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Home My WebLink About20053806.tiff Ii7C501- 0 PI ItS Weld County Planning Department a GREELEY OFFICE ,f1(-- �' MEMORANDUM JUN 14 2005 11 Kim Ogle, nn Manager -iQ FROM :TO : Peter ScheiPla , Ping.E. , Public artment 'Sc:cJ-wn O . COLORADO SUBJECT: USR- 1499 Windsor Assembly of God (Use by Special Review) Weld County Public Works Department has reviewed this Site Plan Review request. Comments made during this phase of the process may not be all-inclusive, as other concerns or issues may arise during the remaining application process. Comments 11. ❑ The applicant has submitted a final drainage report, which is acceptable to Public Works. o The engineer must stamp, sign and date the drainage report, Final Drainage Report — Windsor Assembly II of God — NE Corner of SH #257 & WCR #72, by Latitude 39, dated May 3 , 2005 , to be resubmitted to Public Works. sail o The Department keeps certified reports on file. ❑ The applicant has submitted Construction Plans — Windsor Assembly of God Church — Weld County, Colorado, dated 03 -May-2005 , by Latitude 39 — Engineering & Development Consultants, LLC, which are acceptable to Public Works. o The engineer must stamp, sign and date the construction plans to be resubmitted to Public Works. o The Department keeps certified drawings on file for use during construction. Recommendation ❑ The Public Works Department will sign-off the review process for this site plan once we receive the requested submittal materials. The applicant shall address the comments listed above for this review process . The review process will continue only when all appropriate elements have been submitted. Issues of concern must be resolved with the Public Works Department prior to construction activities.* # PC: USR- 1499 Windsor Assembly of God (Use by Special Review) Email & Original: Planner: Ogle PC by Post: Applicant: Todd Hodges Design PC by Post: Engineer: Latitude 39 Lc1S3 " 380Lo __,_..__.__.__.__ Page 1 of 1 pL. 11 7 2. "' Page 1 of 1 Kim Ogle From: Kim Ogle Sent: Wednesday, June 01, 2005 5:42 AM To: 'Todd Hodges @ Todd Hodges Design, LLC' Cc: Charlotte Davis; Donald Carroll; Roger Vigil Subject: USR-1499; Windsor Assembly of God Staff has reviewed the drawings and supporting documentation submitted to this office for review. We offer the following comments: Drawing 1/2: Overall Site Plan w/Vicinity Map Add "# 1499"to heading on sheet title Callout/Define the solid circular object graphically delineated adjacent to SH 257 at Emergency Access Strike" Ultimate"in note stating Ultimate 100' CDOT right-of-way Property Owner's Certificate: Strike "Signature"replace with Eustis Habighorst, Pastor, on behalf of Windsor Assembly of God Church Drawing 1/2 Site Plan w/o Vicinity Map - Please define role or use of each drawing as there appears to be similarities between the first two drawings discussed herein Drawing 2/2 Overall Site Plan Notes for plat acceptable. Place a space between number 27 and number 28 Discussion of letter dated May 26,2005 Hodges to Ogle Condition 1.A.8 and 1.G - Met Condition 1.B -No permit in hand from CDOT, also application not signed by Eustis Habighorst-Condition NOT MET Condition 3.B- Electronic mail received from C. Davis, Environmental Health Department, -Condition NOT MET,will require appropriate permitting prior to receiving TCO. 06/01/2005 Page 1 of 1 Kim Ogle From: Donald Carroll Sent: Tuesday, November 15, 2005 8:28 AM To: Kim Ogle Subject: RE: WAG, USR-1499 -ALL GOOD TO GO?THEY WANT RELEASE OF BUILDING PERMITS. KIM Public Works is agreeable. From: Kim Ogle Sent: Tuesday, November 15, 2005 8:18 AM To: Charlotte Davis; Donald Carroll Subject: WAG, USR-1499 -ALL GOOD TO GO?THEY WANT RELEASE OF BUILDING PERMITS. KIM 11/15/2005 COLORADO DEPARTMENT OF TRANSPORTATION issuing JUJU iui"y«ww"x"""' STATE HIGHWAY ACCES 'ERMIT'APPLICATION acceptancedate: Instructions: -Contact the Colorado Department of Transportation(CDOT)or your local government to determine your issuing authority. - Contact the issuing authority to determine what plans and other documents are required to be submitted with your application. - Complete this form(some questions may not apply to you)and attach all necessary documents and Submit it to the issuing authority. Please print - Submit an application for each access affected. or type - If you have any questions contact the issuing authority. - For additional information see CDOT's Access Management website at MtpJ/www.dot.state.eo.us/Acces5PennitsAndex.htr 1 I)Property owner(Permittee) 2)Agent for permitter)(if different from property owner) Windsor Assembly of God Eustis Habighorst itreet address Mailing address 416 Oak Street 416 Oak Street amity,state&zip Phone# City,state&zip Phone#(required) Windsor CO 80550 970 686-2096 Windsor CO 80550 970 686-2096 E-mall address E-mail address if available eustis@windsorassembly.org 3)Address of property to be served by permit(required) SH-257 and WCR-72, Windsor CO 80550 1)Legal description of property:If within jurisdictional limits of Municipality,city and/or County,which one? minty Weld 1 Southwest 1/4 1 ion block I lot 1 section 1 6 North 1 67 West i)What State Highway are you requesting access from? 6)What side of the h u y? SH-257 ON S [■ E O W r)How many feet is the proposed access from the nearest mile post? How many feet is the proposed access from the nearest cross street? 0.376 feet flN®SDEDW)from: RP 14.000 0.070 feet MINDSDEDW)from: Centerline Weld CR-72 3)What is the approximate date you intend to begin construction? 5/15/2005 3)Check here if you are requesting a: ®new access ❑temporary access(duration anticipated: ) ❑improvement to existing access 0 change in access use nremoval of access Qrelocation of an existing access(provide detail) 10)Provide existing property use Property use is presently vacant. Access request will be for emergency needs, only. 11)Do you have knowledge of any State Highway access permits serving this property,or adjacent properties in which you have a property interest? a no ❑yes,if yes-what are the permit ntmber(s)and provide copies: and/or,permit date: 12)Does the properbiewner own or have any interests in any adjacent property? null 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 En 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? No 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. businessAand use square footage business square footage Church 113,000 I I 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 I I 17)Provide the following vehicle count estimates for vehicles that will use the access.Leaving the property then returning is two counts. Indicate if your counts are #of passenger cam and light bud`s at peak hour volumes #of mtat wt trucks at peak hour volumes peak hour volumes or[average daily volumes. 0 0 t of single unit vehicles in excess of 30 fm. N of farm vehides(field equipment) Total count of all vehicles 0 0 0 Previous editions are obsolete and may not be used Page 1 of 2 CDOT Form#137 12/04 18)Check vuhth the issuing authority to determine which of the following documents are required to complete the review of your appmcauon. a) Property map indicating other access, ring roads and streets. e) Subdivision,za c development plan. b) Highway and driveway plan profile. f) Proposed awes. sign. 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 studes. development in and along the right-of-way r 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.ui/environmental/Forms.asp. 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ procedures, and all applicable U.S. Occupational Safety and Health Administration (OSHA) regulations- including, but not limited to the applicable sections of 29 CFR Part 1910-Occupational Safety and Health Standards and 29 CFR Part 1926 -Safety and Health Regulations for Construction. Personal protective equipment(e.g. head protection, footwear, high visibility apparel, safety glasses, hearing protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers in the State Highway right of way, except when in their vehicles, shall wear the following personal protective equipment High visibility apparel as specified in the Traffic Control provisions of the documentation accompanying the Notice to Proceed related to this permit(at a minimum,ANSI/ISEA 107-1999, class 2); head protection that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever there is danger of injury to feet, workers shall comply with OSHA's PPE requirements for foot protection per 29 CFR 1910.136, 1926.95, and 1926.96. If required, such footwear shall meet the requirements of ANSI Z41-1999. Where any of the above-referenced ANSI standards have been revised,the most recent version of the standard shall apply. 