 4201 East Arkansas Avenue, Denver, Colorado as required by the terms and conditions of the permit shall
80222-3400. The request shall include reasons for the be completed at the expense of the permittee except as
appeal and may include changes, revisions, or conditions provided in subsection 2.14. All materials used in the
art 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
•
e brought to the Commission within 60 days of transmittal provisions of the permit, that conflict with concurrent
otice of denial or transmittal of the permit. highway construction or maintenance work, that endanger
highway property, natural or cultural resources protected by right-of-way or any adopted municipal system and drainage
law, or the health and safety of workers or the public. plan.
5. Prior to using the access, the permittee is required to 11. By accepting the permit, permittee agrees to save,
the construction according to the terms and indemnify, and hold harmless to the extent allowed by law,
omplete nditions 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
("thin highway right-of-way. Where necessary to remove, MAINTENANCE
locate, or repair a traffic control device or public or private 1. The permittee, his or her heirs, successors-in-interest,
utilities for the construction of a permitted access, the assigns, and occupants of the property serviced by the
relocation, removal or repair shall be accomplished by the access shall be responsible for meeting the terms and
permittee without cost to the Department or issuing conditions of the permit, the repair and maintenance of the
authority, and at the direction of the Department or utility access beyond the edge of the roadway including any cattle
company. Any damage to the state highway or other public guard and gate, and the removal or clearance of snow or ice
right-of-way beyond that which is allowed in the permit shall upon the access even though deposited on the access in the
be repaired immediately. The permittee is responsible for the course of Department snow removal operations. Within
repair of any utility damaged in the course of access unincorporated areas the Department will keep access
construction, reconstruction or repair. culverts clean as part of maintenance of the highway
drainage system. However, the permittee is responsible for
8. In the event it becomes necessary to remove any right- the repair and replacement of any access-related culverts
of-way fence, the posts on either side of the access shall be within the right-of-way. Within incorporated areas, drainage
securely braced with an approved end post before the fence responsibilities for municipalities are determined by statute
is cut to prevent any slacking of the remaining fence. All and local ordinance. The Department will maintain the
posts and wire removed are Department property and shall roadway including auxiliary lanes and shoulders, except in
be turned over to a representative of the Department. those cases where the access installation has failed due to
improper access construction and/or failure to follow permit
9. The permittee shall ensure that a copy of the permit is requirements and specifications in which case the permittee
available for review at the construction site at all times. The shall be responsible for such repair. Any significant repairs
permit may require the contractor to notify the individual or such as culvert replacement, resurfacing, or changes in
office specified on the permit at any specified phases in design or specifications, requires authorization from the
construction to allow the field inspector to inspect various Department.
aspects of construction such as concrete forms, subbase,
base course compaction, and materials specifications. Minor
changes and additions may be ordered by the Department
or local authority field inspector to meet unanticipated site
•nditions.
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
erform 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.aso.
rr CDOT Water Quality Program Manager;Rick Willard (303)757-9343
• CDOT Asbestos Project Manager;Julia Horn (303)512-5519
• 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.army.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/requlatory/
Albuquerque District(SE Colorado),Pueblo Reg.Office(719)-543-6915 http://www.spa.usace.arrnv.mil/req/
• 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 Regional 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://www.dot.state.co.us/environmentaWJildlife/Guidelines asp,or the Colorado Division of
Wildlife website http.//wildlife.state.co.us/WildlifeSpecies/SpeciesOfConcern/. Additional guidance may be provided by the Regional
•ermitting Office in the Permit Special Provisions.
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 OAHP and/or CDOT If
archaeological or historical artifacts are encountered during the progress of the permitted work,work in the subject area shall be
halted and the CDOT Regional Permitting Office and Regional Planning and Environmental Manager shall be contacted immediately.
Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional
Permitting Office in the Permit'Special Provisions. Contact Information Contact the OAHP at(303)866-3395.
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 substances such as wash water, paint, automotive fluids,
solvents, oils or soaps. 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 (WQCD)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,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).
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
ermitted facility or designated collection point(e.g.,for solid waste,a utility or construction company's own dumpster). If pre-existing
olid waste or hazardous materials contamination (including oil or gasoline contaminated soil, asbestos,chemicals, mine tailings,etc.)
s 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:Contact the CDOT/CDPHE Liaison at(303)757-9787,
Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation July'07
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 CDHPE Hazardous Materials and Waste Management Divisions(HMWMD)Solid
Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which
@piuthorization 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 is available from Julia Horn, CDOT Asbestos Project Manager(303)512-5519.
