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Home My WebLink About20210832.tiffCOLORADO Division of Reclamation, Mining and Safety Department of Natural Resources 1313 Sherman St. Room 215 Denver, CO 80203 RECEIVED JUL 0 2 2021 WELD COUNTY COMMISSIONERS NOTICE Consideration of Construction Materials Reclamation Permit Surety Release Request Application DATE: June 14, 2021 TO: Weld County Commissioners 915 10th St Greeley, CO 80631 FROM: Patrick Lennberg RE: Burnham Property Borrow - File No. M-2021-019, Ames Construction, Inc. Surety Release Request Application (SL -1) Please be advised that on June 11, 2021, Ames Construction, Inc., whose address and telephone number are 18450 E 28th Ave, Aurora, CO 80011; (303) 363-1000, filed an application for a/an Surety Release Request (SL- 1) to M2021019, Burnham Property Borrow, which is located approximately 6.5 miles Northeast of Wellington, CO, Section 6, Township 9N, Range 67W, 06th Principle Meridian, in Weld County. Release of permit area because M2021-031 was approved to incorporate all of the affected area of M2021- 019. Areas where the permits do not overlap have not been affected by mining. The application decision is scheduled for August 10, 2021. Written comments or objections to the application may be submitted to and additional information obtained from Patrick Lennberg at the Division of Reclamation, Mining and Safety, 1313 Sherman St. Room 215 Denver, CO 80203, by telephone at (303) 866-3567 x 8114. Comments or objections should be submitted within fifteen (15) days of this notice to be considered in the application review process. The Division is required to provide a thirty (30) day period following a decision on the release application to allow for appeals to its decision. M-GR-03A-P Pub;'C. Rev:�� a7/N /2i cc:pL(TP) Pk)(Sh/ER/cwcw) aO2 1 - 01332 07/08 /2I 1313 Sherman St. Room 215 Denver, CO 80203 P (303) 866-3567 F (303) 832-8106 https://drms.colorado.gov Jared Polis, Governor I Dan Gibbs, Executive Director I Virginia Brannon, Director DATE: TO: COLORADO Division of Reclamation, Mining and Safety Department of Natural Resources 1313 Sherman St. Room 215 Denver, CO 80203 RECEIVED MAY 2 1 2021 WELD COUNTY COMMISSIONERS NOTICE Consideration of 111 Construction Materials Reclamation Permit Application May 14, 2021 Weld County Commissioners 915 10th St Greeley, CO 80631 RE: Burnham Property Borrow, File No. M-2021-031 Please be advised that on May 14, 2021, Ames Construction, Inc., whose address and telephone number are 18450 E 28th Ave, Aurora, CO 80011; (303) 363-1000, filed an application to conduct a(n) Surface mining and reclamation operation, at or near Section 6, Township 9N, Range 67W, 06th Principle Meridian, in Weld County. Please be advised that the permit area may be located in more than one Section, Township, and Range. Affected lands will be reclaimed to support a(n) Rangeland post -mining land use. The application decision date is scheduled for May 29, 2021. A copy of the application is available for review at the Weld County Clerk & Recorder's office and at the office of the Division of Reclamation, Mining and Safety. The application, as well as all other permit documents, can also be viewed at https://dnrweblink.state.co.us/drms/search.aspx by searching M2021031 in the "Permit No" field. A user guide is available to help first time users of the imaged document system and can be viewed at https://drive.google.com/file/d/118OUdf Mpjo3kxIHkP5hMH-w7MeStxX7/view. To be considered in the review process, comments or objections on the application must be submitted in writing by 5:00pm on May 19, 2021. The Office will assume you have no comment or objection to the proposed activity if none are received by the end of the public comment period. If you need additional information or have any questions regarding the above -named application, please contact Patrick Lennberg at the Division of Reclamation, Mining and Safety, 1313 Sherman Street, Room 215, Denver, CO 80203, by telephone at 303-866-3567 x 8114, or by email at Patrick.lennberg@state.co.us. M -AP -05A Pu121,G Rev;ec,-) 05/26/202! CC:PLCTP) PW(314/ER/CH/CIO 05/21/21 1313 Sherman St. Room 215 Denver, CO 80203 P (303) 866-3567 F (303) 832-8106 https://drms.colorado.gov/ Jared Polls, Governor I Dan Gibbs, Executive Director I Virginia Brannon, Director x021 -013z. NOTICE OF FILING APPLICATION FOR COLORADO MINED LAND RECLAMATION PERMIT FOR SPECIAL 111 