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.dpt.state.co.us/DesignSupport/>, then click on Design Bulletins. If an access permit is issued to you, it will state the terms and conditions for its use.Any changes in the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury in the second degree,and any other applicable state or federal laws,that all information provided on this form and submitted attachments are to the best of their knowledge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. ►pplicant's signature Print name Date Eustis Habighorst 5/5/2005 If the applicant is not the owner of the property,we require this application also to be signed by the property owner or their legally authorized representative(or other acceptable written evidence). This signature shall constitute agreement with this application by all owners-of-interest unless stated in writing. If a permit is issued, the property owner, in most cases, will be listed as the permittee. 'roperty owner signature Print name Date Previous editions are obsolete and may not be used Page 2 of 2 CDOT Form#137 12104 CDOT Permit No. COLORADO DEPARTMENT OF TRANSPORTATION 405066 SH/S/MP STATE HIGHWAY ACCESS CODE 257A/013.690/R NOTICE TO PROCEED Local Jurisdiction Windsor Permittee(s): Applicant; Eustis Habighorst Eustis Habighorst Windsor Assembly of God Windsor Assembly of God 416 Oak Street 416 Oak Street Windsor,CO 80550 Windsor,CO 80550 970-686-2096 970-686-2096 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. None 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) c e�� I d� �S k 7/ (405 Copy Distri uti n: Required 1. Region Permit files 2.Staff Access Section. As needed:Local Au on y, MTCE Patrol, Inspector Form 1265 8/98 Weld County Planning Department GREELEY OFFICE JUL 14 2005 RECEIVED COLORADO DEPARTMENT OF TRANSPORTATION CM'Permit No. STATE HIGHWAY ACCESS PERMIT 405066 State Highway No/Mp/Side 257A/013.690/R Permit fee Date of transmittal Region/Section/Patrol Local Jurisdiction 50.00 06/21/2005 04/01/17 Windsor The Permittee(s); Applicant; Ref No. 2005 Eustis Habighorst Eustis Habighorst Windsor Assembly of God Windsor Assembly of God 416 Oak Street 416 Oak Street Windsor,CO 80550 Windsor,CO 80550 970-686-2096 970-686-2096 is hereby granted permission to have an access to the state highway at the location noted below.The access shall be constructed,maintained and used in accordance with this permit,including the State Highway Access Code and any attachments,terms,conditions and exhibits.This permit may be revoked by the issuing authority if at any time the permitted access and its use violate any parts of this permit.The issuing authority,the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location: The emergency access is located on State Highway 257,a distance of 3,659 feet north of Mile Post 13 on the east/right side. Access to Provide Service to: Emergency Services Access 1 Each 100.00% Other terms and conditions: • See Attached Pages 2 and 3 and Other Enclosures for Additional Terms and Conditions. • THIS ACCESS IS FOR EMERGENCY SERVICES ONLY. THE ACCESS IS TO BE GATED AND LOCKED AT ALL TIMES. MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. By Date Title (x) 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 at 970-350- 2147 at least 48 hours prior to commencing construction within the State Highway right-of-way. The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to accept the permit and its terms and con itions. Permitt Date /a s (X) This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION B Date(of issue) Title (x) 01 j T4 La- - 1/101/05- g Access Manager Copy st ibution: Required: Make copie as necessary for. Previous editions are obsolete and may not be used 1.Region Local Authority Inspector CDOT Form#101 8/98 2.Applicant MTCE Patrol Traffic Engineer 3.Staff Access Section 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 or before the expiration of any authorized The following paragraphs are excerpts of the State Highway Access Code. extension.When the permittee is unable to commence construction within one These are provided for your convenience but do not alleviate compliance with all year after the permit issue date,the permittee may request a one year extension sections of the Access Code. A copy of the State Highway Access Code is from the issuing authority. No more than two one-year extensions may be available from your local issuing authority(local government)or the Colorado granted under any circumstances. If the access is not under construction within Department of Transportation (Department). When this permit was issued,the three years from date of issue the permit will be considered expired.Any request issuing authority made its decision based in part on information submitted by the for an extension must be in writing and submitted to the issuing authority before applicant,on the access category which is assigned to the highway,what the permit expires.The request should state the reasons why the extension is alternative access to other public roads and streets is available, and safety and necessary,when construction is anticipated,and include a copy of page 1 (face design standards. Changes in use or design not approved by the permit or the of permit)of the access permit. Extension approvals shall be in writing.The local issuing authority may cause the revocation or suspension of the permit. issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied APPEALS extensions within ten days.Any person wishing to reestablish an access permit 1. Should the permittee or applicant object to the denial of a permit application that has expired may begin again with the application procedures.An approved by the Department or object to any of the terms or conditions of a permit placed Notice to Proceed, automatically renews the access permit for the period of the there by the Department,the applicant and permittee(appellant)have a right to Notice to Proceed. appeal the decision to the[Transportation]Commission[of Colorado].To appeal a decision, submit a request for administrative hearing to the Transportation CONSTRUCTION Commission of Colorado within 60 days of transmittal of notice of denial or 1. Construction may not begin until a Notice to Proceed is approved. (Code transmittal of the permit for signature.Submit the request to the Transportation subsection 2.4] Commission of Colorado,4201 East Arkansas Avenue, Denver, Colorado 80222- 3400.The request shall include reasons for the appeal and may include 2. The construction of the access and its appurtenances as required by the changes, revisions, or conditions that would be acceptable to the permittee or terms and conditions of the permit shall be completed at the expense of the applicant. permittee except as provided in subsection 2.14.All materials used in the construction of the access within the highway right-of-way or on permanent 2. Any appeal by the applicant or permittee of action by a local issuing authority easements, become public property.Any materials removed from the highway shall be filed with the local authority and be consistent with the appeal right-of-way will be disposed of only as directed by the Department.All fencing, procedures of the local authority. guard rail,traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless 3. In submitting the request for administrative hearing,the appellant has the otherwise instructed by the permit or the Department inspector. option of including within the appeal a request for a review by the Department's internal administrative review committee pursuant to[Code]subsection 2.10. 