Construction Stormwater Permit; Stormwater Discharge From Industrial Facilities-Discharges of stormwater runoff from
construction sites disturbing one acre or more-or certain types of industrial facilities-requires a CDPS Stormwater Permit. Contact
Information:For Utility/Special Use activities being performed in conjunction and coordination with a CDOT highway constriction
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.cdphe.state.co.us/wq/PermitsUnit/wgcdpmt.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. Website:http://www.cdphe.state.co.us/wq/PermitsUnit/wocdpmt.html!'
Minimal Industrial Discharge Permit—Discharges of small quantities of wastewater or wastewater requiring minimal treatment,
such as that resulting from hydrostatic testing or certain wash waters,may require a Minimal Industrial Discharge Permit("MINDI").
Contact Info:Contact the CDPHE WQCD at(303)692-3500. Website: http://www,cdphe.state.co.us/wc/PermitsUnit/wocdpmthtrnl
Municipal Separate Storm Sewer$ystem(MS4) Discharge Permit-Discharges from the storm sewer systems of larger
municipalities, and from the COOT highway drainage system that lies within those municipalities, are subject to MS4 Permits issued
by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to a 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 must comply with the applicable provisions of the
Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations,and are subject to inspection by the CDOT and
the CDHPE. Contact Information:'Contact the CDPHE Water Quality Control Division at(303)692-3500 for a listing of municipalities
required to obtain MS-4 Permits,or go to http://www.cdphe.state.co.us/wq/PermitsUnit/wgcdpmt.html#MunicipalFormsGuidance:`
ischarge of Dredged or Fill Material—404 Permits Administered By the U.S.Army Corps of Engineers,and Section 401
later 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 Information: Contact the appropriate Corps District Regulatory Office for information about what type of 404
permit may be required (information provided at top of ECIS). Contact the CDPHE Water Quality Control Division at(303)692-3500.
Erosion and Sediment Control Practices-For activities'requiring a Construction Stormwater 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. In either case,the CDOT Stormwater Quality and Erosion Control Guide(2002)
should be used to design erosion controls. Contact Information:The CDOT Stormwater Quality and Erosion Control'.Guide may be
obtained from the Bid Plans Office at(303)757-9313 or from:http://www.dotstate.co.us/environmental/envWaterQual/woms4.asp
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
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.'Concrete washout shall only
be performed as specified by the COOT Environmental Program and shall be in accordance to CDOT specifications and guidelines.
ontact Information: Contact the CDOT Water Quality Program Manager at(303)757-9343.
pill 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, 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.
Environmental Clearances Information Summary Page 2 of 3 Colorado Department of Transportation July'07
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 at49 CFR, Part 171, The
hazardous material must be properly classed,described,packaged, marked, labeled, and in condition for shipment as required or
authorized by applicable requirements,or an exemption, approval or registration has been issued. Vehicles requiring a placard,must
obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For
authorization and more!info call the Federal Motor Safety Carrier Administration, US DOT for inter-and intra-state HAZMAT
Registration (303)969-6748. Colorado Public Utilities Commission;(303)894-2868.
Paleontology-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 COOT Regional Permitting Office and Regional Planning and
Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work.
Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions.'Contact Information:
Contact the CDOT Paleontologist at(303)757-9632,
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,i 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
www.dot.state.co.us/environmental/wildlife/permitao lication.asp.
About This Form -Questions or comments about this Information Summary may be directed to Dahir Egal,CDOT Safety&Traffic
Engineering, Utilities Unit,at(303)757-9344, dahir.ecialt@dot.state.co us
•
•
Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation July'07
State Highway Access Permit !
Attachment to Permit No. 407142 -Additional Terms and Conditions
I. If there are any questions regarding this permit, please contact Tim Bilobran at(970) 350-2163.
2. The Permittee shall refer to all additional standard requirements included with this permit and any
enclosed additional terms, conditions, exhibits, and noted attachments.
3. Incorporated as part of this permit are the following:
Application for Access Permit (CDOT Form No. 137) }A
Permit (CDOT Form No. 101) and its two page attachment '1
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 - Occupation 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 protective equipment:
* Head protection that complies with the ANSI Z89-1-1997 standard;
* At all construction sites or whenever there is a danger of injury to feet, protective footwear that complies
with the ANSI Z41-1999 standard will be worn;
* High visibility apparel as specified in the Traffic Control provisions of this permit (at a minimum,
ANSUISEA 107-1999, Class 2).
Where any of the above-reference 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)
Ask 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. 407142 -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. All costs associated with the maintenance of this access are the responsibility of the Permittee. This
includes design, construction, signing and striping, utility relocation, testing of materials, and inspections.
12. Landscaping and site construction shall not obstruct sight distance at any State Highway access point.
Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping
Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of
features within the right-of-way may require the Permittee to install a subsurface drain in accordance with
CDOT Standard M-605-1 or other approved system. The Permittee shall contact Linda McWilliams at the
Greeley Traffic Office, (970) 350-2147 to obtain the Landscaping Permit.