OPERATION NOTICE TO THE BOARD OF COUNTY COMMISSIONERS Weld COUNTY RECEIVED MAY 13 2021 WELD COUNTY COMMISSIONERS Ames Construction, Inc. (the "Applicant/Operator") has applied for a Special 111 reclamation permit from the Colorado Mined Land Reclamation Board (the "Board") to conduct the extraction of construction materials in Weld County. The attached information is being provided to notify you of the location and nature of the proposed operation. The entire application is on file with the Division of Reclamation, Mining, and Safety (the "Division") and the local county clerk or recorder. The Applicant/Operator proposes to reclaim the affected land to Rangeland use. Pursuant to Section 34-32.5-116(4)(m), C.R.S., the Board may confer with the local Board of County Commissioners before approving of the post -mining land use. Accordingly, the Board would appreciate your comments on the proposed operation. Please note that, in order to preserve your right to a hearing before the Board on this application, you must submit written comments on the application within five (5) working days after the application was filed with the Division. If you would like to discuss the proposed post -mining land use, or any other issue regarding this application, please contact the Division of Reclamation, Mining, and Safety, 1313 Sherman St., Room 215, Denver, Colorado 80203, (303) 866-3567. NOTE TO APPLICANT/OPERATOR: You must attach a copy of the application form to this notice. If this is a notice of a change to a previously filed application you must either attach a copy of the changes, or attach a complete and accurate description of the changes. PtA7 r.c 1Rev; ew o s GI al c c : PL(TP), P w (M/ER/cH/ck) 05/14/2.l XoaI-O$3.. STATE OF COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY Department of Natural Resources 1313 Sherman St., Room 215 Denver, Colorado 80203 Phone: (303) 866-3567 FAX: (303) 832-8106 CONSTRUCTION MATERIALS SPECIAL (111) OPERATION RECLAMATION PERMIT APPLICATION FORM COLORADO DIVISION OF RECLAMATION MINING —&— SAFETY The application for a Construction Materials Special 111 Operation Reclamation Pemvt contains four major parts: (1) the application form; (2) Exhibits A -L, Addendum 1, and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); (3) the application fee; (4) the Performance Warranty and if required a Financial Warranty. When you submit your application, be sure to include one (1) completed. signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of Exhibits A -L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required, a check for the application fee described under (4) below, and the fully executed Performance Warranty and Financial Warranty, if required. Exhibits should ESLT be bound or in 3 -ring binders; maps should be folded to 8 2" X 11" or 8 2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, an information described below 1. Avnlicantionerator or company name (name to be used on the permit): Ames Construction, Inc. 1.1 Type of organization (corporation, partnership, etc.): Corporation 2. Operation name (pit. mine or site name): Burnham Property Borrow 3. Permitted acreage: 4. New Application: 5. Primary commodities) to be mined: Fill Dirt 6. Name of owner to the surface of affected land: Arlene Burnham 7. Name of owner to the subsurface rights of affected land: Arlene Bumham 8. Type of mining ()aeration: E, Surface a Underground 1.:=1. In -situ 9. Location information: The center of the area where the majority of mining will occur: CO Weld PRINCIPAL MERIDIAN (check one): 6th (Colorado) r- 1 10th (New Mexico) n Ute SECTION (write number): S 6 TOWNSHIP (write number and check direction): T 9 North _+� South RANGE (write number and check direction): R 67 East ✓ West QUARTER SECTION (check one): ✓ NE NW _ SE SW QUARTER/QUARTER SECTION (check one): L NE ✓ NW ___, SE SW GENERAL DESCRIPTION: (the number of miles an trection from the nearest town and the approximate elevation): 6.5 miles NE of Wellington. CO Approx Elevation 5600 16.00 Permitted Acres $898.00 Application Fee Mined Land Reclamation Office of Office of Denver • Grand junction • Durango Active and Inactive Mines -2- 10. Primary Mine Entrance Location (report in either Latitude/Longitude OR UTM): Latitude/Longitude: Example: (N) 39° 44' 12.98" (W) 104° 59' 3.87" Latitude (N): deg 40 min 46 sec 59 75 (2 decimal places) Longitude (W): deg 104 nun 55 sec 48 92 (2 decimal places) OR Example: (N) 39.73691° (W) -104.98449° Latitude (N) Longitude(W) OR Universal Tranverse Mercator (UTM) Example: 201336.3 E NAD27 Zone 13 4398351.2 N (5 decimal places) (5 decimal places) UTM Datum (specify NAD27, NAD83 or WGS 84) Easting Northing 11. Primary Future (Post -mining) Land Use (check only one): Cropland(CR) 0 Rangeland(RL) © Residential(RS) Pastureland(PL) O Forestry(FR) Recreation(RC) O Developed Water Resources(WR) Zone El General Agriculture(GA) Wildlife Habitat(WL) O Industrial/Commercial(IC) O Solid Waste Disposal(WD) 12. Primary Present Land Use (check only one): O Cropland(CR) O Pastureland(PL) © General Agriculture(GA) O Rangeland(RL) 0 Forestry(FR) O Wildlife Habitat(WL) Residential(RS) Recreation(RC) n Industrial/Commercial(IC) O Developed Water Resources(WR) © Mining(MN) 13. Estimated Beginning Date of Contract: 13.1 Estimated completion date of contract: April 20, 2021 December 23, 2021 -3- 17. Correspondence Information: APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) Contact's Name: Trent Irick Title: Senior Vice President Company Name: Ames Construction, Inc Street/P.O. Box: 18450 E 28th Ave P.O. Box: City: Aurora State: CO Zip Code: 80011 Telephone Number: (303 ) _ 363-1000 Fax Number: ( ) - PERMITTING CONTACT (if different from applicant/operator above) Contact's Name: Kirk Bergstrom Title: Project Manager Company Name: Ames Construction, Inc Street/P.O. Box: 18450E 28th Ave P.O. Box: City: Aurora State: CO Zip Code: 80011 Telephone Number: (720 ) - 334-3680 Fax Number: ( ) - INSPECTION CONTACT Contact's Name: Kirk Bergstrom Title: Project Manager Company Name: Ames Construction, Inc . Street/P.O. Box: 18450E 28th Ave P.O. Box: City: Aurora State: CO Zip Code: 80011 Telephone Number: (720 ) _ 334-3680 Fat Number: ( ) - CC: STATE OR FEDERAL LANDOWNER (if any) Agency: Street: City: State: Zip Code: Telephone Number: ( ) - CC: STATE OR FEDERAI. LANDOWNER (if any) Agency: Street: City: State: Zip Code: Telephone Number. ( ) - 4 - 14. Maps & Exhibits: Submit two (2) complete, unbound copies of the following application exhibits: 6.3.1 EXHIBIT A - Legal Description and Location Map 6.3.2 EXHIBIT B - Site Description 6.3.2 EXHIBIT C - Mining Plan 6.3.4 EXHIBIT D - Reclamation Plan 6.3.5 EXHIBIT E - Maps, to include the location of any recorded easements 6.3.6 EXHIBIT F - List of Other Permits and Licenses Required 6.3.7 EXHIBIT G - Source of Legal Right -to -Enter 6.3.8 EXHIBIT H - Municipalities Within a Two-mile Radius 6.3.9 EXHIBIT I - Proof of Filing with County Clerk 6.3.10 EXHIBIT I - Proof of Mailing Notices of Permit Application 6.3.11 EXHIBIT K - Terms of Governmental Contract 6.3.12 EXHIBIT L - Permanent Man-made Structures 1.6.2(1)(b) ADDENDUM 1 - Notice Requirements 6.5 Geotechnical Stability Exhibit (as required) Responsibilities as a Permittee: Upon application approval and permit issuance, this application becomes a legally binding document. Therefore, there are a number of important requirements which you, as a permittee, should fully understand. These requirements are listed below. Please read and initial each requirement, in the space provided, to acknowledge that you understand your obligations. If you do not understand these obligations then please contact this Office for a full explanation. 1. Your obligation to reclaim the site is not limited to the amount of the financial warranty. You assume legal liability for all reasonable expenses which the Board or the Office may incur to reclaim the affected lands associated with your mining operation in the event your permit is revoked and financial warranty is forfeited; l43,3 2. The Board may suspend or revoke this permit, or assess a civil penalty, upon a finding that the permittee violated the terms or conditions of this permit, the Act, the Mineral Rules and Regulations, or that information contained in the application or your permit nvsrepresent important material facts; 3. If your mining and reclamation operations affect areas beyond the boundaries of an approved permit boundary, substantial civil penalties, to you as permittee can result; 4. Any modification to the approved mining and reclamation plan from those described in your approved application requires you to submit a new permit application and obtain approval from the Board or Office; 5. It is your responsibility to notify the Office of any changes in your address or phone number; 6. Upon permit issuance and prior to beginning