3. The permittee shall notify the individual or the office specified on the permit When such committee review is requested, processing of the appeal for formal or Notice to Proceed at least two working days prior to any construction within administrative hearing,2.9(5)and (6),shall be suspended until the appellant state highway right-of-way. Construction of the access shall not proceed until notifies the Commission to proceed with the administrative hearing,or the both the access permit and the Notice to Proceed are issued.The access shall _ appellant submits a request to the Commission or the administrative law judge to be completed in an expeditious and safe manner and shall be finished within 45 withdraw the appeal.The two administrative processes,the internal days from initiation of Construction within the highway right-of-way.A construction administrative review committee,and the administrative hearing, may not run time extension not to exceed 30 working days may be requested from the _ concurrently. individual or office specified on the permit. 4. Regardless of any communications, meetings,administrative reviews or 4. The issuing authority and the Department may inspect the access during negotiations with the Department or the internal administrative review Committee construction and upon completion of the access to ensure that all terms and regarding revisions or objections to the permit or a denial, if the permittee or conditions of the permit are met. Inspectors are authorized to enforce the applicant wishes to appeal the Department's decision to the Commission for a conditions of the permit during construction and to halt any activities within state hearing,the appeal must be brought to the Commission within 60 days of right-of-way that do not comply with the provisions of the permit,that conflict with transmittal of notice of denial or transmittal of the permit concurrent highway construction or maintenance work,that endanger highway property, natural or cultural resources protected by law, or the health and safety 10. Each access shall be constructed in a manner that shall not cause water to of workers or the public. enter onto the roadway or shoulder,and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and 5. Prior to using the access,the permittee is required to complete the drainage plan.. construction according to the terms and conditions of the permit. Failure by the permittee to abide by all permit terms and conditions shall be sufficient cause for 11. By accepting the permit, permittee agrees to save, indemnify,and hold the Department or issuing authority to initiate action to suspend or revoke the harmless to the extent allowed by law,the issuing authority,the Department,its permit and close the access. If in the determination of the Department or issuing officers,and employeet from suits,actions,claims of any type or character _ authority the failure to comply with or complete the construction requirements of brought because of injuries or damage sustained by any person resulting from the permit create a highway safety hazard, such shall be sufficient cause for the the permittee's use of the access permit during the construction of the access. summary suspension of the permit. If the permittee wishes to use the access prior to completion, arrangements must be approved by the issuing authority and CHANGES IN ACCESS USE AND PERMIT VIOLATIONS Department and included in the permit.The Department or issuing authority may 1. It is the responsibility of the property owner and permittee to ensure that the order a halt to any unauthorized use of the access pursuant to statutory and use of the access to the property is not in violation of the Code, permit terms and regulatory powers. Reconstruction or improvement of the access may be conditions or the Act.The terms and conditions of any permit are binding upon all required when the permittee has failed to meet required specifications of design assigns, successors-in-interest, heirs and occupants. If any significant changes or materials. If any construction element fails within two years due to improper are made or will be made in the use of the property which will affect access construction or material specifications,the permittee shall be responsible for all operation,traffic volume and or vehicle type,the permittee or property owner repairs. Failure to make such repairs may result in suspension of the permit and shall contact the local issuing authority or the Department to determine if a new closure of the access. access permit and modifications to the access are required. 6. The permittee shall provide construction traffic control devices at all times 2. When an access is constructed or used in violation of the Code,section 43- during access construction, in conformance with the M.U.T.C.D.as required by 2-147(5)(c), C.R.S.,of the Act applies.The Department or issuing authority may section 42-4-104, C.R.S.,as amended. summarily suspend an'access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, 7. A utility permit shall be obtained for any utility work within highway right-of- welfare or safety.Summary suspension shall comply with article 4 of title 24, way.Where necessary to remove, relocate,or repair a traffic control device or C.R.S. public or private utilities for the construction of a permitted access,the relocation, removal or repair shall be accomplished by the permittee without cost to the MAINTENANCE Department or issuing authority, and at the direction of the Department or utility 1. The permittee, his or her heirs,successors-in-interest, assigns, and company.Any damage to the state highway or other public right-of-way beyond occupants of the property serviced by the access shall be responsible for that which is allowed in the permit shall be repaired immediately.The permittee is meeting the terms and conditions of the permit,the repair and maintenance of responsible for the repair of any utility damaged in the course of access the access beyond the'edge of the roadway including any cattle guard and gate, construction, reconstruction or repair. and the removal or clearance of snow or ice upon the access even though deposited on the access in the course of Department snow removal operations. 8. In the event it becomes necessary to remove any right-of-way fence,the Within unincorporated areas the Department will keep access culverts clean as posts on either side of the access shall be securely braced with an approved end part of maintenance of the highway drainage system. However,the permittee is post before the fence is cut to prevent any slacking of the remaining fence. All responsible for the repair and replacement of any access-related culverts within posts and wire removed are Department property and shall be turned over to a the right-of-way.Within incorporated areas,drainage responsibilities for representative of the Department. municipalities are determined by statute and local ordinance.The Department will maintain the roadway including auxiliary lanes and shoulders,except in those 9. The permittee shall ensure that a copy of the permit is available for review at cases where the access installation has failed due to improper access the construction site at all times.The permit may require the contractor to notify construction and/or failure to follow permit requirements and specifications in the individual or office specified on the permit at any specified phases in which case the permittee shall be responsible for such repair.Any significant construction to allow the field inspector to inspect various aspects of construction repairs such as culvert'replacement,resurfacing,or changes in design or such as concrete forms,subbase,base course compaction,and materials specifications, requires authorization from the Department. specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. Form 101, Page 3 State Highway. Access Permit Page 1 Attachment to Permit No. 405066 -Additional Terms and Conditions 1. If there are any questions regarding this permit,please contact Gloria Hice-Idler at(970) 350-2148. 2. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms,conditions, exhibits,and noted attachments. 3. Incorporated as part of this permit are the following: Application for Access Permit(CDOT Form No. 137) Permit(CDOT Form No. 101)and its two page attachment Exhibits: "A" -Access Plan "B" -Vicinity Map "C'-Letter from Windsor/Severance Fire District dated January 5,2005 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 exisiting 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. 