13. 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.
14. If highway right-of-way fence exists or is proposed, the Permittee must contact Linda McWilliams at
the Greeley Traffic Office, (970) 350-2147, prior to removal or installation.
15. The access shall be maintained at 118 feet wide with no radii.
16. Surfacing of the access shall be maintained as per Exhibit "A".
17. The access shall be 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.
18. The maintenance of the access and/or further 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.
State Highway Access Permit 3
Attachment to Permit No. 407142-Additional Terms and Conditions
19. 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.
20. 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.
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 acc\ptanoedate:
m—≥il
•Instructions:-Contact the Colorado Department of Transportation(CDOT)or your local government to determine yourr issuiinng authority.
- Contact the issuing authority to determine what plans and other documents are required to be submitted with your application.
- Complete this form(some questions may not apply to you)and attach all necessary documents and Submit it to the issuing authority.
Please print - Submit an application for each access affected.
or type - If you have any questions contact the issuing authority.
- For additional information see CDOT's Access Management website at htto://www.dot.state.co.us/AccessPermits/index.htm
1)Property owner(Permittee) 2)Agent for permittee(if different from property owner)
Lucerne Commons, LLC AGPROfessionals, LLC by Dusty McCormick
Street address Mailing address
5412 Varden Way 4350 HWY 66
City,state&zip Phone# City, state&zip Phone#(required)
Fort Collins, CO 80528 Longmont, CO 80504 970-535-9318
E-mail address E-mail address if available
dmccormick@agpros.com
3)Address of property to be served by permit(required)
19009 HWY 392 Lucerne, CO
4)Legal description of property:If within jurisdictional limits of Municipality,city and/or County,which one?
county subdivision block lot section township range
Weld I II 117 6 North 165 West
5)What State Highway are you requesting access from? 6)What side of the highway?
HWY 392 ®N IIS IIIFIIIW
7)How many feet is the proposed access from the nearest mile post? How many feet is the proposed access from the nearest cross street?
feet UN❑S❑E OW)from: '59, Li3 feet ON❑SEE OW)from: (.UJCA. 3 7
8)What is the approximate date you intend to begin construction?
�eck here if you are requesting a:
new access ntemporary access(duration anticipated: ) nimprovement to existing access
change in access use nremoval of access Qelocation of an existing access(provide detail)
10)Provide existing property use
Commercial Agriculture commodity storage
11)Do you have knowledge of any State Highway access permits serving this property,or adjacent properties in which you have a property interest?
no Dyes,if yes-what are the permit number(s)and provide copies: and/or,permit date:
12)Does the property owner own or have any interests in any adjacent property?
®no 0 yes, if yes-please describe:
13)Are there other existing or dedicated public streets,roads,highways or access easements bordering or within the property?
0 no ®yes,if 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 of each.
business/land use square footage business square footage
Commercial Ag. Commodity Storage 17,300 Recycling 134,100
Oil and Gas Equip. Maint/Storage 118,400
16)If you are requesting residential developement access,what is the type(single family,apartment,townhouse)and number of units?
type number of units type number of units
I I
ovide the following vehicle count estimates for vehicles that will use the access.Leaving the property then returning is two counts.0Ito if your counts are N of passenger cars and light trucks at peak hour volumes n of multi unit trucks at peak hour volumes
peak hour volumes or igaverage daily volumes. 2 3 ,-,21/ ,�.
fFc /lye),
/I of single unit vehicles in excess of ao ft. t/of farm vehicles(Bela equipment) Total count of all vehicles/ D cli# acs too
Previous editions are obsolete and may not be used Page 1 of 2 CDOT Form#137 12/04
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
CDOT Planning/Construction-Environmental-Guidance webpage http://www.dot.state.co.us/environmental/Forms.asp.
2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/
procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations - including, but not
limited to the applicable sections of 29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926
- Safety and Health Regulations for Construction.
Personal protective equipment (e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection,
respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a
minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal
protective equipment: High visibility apparel as specified in the Traffic Control provisions of the documentation
accompanying the Notice to Proceed related to this permit (at a minimum, ANSI/ISEA 107-1999, class 2); head
protection that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there is danger of
injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95,
and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999.
Where any of the above-referenced ANSI standards have been revised, the most recent version of the standard shall
Oply.
3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board
under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the
use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and
can be found on the Design and Construction Project Support web page at:
<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 doe not constitute permission to start access construction work.
Appli nt' signa / Print name Date
•
If th plic t is not the owner the property, we require this application also to be signed by the property owner or
their legal 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.
Propery owner signature )
Print name Date
•% ,..S4472-( inkii 107 /12A2ci•cd , /A/V-07
J
Previous editions are obsolete and may not be used Page 2 of 2 CDOT Form#137 12/04
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