on -site mining activity, you must post a sign at the entrance of the mine site, which shall be clearly visible from the access road, with the following information (Rule 3.1.12): a. the name of the operator; b. a statement that a reclamation permit for the operation has been issued by the Colorado Mined Land Reclamation Board; and, c. the permit number. -5- 7. The boundaries of the permit boundary area must be marked by monuments or other markers that are clearly visible and adequate to delineate such boundaries prior to site disturbance; V -A -6i 8. It is a provision of this permit that the operations will be conducted in accordance with the terms and conditions listed in your application, as well as with the provisions of the Act and the Mineral Rules and Regulations in effect at the time the permit is issued. 9. Annually, on the anniversary date of permit issuance, you must submit an annual fee (S504), and an annual report which includes a map describing the acreage affected and the acreage reclaimed to date (if there are changes from the previous year), any monitoring required by the Reclamation Plan to be submitted annually on the anniversary date of the permit approval. Annual fees are for the previous year a permit is held. For example, a permit with the anniversary date of July 1, 1995, the annual fee is for the period of July 1, 1994 through June 30, 1995. Failure to submit your annual fee and report by the permit anniversary date may result in a civil penalty, revocation of your permit, and forfeiture of your financial warranty. It is your responsibility, as an operator, to continue to pay your annual fee to the Office until the Board releases you from your total reclamation responsibility. NOTE TO COMMENTORS/OBJECTORS: It is likely there will be additions, changes, and deletions to this document prior to final decision by the Office. Therefore, if you have any comments or concerns you must contact the applicant or the Office prior to the decision date so that you will know what changes may have been made to the application document. The Office is not allowed to consider comments, unless they are written, and received prior to the end of the public comment period. You should contact the applicant for the final date of the public comment period. If you have questions about the Mined Land Reclamation Board and Office's review and decision or appeals process, you may contact the Office at (303) 866-3567. -6- Cerfification: As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following terms and conditions: 1. All necessary approvals from local government have been applied for (Section 34-32.5-111(1)(a)(IX)); 2. This entire mining operation will not affect more than 30 acres; 3. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made structure(s) located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator (Section 34-32.5-115(4)(e), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be submitted to the Office prior to the decision date.) 4. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(f), C.R.S. 1984, as amended); 5. As the applicant/operator, I do not have any mining/exploration operations in this state of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. 1984, as amended) as determined through a Board fording. 6. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. This form has been approved by the Mined Land Reclamation Board pursuant to section: 34-32.5-111,C.R.S., of the Colorado Land Reclamation: Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32.5-123, C.R.S. Signed and dated this _ day of I Lot. L.x , 2024 Ames Construction, Inc. Applicant/Operator By: Title: Senior Vice President If Corporation Attest (Seal) By: Corporate Secretary or Equivalent Town/City/County Clerk State of OrNi d CLA Uo ) ) ss. County of tN m 5 ) The foregoing instrument was acknowledged before me this 1 ci` day of (\lat 'e \n �O a 1 by -7c -e < as -3e_r\irtQ of 1—�Mz5eor1StC�ve:ZocvZ�c. CATHERINE ANN HARRISON NOTARY PUBLIC STATE OF COLORADO NOTARY ID 19974014716 My Commission Expires August 21, 2021 1 �i tI Notary Public My Commission expires: `b t a1' ZV SIGNATURES MUST BE IN BLUE INK Publ: C. Rev,ewS oyh9 /11 COLORADO Division of Reclamation, Mining and Safety Department of Natural Resources 1313 Sherman St. Room 215 Denver, CO 80203 RECEIVED APR 12 2021 WELD COUNTY COMMISSIONERS NOTICE Consideration of 111 Construction Materials Reclamation Permit Application