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 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 reparis. 9. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exist 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. 10. All other accesses to the property shall be removed immediately. Removal shall include,but not limited to, the return of the highway right-of-way side slopes, ditches,and fences to match existing adjacent conditions, INCLUDING REMOVAL OF ASPHALT APRONS. Any asphalt removed from the highway shall result in a smooth finished edge. 11. The Permittee is responsible for obtaining any necessary additional federal, state,and/or City/County permits or clearances required for construction of the access. Approval of this access permit does not constitute verification of this action by the Permittee. State Highway,Access Permit Page 2 Attachment to Permit No. 405066 -Additional Terms and Conditions 12. All costs associated with the installation of this access are the responsibility of the Permittee. This includes design,construction, signing and striping,utility relocation,testing of materials,and inspections. 13. No work will be allowed at night,or on Saturdays, Sundays,and legal holidays without prior authorization from the Department. The Department may also restrict work within the State Highway right-of-way during adverse weather conditions. 14. Traffic detours or lane closures will not be allowed,unless pre-approved by the Department. 15. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. 16. No construction vehicles shall be parked,or construction materials/equipment stored,on the State Highway right-of-way overnight. 17. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requies the Perinittee to-obtain-a CDOT Landscaping Permit from the Maintenance Section. The access permit does not authorize that activity,although a proposed landscaping plan shall be included in the access permitting document. 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 Ed Stieber at the Evans Maintenance Office, (970)506-4973,to obtain the Landscaping Permit. 18. Routine,periodic maintenance and emergency repairs may be performed within the State Highway right-of-way,under the general terms and conditions of the permit. Any significant repairs such as culvert replacement,resurfacing,or changes in design or specifications,will require written authorization from the Department. The Department shall be given proper advance notice whenever maintenance work will affect the movement or safety of traffic on the State Highway. In an emergency,the Department Region Office and the State Patrol shall immediately be notified of possible hazards. 19. All work is to conform to the plans referenced by this permit on file with the Department or as modified by this permit. (If discrepancies arise,this permit shall take precedence over the plans.) The Department plan review is only for the general conformance with the Department's design and code requirements. The Department is not responsible for the accuracy and adequacy of the design, dimensions, elevations,and any other elements which shall be confirmed and correlated at the work site. The Department through the approval of this document,assumes no responsibility for the completeness and/or accuracy of the plans. 20. The State requires a Certificate of Insurance prior to commencing any work on the State Highway right-of-way. Policies shall name the State of Colorado as additional insured party. All vendors,contractors, and utility companies shall procure,at their own expense,and maintain for the duration of the work period,the following minimum insurance coverages: A. Standard workman's compensation and employer's liability,including occupational disease,covering all employees engaged in performance of the work at the site,in the amount required by State Statutes. B. Comprehensive general liability in the amount of$600,000 combined single limit bodily injury and property damage,each occurrence and$2,000,000 annual aggregate. C. Automobile liability in the amount of$600,000 combined single limit bodily injury and property damage, for each accident. Certificates of insurance showing compliance with these provisions shall be attached to and made a part of this State Highway Access Permit Page 3 Attachment to Permit No.405066 -Additional Terms and Conditions permit and be available on the site during construction. 21. Survey markers or monuments must be preserved in their original positions. Notify the Department at(970) 350-2173 immediately upon damage to or discovery of any such markers or monuments at the work site. Any survey markers or monuments disturbed during the permitted work shall be repaired and/or replaced immediately at the expense of the Permittee. 22. Should any excavation encounter plant or animal fossils,the remains of historic or prehistoric structures, artifacts, (pottery, stone tools,arrowheads,etc.),the work shall be stopped and the Permittee shall notify the Department inspector. 23. The Permittee or the contractor shall notify Linda McWilliams at(970)350-2147,at least two working days prior to beginning any access improvements or construction of any kind within the State Highway right-of-way. Failure to comply with this requirement may result in revocation of this permit. 24. 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. 25. If highway right-of-way fence exists or is proposed,the Permittee must contact Ed Stieber at the Evans Maintenance office,(970)506-4973,prior to any removal or installation. 26. The access shall be constructed 24 feet wide with no radii. The access shall be gated and locked at all times. Emergency services are the only authorized users. 27. Construction traffic control devices,when not in use,shall be removed or turned away from traffic. 28. The access shall be constructed perpendicular to the travel lanes of the State Highway for a minimum distance of 40 feet, and shall slope down and away from the adjacent pavement edge at a rate of 2%grade for a minimum of 20 feet. 29. The access shall be completed in an expeditious and safe manner and shall be fmished within 45 days from initiation of construction within State Highway right-of-way. 30. The access gate shall be set back so that the longest vehicle using the access can completely clear the traveled way when the gate is closed. 31. All required access improvements shall be installed prior to the herein authorized use of this access. 32. The access shall be surfaced immediately upon completion of earthwork construction and prior to use. 33. Surfacing of the access shall be completed as per Exhibit"A". 34. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. 35. If frost,water or moisture is present in the subgrade,no surfacing materials shall be placed until all frost, water or moisture is gone or removed. 36. The Permittee shall install a new 18 inch corrugated metal pipe and shall provide for proper side slopes. Culverts over 18 inches in diameter shall have end sections. 37. The access shall be constructed and maintained in a manner that will not cause water to enter onto the State Highway Access Permit Page 4 Attachment to Permit No. 405066 -Additional Terms and Conditions 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. 38. The design and construction of access and/or development of this property shall not negatively impact adjacent nearby properties. Correction of the problem and cost resulting from damages shall be borne by the Permittee. 39. All existing drainage structures shall be extended,modified,or upgraded as necessary,to accommodate all new construction and safety standards,in accordance to the Department's standard specifications. 40. The Permittee shall request fmal inspection by Linda McWilliams at(970)350-2147,within 10 days following completion of access construction,and prior to authorized use. The Permittee or their representative shall be present. 41. A fully executed complete copy of this permit must be on the job site with the contractor at all times during construction. Failure to comply with this or any other construction requirement may result in the immediate suspension of work by order of the Department inspector or the issuing authority. EXHIBIT "A" - SIMPLE ACCESS DESIGN r 09/00 -1 Define: width of access exclusive of radii "„ - radii profile \...C- i . angle if other than 90° surfacing—material type (asphalt grading, concrete class,total Q thickness,individual mat thickness for asphaltic materials) curb and gutter type/dimensions/material �i__ • permanent signing or pavement markings necessary drainage features—culvert type and size (no RCP in ROW), no =1 increased runoff to ROW special or unusual features any landscaping in ROW E A K2‘tt &tir-PacA. n a' it Nec Oas., co . ITV_ b C- hal 1 i • / A -‹ 5 ©c I� -o h.�-5 4 1� YJ'1 DTN„,,,,,°i QX3 cr�n �.l x,, ,,,, ,,, '11 9 . • W . —1*-3" wk ire. l;nG • Ms 'cO r film ,` 1,/ S.N. �6. c,enter 1;nea t[) N WCR72 SITE °"---"\ WINDSOR V\Is&2-l1Mb ./6\(Yr d kP,50(a(1 "B" Page l of 1 Kim Ogle From: Charlotte Davis Sent: Tuesday, May 31, 2005 4:59 PM To: Kim Ogle Subject: USR-1499 Kim, FYI- I am in receipt of information, from Todd Hodges, regarding USR-1499. Condition 3B-UIC-Permit The applicants have submitted an inventory request form to the USEPA. EPA has determined that the system will be a Class V disposal system. They will need to have the Class V Permit prior to Certificate of Occupancy. This condition is not satisfied at this time but it seems evident that the applicant's plan to comply with EPA's determinination and will have a Class V Permit prior to C of O. Questions? Call me @ 2208. Char 05/31/2005 Mark Belford • 26 May 2005 Kim Ogle,Planning Manager Weld County Planning Services 918 10th Street Greeley,CO 80631 Re:Windsor Assembly of God Church,USR-1499 Dear Kim, Regarding the requirements for approval,we submit the following: 1. Item 1A8 the building is designed so that all occupied spaces are accessible. Currently we are finishing the construction documents and we submit these drawings to Building Inspection for approval. 2. Item 1G—we have met with the Fire Department to review the drawings and will provide automatic sprinklers for the building as requested. We will also be submitting drawings • to the Fire Department for building permits. Please contact us or Todd Hodges if you have any concerns or comments. Sincerely 40141filtifr"114?A#1 Mark Belford Project Architect 141 South Colege Ave. Suite 104 Fort Coitus,CO 80524 fax:970A07.1011 mattexpeoluarchiectLean - u*L Todd Hodges Design, LL C May 26, 2005 Weld County Planning Department GREELEY OFFICE Mr. Kim Ogle MAY 2:a 2005 Weld County Planning Department RECEIVED 918 10th Street Greeley, Colorado 80631 RE: Conditions of approval 1A8, 1B, 1G, and 3B for USR-1499, Windsor Assembly of God Dear Mr. Ogle: This letter is an update concerning the status of the conditions of approval per the Weld County Board of County Commissioner's Resolution for USR-1499. I have enclosed information concerning the four previously listed conditions. Please review the information and call or write me if you need any further information or clarification concerning the conditions listed below: o)' Condition 1A�& 1G: Attached is a letter from Mark Belford, project Architect. This addresses the conditions. ,, Condition 1B: Attached is a copy of the access permit that has been filed and under review by \? .1" CDOT. This addresses the condition. Condition 3B: Attached is the information from the EPA. This addresses this condition. I will forward other information to you as we complete the remaining conditions. You should be receiving paper copies of the USR plat from Cathy Johnson in the near future. If you have any questions, or need further information please contact me at the number or email below. Thank you for your time and consideration in this matter. Sincerely, Todd A. Hodges, 'ncipal Todd Hodges Design, LLC Enclosures Cc: Eustis Habighorst,Pastor Cc: Char Davis with EPA info 1269 North C7evelandAvenue•Loveland Colorado 80537 • (970)6134556•far(970)613-8775 1 email:toddhodgesdesign(arthlinLnet 115 r-- Robert Hazlett, P.E. 10691 Chadsworth Lane Highlands Ranch CO 80126-7505 303 683-4334 roberc.hazleu0'comcasc.nec RECEIVED May 4,2005 MAY 1 2 2005 Ms.Gloria Hice-idler,Access Manager BY: Traffic Section Colorado Department of Transportation Region 4 1420-2nd Street Greeley CO 80631 Re: Windsor Assembly of God Church Dear Gloria: The Windsor Assembly of God Church proposes construction of a new church building on a 14.9-acre parcel that is located in the northwest quadrant of Colorado State Highway 257 (SH-257) and Weld County Road (WCR- 72). In December 2004, Parametrix Consulting completed a traffic impact study of existing and future conditions within the project vicinity,and found the impacts to be minimal. Within the context of that study, the proposal for the project includes a recommendation for an access driveway to SH-257 that will serve the site in emergency situations,only. The subject of this submittal is an application package for the emergency access driveway. The following information accompanies the submittal: • The Windsor Assembly of God Traffic Impact Study traffic impact study by Parametrix Consulting(dated December 2004) • A completed CDOT Form No. 137, State Highway Access Permit Application for the emergency driveway ac- cess proposal(dated May 5, 2005) • Construction documents illustrating the site development and the construction of the emergency driveway access proposal (dated May 2005) • The project's Drainage Report(dated May 2005) With this application package, the Windsor Assembly God Church requests an access permit,for an emergency use driveway to be located at RP 13.624 (in miles) from SH-257 in Weld County. If additional information is needed to fulfill the application, please call me at 303 683-4334 or Eustis Habighorst with Windsor Assembly of God Church at 970 686-2096. Thank you For your assistance. Sincerely. FP—C4, Robert C. Hazlett,'[:E s'a` ' UNITED t ATES ENVIRONMENTAL PRO's riTION AGENCY REGION 8 (Fail 99918TM STREET - SUITE 300 • anal DENVER, CO 802022468 http://www.epa.govhegion08 APR 15 NS Ref 8P-W-GW Thomas W.Finley Terra Logics Consulting,LLC P.O.Box 7676 Loveland,Colorado 80537-0676 RE: Underground Injection Control(UIC) Class V Injection Well Program Rule Authorization:Large Capacity Septic System Windsor Assembly of God SW V4 Section 4,T6N,R67W Weld County,Colorado EPA File#CO50000-06739 Dear Mr. Finley: Thank you for submitting the completed inventory request form,which we received on March 14,2005,for the Windsor Assembly of God. Based on the size of the system,we have determined that the septic system to be located at the Windsor Assembly of God will be a Class V disposal system as defined by 40 Code of Federal Regulations(CFR)Section 144.80. This Class V disposal system is now currently"authorized by rule"under 40 CFR Section 144.84(a). "Authorization by rule"allows the Class V disposal system to be constructed and operated,with the requirement that only sanitary waste is intended to enter the system. This Class V disposal system will be regulated under the Underground Injection Control (UIC)Program requirements found in 40 CFR.Parts 144, 146,and 147,which have been promulgated under Part C of the Safe Drinking Water Act,42 United States Code Sections 1421 through 1428. A copy of 40 CFR Part 144 Subpart G,which applies specifically to Class V injection wells,is enclosed. This Class V disposal system must comply with,among other requirements,40 CFR Section 144.82(a)which prohibits any underground injection that may endanger an underground source of drinking water(see enclosure). This Class V disposal system will also be subject to periodic compliance inspections,which may include sampling and analysis of the waste fluids. Finally,be aware that under 40,CFR Sections 144.12(c),(d),and(e),we can require the owner or operator of this system to apply for a permit or close the disposal system under certain circumstances(e.g.,if all or part of the fluids discharged changes from solely sanitary to industrial wastes). ()Printed on Recycled Paper Failure to comply with the above requirements will result in violations of UIC regulations and possible enforcement action. If you have any questions or need more information,or if you have any questions concerning Class V regulations,policies,or