DATE: April 2, 2021 Weld County Commissioners 915 10th St Greeley, CO 80631 Burnham Property Borrow, File No. M-202.1-019 Please be advised that on April 2, 2021, Ames Construction, Inc., whose address and telephone number are 18450 E 28th Ave; Aurora, CO 80011; (303) 363-1000, filed an application to conduct a(n) Surface mining and reclamation operation, at or near Section 6, Township 9N, Range 67W, 06th Principle Meridian, in Weld County. Please be advised that the permit area may be located in more than one Section, Township, and Range. Affected lands will be reclaimed to support a(n) Rangeland post -mining land use. The application decision date is scheduled for April 17, 2021. A copy of the application is available for review at the Weld County Clerk & Recorder's office and at the office of the Division of Reclamation, Mining and Safety. The application, as well as all other permit documents, can also be viewed at https://dnrweblink.state.co.us/drms/search.aspx by searching M2021019 in the "Permit No" field. A user guide is available to help first time users of the imaged document system and can be viewed at https://drive:.google.com/file/d/1:180Udf Mpjo3kxIHkP5hMH-w7MeStxX7/view. To be considered in the review process, comments or objections on the application must be submitted in writing by 5:00pm on April 7, 2021. The Office will assume you have no -comment or objection to the proposed activity if none are received by the end of the public comment period. If you need additional information or have any questions regarding the above -named application, please contact Patrick Lennberg at the Division of Reclamation, Mining and Safety, 1313. Sherman Street, Roona 215, Denver, CO 80203, by telephone at 303-866-3567 x 8114, or by email at Patrick.lennberg@state.co.us. M -AP -05A 1313 Sherman St. Room 215 Denver, CO 80203 P (303) 866-3567 F (303) 832-8106 https://drms.colorado.gov Jared Polls, Governor I Dan Gibbs, Executive Director I Virginia Brannon, Director C c'. PUTP), Pw(sK/ER /C H/OO /O42-1 2,021- O8'32 NOTICE OF FILING APPLICATION FOR COLORADO MINED LAND RECLAMATION PERMIT FOR SPECIAL 111 OPERATION NOTICE TO THE BOARD OF COUNTY COMMISSIONERS Weld COUNTY RECEIVED MAR 2 2 2021 WELD COUNTY COMMISSIONERS Ames Construction, Inc (the "Applicant/Operator") has applied for a Special 111 reclamation permit from the Colorado Mined Land Reclamation Board (the "Board") to conduct the extraction of construction materials in Weld County. The attached information is being provided to notify you of the location and nature of the proposed operation. The entire application is on file with the Division of Reclamation, Mining, and Safety (the "Division") and the local county clerk or recorder. The Applicant/Operator proposes to reclaim the affected land to Rangeland use. Pursuant to Section 34-32.5-116(4)(m), C.R.S., the Board may confer with the local Board of County Commissioners before approving of the post -mining land use. Accordingly, the Board would appreciate your comments on the proposed operation. Please note that, in order to preserve your right to a hearing before the Board on this application, you must submit written comments on the application within five (5) working days after the application was filed with the Division. If you would like to discuss the proposed post -mining land use, or any other issue regarding this application, please contact the Division of Reclamation, Mining, and Safety, 1313 Sherman St., Room 215, Denver, Colorado 80203, (303) 866-3567. NOTE TO APPLICANT/OPERATOR: You must attach a copy of the application form to this notice. If this is a notice of a change to a previously filed application you must either attach a copy of the changes, or attach a complete and accurate description of the changes. Pvbrc Rev;eW 3/29121 CC : pL_CI P), pO(5al lER/cH /CK) 3/22/2.1 2021-0832 STATE OF COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY Department of Natural Resources 1313 Sherman St., Room 215 Denver, Colorado 80203 Phone: (303) 866-3567 FAX: (303) 832-8106 CONSTRUCTION MATERIALS SPECIAL (111) OPERATION RECLAMATION PERMIT APPLICATION FORM COLORADO Drvrsrot� of RECLAMATION MINING - &- SAFETY The application for a Construction Materials Special 111 Operation Reclamation Permit contains four major parts: (1) the application form; (2) Exhibits A -L, Addendum 1, and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); (3) the application fee; (4) the Performance