guidance,please call Valois Shea at 1-800-227-8917, x6276 or 303-312-6276. Sincerely, Sandra A. Stavnes Director Ground Water Program Enclosures: UIC Class V Regulations 40 CFR 144.12 and Subpart G Class V Septic System Brochure Todd Hodges Design, LLC April 4,2005 Mr.Kim Ogle Weld County Planning Department 918 10th Street Greeley,Colorado 80631 RE: Conditions of approval for USR-1499,Windsor Assembly of God Dear Mr.Ogle: This letter is an update concerning the status of the conditions of approval per the Weld County Planning Commission Resolution for USR-1499. The status is as follows: Condition 1A4: Per the prior recorded exemption plat and the updated USR plat map a total of 50'from center line has been dedicated and an additional 10'has been reserved for a total ROW of 60'from centerline of WCR 72. This condition has been met. Condition 1A5: As indicated in the prior condition,a total of 60'from centerline of WCR 72 has been dedicated and reserved on the USR plat. This condition has been met Condition 1A6: The USR plat has shown an existing 40'ROW and an additional reservation of 60'for a total of 100'from centerline of SH 257 as requested by CDOT. This condition has been met Condition 1A7: The USR plat shows a total of 101 parking spaces. This condition has been met Condition 1A8: Plans are currently being prepared to comply with current accessibility standards and per current building code. We request that this condition be moved to"Prior to Release of Building Permits"section of the conditions. Con4iti6n 1A9: The parking lot and the access road into the property are to be paved. The emergency access is an all weather surface. Attached is an updated plat showing the surfaces. This condition has been met. Conditiou`1A10: The parking lot is proposed to be curbed and guttered on the perimeter. The plat delineates the parking spaces. It is not the intent to place wheel stops in the internal parking area. It is the applicant's opinion that the parking area functions much better without wheel stops for traffic flow and snow removal. The parking lot is proposed to be paved and curbed which is above standard for many applications of this nature. We request that this condition be deleted. Condition 1A11: The minimum 25"has been delineated on the plat and is located mostly off the site. This condition has been met. Condition 1B: The applicant's Traffic Engineer spoke with the CDOT Region 4 Access Manager,Gloria Hice- Idler on March 10.2005 and received verbal confirmation that CDOT has accepted the traffic impact study and is in support of its conclusions and recommendations. An access permit will be submitted for review and approval to CDOT for the emergency access onto SH 257. 1269 North Cleveland Avenue•Loveland Colorado 80537 • (970)613-8556*fax(970)613-8775 1 email:taddhodgesdesign earthlrnknet s ;yrs Todd Hodges Design, LLC We request that this condition be moved to the-Prior to CO"Section of the conditions. Condition IC: A traffic study was provided for review by CDOT. To our knowledge,CDOT has not requested any additional information pertaining to the submitted traffic study. The traffic study was stamped by a professional engineer licensed in the State of Colorado. This condition has been met. Condition ID: The applicant has reviewed the information provided by the West Greeley Soil Conservation District and will use it to positively manage on site soils. This condition has been met. Condition 1E: The applicant is willing to enter into an agreement with the Windsor Reservoir Outlet Ditch concerning drainage into the ditch. The applicant will complete the agreement when approval by the Weld County Board of County Commissioners is received. Condition IF: The applicant is proposing that only improvements not completed just prior to the Certificate of Occupancy are to be bonded at that time. The applicant requests that this condition be deleted or modified. Condition 1G: The applicant and representative have met with the Windsor Fire Protection District and the applicant is working through all of the necessary requirements. Condition 3B: The applicant's representative has been in contact with the EPA concerning this condition. Attached is the information submitted to the EPA for review. It is the applicant's intent to move forward into the construction portion of the project as quickly as possible after final Board approval. Please let me know how Planning Staff is going to proceed concerning these conditions. If you have any questions.or need further information please contact me at the number or email below. Thank you for your time and consideration in this matter. Sincerely. Todd A.Hodges,Principal Todd Hodges Design,LLC Enclosures Cc:Eustis Habighorst,Pastor 1269 North Cleveland Avenue•Loveland,Colorado 80537 • (970)613-8556•far(970)613-8775 2 email:toddhodgesdesign@earthlinknet Terra P.O.Box 7676 ' ` ` �'��,; Phone:970-663-7480 !'Loveland,Colorado 80537-0676 Fax:970-667-9959 Logics _;. Consulting,tic -Over 20 years experience in Northern Colorado- March 9,2005 Valois Shea U.S. EPA Region 8 Mail Code 8P-W-GW 999 1 e Street, Suite 300 Denver, Colorado 80202-2466 Subject: U.S. EPA Shallow Waste Disposal System/Well Inventory Request Form Windsor Assembly of God, Lot B,RE-1452 SW 'A Section 4,T. 6 N., R. 67 W. of the 6th P.M. Weld County, Colorado Job No. 05-1055 Ms. Shea, Attached are the Shallow Waste Disposal System/Well Inventory Request Form, Vicinity Map and preliminary construction drawings for the project referenced above.Weld County Department of Public Health and Environment has requested that a Class V Injection Well Permit or evidence from the EPA that the project is not subject to the EPA Class V requirements be incorporated into the building permit. Thank you for you time to evaluate the inventory request form. If there are questions or if we may be of further service,please call. Sincerely, _ �Z�Of PHofEss,'lb Terra Logics Consulting, LLC =�y�\ .: GATE 71;;;.:Y/6, 4 e10516 ' P•1• O`�,� AIPG y' Thomas W. Finley C.P.G. % �,':., h o tWf 2 copies sent attachments: Inventory Request Form, Figures 1 &2, GEC Figures 9, 10 & 11 cc: Windsor Assembly of God,Attn: Eustis Habighorst,416 Oak St., Windsor, CO 80550 Todd Hodges Design, LLC, 1269 N. Cleveland Ave., Loveland, CO 80537 e-mail:terralogics@att.net UNITED STATES ENVIRONMENTAL PROTECTION AGENCY SHALLOW WASTE DISPOSAL SYSTEM/WELL INVENTORY REQUEST FORM (Form adapted from OMB No.2040-0042) Shallow waste disposal systems/wells release waste fluids into or above shallow ground water and include: commercial or industrial septic systems,sumps,drain fields,french drains,cesspools,abandoned drinking water wells, dry wells,and infiltration galleries.The Underground Injection Control(UIC)regulations require inventory information for all disposal systems/wells and additional information for certain types of systems/wells. This form is designed to collect basic information for all systems to determine which are used for underground disposal of waste fluids,and additional information for those systems with a greater potential for contaminating ground water. • If your business has more than one location within the states of Montana, South Dakota or Colorado, please copy and submit the Inventory Request Form for each facility. • If this is your residence ONLY,and your facility is located elsewhere,provide the information for your facility. However;if you work out of your home,please fill out and submit this form. • If your sanitary wastes(i.e.bathroom,kitchen)are hooked to the public sewer system,but you have floor drains in your garage or maintenance/shop area,industrial process wastes,and/or storm water that are not disposed into the public sewer,complete the form for discharge of these wastes. • If you lease and/or rent the space for your business,you as the operator of the business are responsible for submitting the inventory information for the facility. • At a minimum,you must.fully complete Section 1 AND Section III • (Certification on side 2)and return to the EPA. I. IDENTIFICATION OF DISCHARGE/DISPOSAL SYSTEM/WELL Please circle YES or NO to ALL items that pertain to the way your facility disposes of waste fluids(including wash water,storm water,bathroom or kitchen wastes,and spills). 1. Is your facility connected to a public sewer system? YES 1 r/ 2. Excluding bathroom and kitchen wastes,does your facility dispose of any waste fluids YES through a connection to a septic system with a drain field? 3. A self-contained holding tank is one that has no overflow line. Are fluids from your facility YES discharged into a self-contained holding tank that is pumped periodically? 4. Are there any floor drains or sinks in a processing or shop area,engine service or YES C) maintenance bay,or vehicle/equipment washing area? 4a. If yes to question 4,do the floor drains or sinks receive fluids? YES NO 4b. If yes to question 4,are the floor drains or sinks connected to a septic system,drain YES NO field,french drain,abandoned drinking water well,dry well,or tank with an overflow line? 5. Is your facility run as a dry shop(i.e.,no running water and no sewer or septic connections)? YES 6. Are waste fluids discharged from your facility to a lagoon or pond? YES 1�[.) 7. Are waste fluids from your facility discharged to surface water,lake,river, YES 1 stream or wetland? 8. Are waste fluids from your facility stored and/or hauled away(recycled)? E NO This includes wash water,oil,fuel,solvents,antifreeze,etc. Please list: Septage from septic tanks 9. If you do discharge solely bathroom and kitchen wastes,does your disposal(e.g., septic) ki@ NO system(s)have the physical capacity to treat waste fluids generated by 20 or more persons per day(i.e.,approximately 2,000 or more gallons per day)? 9a. What is the size of your disposal(e.g.,septic)system(s)? 3600 sq. ft. and add' l 3600 sq. ft. for replacement(future) SEE OTHER SIDE If you answered YES to either question#2,#4b,or#9,please complete Section II and III below. II. BASIC INVENTORY INFORMATION. Inventory all disposal systems/wells separately(i.e. septic tank,dry well,french drain). If more space is needed or you have more than one well,please use and attach separate sheets. 1. Operating Status(AC=Active,AN=Abandoned,UC=Under Construction,TA=Temporarily Abandoned): - Disposal System/Well#1 UC, Planning stage 2. General Location(please attach a diagram of the system(s)/well(s)including construction design): Disposal System/Well#1 See Figs. 1 & 2. 1-1 /2 mile north of Windsor at NE cor. of State Hwy 257 & County Road 72 3. Date of Construction: Disposal System/Well#1 Proposed construction to begin Summer 2005 4. Depth of Well/System(and ground water if known): Disposal System/Well#1 2 feet max. depth, Ground water @ 6 feet 5. Average and Maximum Volumes of Disposed Fluids(gallons/day): Disposal System/Well#1 Avg. 1480 a1/day, Max. 2220 gal/day 6. Source and Nature of Disposed Fluids(i.e.,solvents,waste oil or paint,brake fluid, antifreeze,wash water,snow melt,cooling or boiler blow down water,industrial process waste,misc. spills,bathroom wastes,etc.): Disposal System/Well#1 Bathroom wastes in.CERTIFICATION (This section must be completely filled out) I certify,under penalty of law,that this document was prepared under my guidance and supervision,and that I am assured that qualified personnel properly gathered and evaluated the information reported here. To the best of my knowledge, the information presented above is true,accurate and complete. Signature: Date: Name(please print): Thomas W. Finley Title: Geologist Name of Company:morrA r.ng-i rc r'nc1 g,r.r.r• Phone: 970-663-7480 Physical Address of Facility To be determined Property Owner(If different than above):Windsor Assembly of God Property Owner Address: 416 Oak St. ,Windsor, Colorado 80550 Type of Business or Facility: Church Further information on the UIC Class V program can be found at: http://www.epa.gov/region8/water/uic/classv.html. An Inventory Request Form FAQ is available at http://www.epa.gov/region8/water/uic/r8cvprog.html. , WINDSOR ASSEMBLY OF GOD PART OF SECTION 4, T. 6 N., R. 67 W. OF THE 6TH P.M., LOT B, RE-1452 WELD COUNTY, COLORADO orth G ------_ // Scale •l Approximate location of \------._ \ . '11.-9*-,j ---- - 1:25,000 Church property• . ' ii. , j proposed drain field ` Air_ ic------ RI ________ i\_ 1.--A--\_____ _,,,,,, -1 ' ■ ik_ A../.__ . ... _..... L___ \__,.., --- ____.\, _,,, ,,...___ _____ c.,./ _\,, \,/ ,..,, --\_ r. - __.. ■ ■ • `-- ..„, --„,,, . . ., ,.,-,:: 7-4.:41,,,,,-;...7-,N:.,. -fr;'''P Na, li s7; • • \V• ..ter"` '�' � a;;:.r7 r..�:Y4,„7su. ''cyr K,. '■ f 6 ter;„ z0-�� 1 4�A Ai _ .tea.r� - - N::1:.^`''_e r J-'u 1 fJ4 1" 1 ! I 1$� J N « i .'c �`j:^:'2�`?,`.;r::+=:atcsri;'::i`:'c.`:'F;:::'?�.,.,:.:_;:,;.C''O+Cr:;+'S?�3 ..,:�.:...z1 1 25 �ct. bi �t f a.�rF ds O I,� y+' .rg.. ;tom'= �:tir ' r�i i �rktin ' F r4��I16OL�f'4`64) ; • The location of the proposed drain field is based on a Use by Special Review prepared by Latitude 39, Project No. 03-20, Drawing Name 3-20-0A.dwg, dated 12-20-04. w3�� P.O.BOX 7676 VICINITY MAP .....,;:,;q3„,., Tau ??:;;., LV +ND•COLOM1 JOB NO. 05-1055 C.wa 970-663-7+80 • FIGURE 1 • \ \ 7 \ N t 1-. 1 4 0,/'' N\ ,A)c4,2/ N. l ',S \` Wiz \ 1 l 4�/ a N. �2 tt. \\ L \\ � \\ kfl°1 \ ---1 ,kc. „.."( _,..4 \\ % Affil \ 4 /� . 11\ 4 r- 1, r ‘ \ ‘ 46. 43Te/ \ 1 • . . 4/ \ r., n 1 4. �O f J r �� 1A , k 1 +c'42: \ \ \ \ 1 21\ $ 11 \ \ ca ..,j 1 N. !fa.: ?1:A I\ 1 --.b \ " 1 \ LaN.,...:\ \ • \ \-. . il\La- \ \ \ id. \ `�� \� `\ II I 1 1 \` \ 1 , x \ \\ / .� -- \�► iiIIIIfd111., \ \ / 40/' , \� \ / / 1 1 \ 1 1 ca �\ 1 — z 1 \ III 1 C \ \`�� 1 _._ 1.1 i\i‘l ''!. I ii\ This drawing provided by Latitude 39 Engineering & Devlpmnt, .LLC Project No. 03-20. TLC,LLC Job No. 05-1055 Figure 2 - -.......- ..._-_......_.w-••_ ______ Finished Grade _ Access holes shall be . k manufacturers -- located to provide easy I make 6"access `'� 's available to 8" w '`•••••.•„. access to clean inlet and outlet tees.' v grade adjustment — -.s— 20"Manhole `N i 8"Max.backfill over open( - cover of manholes 1..______-______ Minim—.. J-2 .••. #4 Reber Handle 6"Min e" sue- 20"Manhole Sweep Plastic"T" - / Seal Risers of _� 4n �_ — 10" or Baffle \ % /` Top of Tank • 2., t • •• •• % • — ____I;st...... *:.;_i_l_ . Vent —s,... I ` f 1"Spate ----II'— L Inlet ucum rrt7t —_ a. t Mg5, I ' r" r, cum ma: `' Outlet r ASTM-D-3034 Not less than Water level -- or Pipe of Equal • 9"or more 14" ":•4'. 14" ASTM-D-3034 Strength than 17" ASTM D 3034 T-- , -r=Criss over .. or Pipe of Equal 4: a Strength ,,•' I 4 First Compartment Shall Hold .•'• . ..!, Between i and i of the Required "-, •, ,_1.. (60"Max.) Effective Capacity of the Tank .1i (30"Min.) f Tank Divider --w".-.+; .."-- 3-1/2"Min -�I .- 3"Min Sludge Sludge 4"Min ..4.f. 4 ''+' . t •". •41 it - ERoUND ENGINEERINGS CONSULTFINTS TYPICAL CONVENTIONAL CONCRETE SEPTIC TANK-CROSS SECTION VIEW , JOB NO. 04-0053 DRAWN BY: SKS Reference:Diagram 5,page 28,Regulation No.I-02, FIGURE: 9 APPROVED BY: JBK Tri-County District Health Dept. CADFILE NAME: 04-0053STXV.DWG C. / 1% Grade ( Minimum 1r 2 x 2,000 Gallon Tanks 4,000 Connected in Series is Recommended IGallon Septic I Tank I. T set level for equal distribution 4 inch diameter perforated PVC pipe 1. 3' 1 1 • • • • 60' • See Figure 11 For Cross-Section View AA' A A' Limits of seepage bed • T I 3' t: 60' f • Inspection Pipe --r► 6' TYP. --+ 9' J. 3 GROUND • ENSINEERIN5 CON.5ULTRONIT5 TYPICAL CONVENTIONALGRAVEL , S!ope ABSORPTION FIELD - PLAN VIEW ri JOB NO.:04-0053 DRAWN BY: SKS i • Inspection Pipe • \\.... Topsoil in upper A 12 inches of cover A' -- \ ,' • Drain Fabric • 2' min (Mirafi 140N or equal)or 1/2"-2 1/2" Drain Material (see Appendix B) Iwashed rock • •/ a rn2 min. '�.��6-,. ..� . .C .C�� ,.^..{�� • .�. �Irq• :p 0. �7 `p-p.}o°0gck o. .c j. U c• a Q ae 1 min 6"� f„` G, -Cod c. 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I January 5, 2005 H ' 10 . __ _- Weld County Planning Dept. 918 10t Street r" . Greeley, Co 80631 i ' Attn: Kim Ogle --- Re: USR-1499, This review is consistent with a previous review of PK-1055 on March 14,2004. The following comments are repetitive in nature. Please note that the requirement for two points of access has been added as well as the minimum number of fire hydrants and fire flows that are required from the 2003 International Fire Code. 1. There shall be a minimum of two points of access to this facility. 2. Each access shall be designed to carry a designed wheel load of I8000pounds (80000 pound gvw) (H2O loading). 