Warranty and if required a Financial Warranty. When you submit your application, be sure to include one (1) completed, signed and notarized ORIGINAL and one (I) copy of the completed application form, two (2) copies of Exhibits A -L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required, a check for the application fee described under (4) below, and the fully executed Performance Warranty and Financial Warranty, if required. Exhibits should NOT be bound or in 3 -ring binders; maps should be folded to 8 2" X 11" or 8 2" X l4" size. To expedite processing, please provide the information in the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below 1. Applicant/operator or company name (name to be used on the permit): Ames Construction, Inc. 1.1 Type of organization (corporation, partnership, etc.): Corporation 2. Operation name (alt, mine or site name): Burnham Property Borrow 3. Permitted acreaee: 32.0 Permitted Acres 4. New Application: $898.00 Application Fee 5. Primary commoditle(s) to be mined: Fill Dirt 6. Name of owner to the surface of affected land: Arlene Burnham 7. Name of owner to the subsurface riehts of affected land: Arlene Burnham 8. Type of minine operation: II Surface Q Underground 0 In -situ 9. )Location information: The center of the area where the majority of mining will occur: CO Weld PRINCIPAL MERIDIAN (check one): 6th (Colorado) ri 10th (New Mexico) f=1.. Ute SECTION (write number): S 6 TOWNSHIP (write number and check direction): T 9 North South RANGE (write number and check direction): R 67 East ✓ West QUARTER SECTION (check one): ✓ NE NW SE _,•„•_ SW QUARTER/QUARTER SECTION (check one): NE ✓ NW SE �__ SW GENERAL DESCRIPTION: (the number of miles an rection from the nearest town and the approximate elevation): 6.5 miles NE of Wellington. CO Approx Elevation 5600 Office of Office of Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines -2- 10. Primary Mine Entrance Location (report in either Latitude/Longitude OR UTM): Latitude/Longitude: Example: (N) 39° 44' 12.98" (W) 104° 59' 3.87" Latitude (N): deg 40 Longitude (W): deg 104 OR Example: (N) 39.73691° (W) -104.98449° min 46 min 55 Latitude (N) Longitude(W) OR Universal Tranverse Mercator (UTM) Example: 201336.3 E NAD27 Zone 13 4398351.2 N sec 59 77 (2 decimal places) sec 47 30 (2 decimal places) (5 decimal places) (5 decimal places) UTM Datum (specify NAD27, NAD83 or WGS 84) Easting Northing Zone 11. Primary Future (Post -mining) Land Use (check only one): O Cropland(CR) O Pastureland(PL) ID General Agriculture(GA) Rangeland(RL) Forestry(FR) O Wildlife Habitat(WL) Residential(RS) Recreation(RC) Industrial/Commercial(IC) O Developed Water Resources(WR) O Solid Waste Disposal(WD) 12. Primary Present Land Use (check only one): El Cropland(CR) Pastureland(PL) ❑ General Agriculture(GA) El Rangeland(RL) O Forestry(FR) O Wildlife Habitat(WL) Residential(RS) O Recreation(RC) n Industrial/Commercial(IC) O Developed Water Resources(WR) Mining(MN) 13. Estimated Beginning Date of Contract: April 5, 2021 13.1 Estimated completion date of contract: December 23, 2021 -3- 15. Correspondence Information: APPLICANT/OPERATOR (name, address, and phone of name to be used on permit) Contact's Name: Trent Irick Title: Senior Vice President Company Name: Ames Construction, Inc Street/P.O. Box: 18450E 28th Ave P.O. Box: City: Aurora State: CO Zip Code: 80011 Telephone Number: (303 ) _ 363-1000 Fax Number: PERMITTING CONTACT (if different from applicant/operator above) Contact's Name: Kirk Bergstrom Title: Project Manager Company Name: Ames Construction, Inc Street/P.O. Box: 18450E 28th Ave P.O. Box: City: Aurora State: CO Zip Code: 80011 Telephone Number: (720 ) _ 334-3680 Fax Number: ( ) - INSPECTION CONTACT Contact's Name: Kirk Bergstrom Title: Project Manager Company Name: Ames Construction, Inc Street/P.O. Box: 18450E 28th Ave P.O. Box: City: Aurora State: CO Zip Code: 80011 Telephone Number: (720 ) _ 334-3680 Fax Number: CC: STATE OR FEDERAL LANDOWNER (if anyl Agency: Street: City: State: Zip Code: Telephone Number: ( ) - CC: STATE OR FEDERAL LANDOWNER (if any) Agency: Street: City: State: Zip Code: Telephone Number: ( ) - - 4 - 14. Maps & Exhibits: Submit two (2) complete, unbound copies of the following application exhibits: 6.3.1 EXHIBIT A - Legal Description and Location Map 6.3.2 EXHIBIT B - Site Description 6.3.2 EXHIBIT C - Mining Plan 6.3.4 EXHIBIT D - Reclamation Plan 6.3.5 EXHIBIT E - Maps, to