3. The accesses shall be constructed of a permanent all weather road base. 4. Addresses shall be posted clearly on the road fronting the property. 5. Addresses shall be posted clearly on the structure. 6. This building shall be provided with an approved Fire Sprinkler System and the fire line shall be shown on the site utility drawings and approved by the Windsor- Severance Fire Protection District. 7. The minimum fire flows required for this project are 3000 gpm at 20 psi and a flow duration of three (3) hours. 8. The minimum number of fire hydrants required shall be three(3). 9. The Windsor-Severance Fire Protection District shall be afforded the opportunity to review and approve all building drawings before a building permit is issued. If you have any questions,please contact me at 686-9596. Cordially, Captain, Mike L Davis Fire Prevention Division EXHIBIT a EXHIBIT I 40_ ph 970.686.9596 • fir 970.686.9623 • 100 7th Street • Windsor,Colorado 80550 5 wwwwin r-severance ire.org t ii - eitl COLORADO DEPARTMENT OF TRANSPORTATION Issuing authority application t/ STATE HIGHWAY ACCESS PERMIT APPLICATION acceptance date: t_/a©/Q5 Instructions: -Contact the Colorado Department of Transportation(CDOT)or your local government to determine your issuing authority. - Contact the issuing authority to determine what plans and other documents are required to be submitted with your application. - Complete this form(some questions may not apply to you)and attach all necessary documents and Submit it to the issuing authority. Please print - Submit an application for each access affected. or type - If you have any questions contact the issuing authority. -For additional information see CDOT's Access Management website at http://www.dot.state.co.uslAccessPermitslindex.htrrt 1)Property owner(Permittee) 2)Agent for permittee(if different from property owner) Windsor Assembly of God Eustis Habighorst Street address Mailing address 416 Oak Street 416 Oak Street City,state&zip Phone# City,state&zip Phone#(required) Windsor CO 80550 970 686-2096 . Windsor CO 80550 970 686-2096 E-mail address E-mail address if available eustis@windsorassembly.org 3)Address of property to be served by permit(required) SH-257 and WCR-72, Windsor CO 80550 4)Legal description of property:If within jurisdictional limits of Municipality,city and/or County,which one? county I Subdivision Southwest 1/4 I block I lot I section I township range Weld 4 6 North 167 West 5)What State Highway are you requesting access from? 6)What side of the hi hway?^ SH-257 FIN US I I E n 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? 1,985.2 feetaNIS❑E0W)from: RP 14.000 369.6 feet RN❑S❑E❑W)from: Centerline Weld CR-72 8)What is the approximate date you intend to begin construction? 5/15/2005 9 Check here if you are requesting a: M new access ntemporary access(duration anticipated: ) nimprovement to existing access ❑change in access use removal of access Drelocation of an existing access(provide detail) 10)Provide existing property use Property use is presently vacant. Access request will be for emergency needs, only. 11)Do you have knowledge of any State Highway access permits serving this property,or adjacent properties in which you have a property interest? a no a 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? El 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? ®no a 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? No 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 Church 113,000 I I 16)If you are requesting residential developement access,what is the type(single family,apartment,townhouse)and number of units? number of units type number of units type • I I 17)Provide the following vehicle count estimates for vehicles that will use the access.Leaving the property then retuming is two counts. #of passenger cars and light trucks at peak hour volumes #of multi unit trucks at peak hour volumes Indicate if your counts are 0 E eak hour volumes or®average daily volumes. 0 #of single unit vehicles in excess of 30 ft. #of farm vehicles(field equipment) Total count of all vehicles 0 0 0 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. 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 apply. 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board under the American Disabilities Act(ADA). These guidelines define traversable slope requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be found on the Design and Construction Project Support web page at: <http://wvvw.dot.state.co.us/DesignSupport/>, then click on Design Bulletins. If an access permit is issued to you, it will state the terms and conditions for its use. Any changes in the use of the permitted access not consistent with the terms and conditions listed on the permit may be considered a violation of the permit. The applicant declares under penalty of perjury in the second degree,and any other applicable state or federal laws,that all information provided on this form and submitted attachments are to the best of their knowledge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. Applica signature Print name Date • Eustis Habighorst 5/5/2005 eapplicant i t the ow er of the property, we require this application also to be signed by the property owner or their legally aut 'zed representative (or other acceptable written evidence). This signature shall constitute agreement with this application by all owners-of-interest unless stated in writing. If a permit is issued, the property owner, in most cases, will be listed as the permittee. Property owner signature Print name Date Previous editions are obsolete and may not be used Page 2 of 2 CDOT Form#137 12/04 Weld County Planning Department GREELEY OFFICE FELSBURG JUL 2 5 2005 H O LT & RECEIVED ULLEVIG engineering paths to transportation solutions July 15 , 2005 Ivo) OS CS Ms . Gloria Hice - Idler 1I a Region 4 Access Managere��p1° Colorado Department of Transportation e�,opqi� S 1420 2"d Street CSIt- Greeley , CO 80634 RE : Review of Final Drainage Report, Windsor Assembly of God FHU Reference No . 04- 184 Dear Gloria : I have reviewed the Final Drainage Report for the Windsor Assembly of God prepared by Latitude 39 dated May 3 , 2005 . The site is below the highway grade and the flow will be directed away from the CDOT Right of Way ( ROVE . The proposed project will have an emergency access located at the northeast corner within CDOT ROW. The access will have no negative impacts to CDOT drainage. Recommendations : Although there are no negative impacts to CDOT , the hydrology and hydraulics as it relates to the detention pond appear to be incorrect . The hydrology was done assuming that all of the developed basins have the same runoff coefficients . Two examples of this are basins C and F . Both basins are over 75 percent impervious and yet the runoff coefficients used in the calculation reflect an area with a percent impervious of approximately 12 percent. Secondly , the hydraulic calculations assume that the entire basin follows to the detention pond at the maximum time of concentration . Some of the basins do not flow into the pond and the lack of routing over estimates the time of concentration . The hydrologic and hydraulic routing calculations should be performed to accurately size the detention pond . As stated previously , this has no impact to CDOT and is only for information . ; FYT If you have any further questions please contact me . • 1/445-', 0; Sincerely , 00 Ca. FELSBURG HOLT & U LEVIG William J . Carrier, P . : . , C . F . M . 6300 South Syracuse Way, Suite 600 Centennial, CO 80111 tel 303 . 721 . 1440 fax 303 . 721 . 0832 www.fhueng. com info@fhueng. com < -u`,^,<�`„,r , ,� r.�M; - .,,,.c "'`a" .tlxi- •M:"`� III -' '�. `,•«rr , ,, ,..�., %:, _ °, «.,. >1Z'k - ay. :, ``tee". °'T,,,....!°"" 'M, . -v-17- - -- ≤-e s ter- ,, ari ', , /4514,V,•;',.:,1„---^ —5," mom' . 'a -,,,,m, •a•-44,,,,,,,„,s,,,g,„,,,,•••!-.‘„,•',... .," 4g ..,-,0--- ;,_ - -,._2 .,,-,,,7,144•,• •,,,,,:l.„.,:,-•.::-:-•,,„a,g..--g--,,- -.-1--,-,74witopiwg,r.4;:›:', ••:'''. •..%.,-,,,4% .',M, •# . . k H a?•:w.1„,,,,,,,41,,h-'@ ., �e .ya, �, S, a7/4.,`' .H;.. - . p „ "e, P 1�, J .',". ° <�`44 ' _'lFisa�. r3•". ,�, if�;;a ",,./.4„C"*„,-,;f4 t, 11 ,3; "'',^,=. 4416�1. ° ° `-4.'<` ,"' `4,,• '<f c>w,.. 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