include the location of any recorded easements 6.3.6 EXHIBIT F - List of Other Permits and Licenses Required 6.3.7 EXHIBIT G - Source of Legal Right -to -Enter 6.3.8 EXHIBIT H - Municipalities Within a Two-mile Radius 6.3.9 EXHIBIT I - Proof of Filing with County Clerk 6.3.10 EXHIBIT J - Proof of Mailing Notices of Permit Application 6.3.11 EXHIBIT K - Terms of Governmental Contract 6.3.12 EXHIBIT L - Permanent Man-made Structures 1.6.2(1)(b) ADDENDUM 1 - Notice Requirements 6.5 Geotechnical Stability Exhibit (as required) Responsibilities as a Permittee: Upon application approval and permit issuance, this application becomes a legally binding document. Therefore, there are a number of important requirements which you, as a permittee, should fully understand. These requirements are listed below. Please read and initial each requirement, in the space provided, to acknowledge that you understand your obligations. If you do not understand these obligations then please contact this Office for a full explanation. 1. Your obligation to reclaim the site is not limited to the amount of the financial warranty. You assume legal liability for all reasonable expenses which the Board or the Office may incur to reclaim the affected lands associated with your mining operation in the event your permit is revoked and financial warranty is forfeited; 1413 2. The Board may suspend or revoke this permit, or assess a civil penalty, upon a finding that the permittee violated the terms or conditions of this permit, the Act, the Mineral Rules and Regulations, or that information contained in the application or your permit misrepresent important material facts; 6-0/ 3. If your mining and reclamation operations affect areas beyond the boundaries of an approved permit boundary, substantial civil penalties, to you as permittee can result; 4. Any modification to the approved mining and reclamation plan from those described in your approved application requires you to submit a new permit application and obtain approval from the Board or Office; 5. It is your responsibility to notify the Office of any changes in your address or phone number; 6. Upon permit issuance and prior to beginning on -site mining activity, you must post a sign at the entrance of the mine site, which shall be clearly visible from the access road, with the following information (Rule 3.1.12): a. the name of the operator; b. a statement that a reclamation permit for the operation has been issued by the Colorado Mined Land Reclamation Board; and, c. the permit number. -5- 7. The boundaries of the permit boundary area must be marked by monuments or other markers that are clearly visible and adequate to delineate such boundaries prior to site disturbance; Pk67 8. It is a provision of this permit that the operations will be conducted in accordance with the terms and conditions listed in your application, as well as with the provisions of the Act and the Mineral Rules and Regulations in effect at the time the permit is issued. O6, 9. Annually, on the anniversary date of permit issuance, you must submit an annual fee ($504), and an annual report which includes a map describing the acreage affected and the acreage reclaimed to date (if there are changes from the previous year), any monitoring required by the Reclamation Plan to be submitted annually on the anniversary date of the permit approval. Annual fees are for the previous year a permit is held. For example, a permit with the anniversary date of July 1, 1995, the annual fee is for the period of July 1, 1994 through June 30, 1995. Failure to submit your annual fee and report by the permit anniversary date may result in a civil penalty, revocation of your permit, and forfeiture of your financial warranty. It is your responsibility, as an operator, to continue to pay your annual fee to the Office until the Board releases you from your total reclamation responsibility. NOTE TO COMMENTORS/OBJECTORS: It is likely there will be additions, changes, and deletions to this document prior to final decision by the Office. Therefore, if you have any comments or concerns you must contact the applicant or the Office prior to the decision date so that you will know what changes may have been made to the application document. The Office is not allowed to consider comments, unless they are written, and received prior to the end of the public comment period. You should contact the applicant for the final date of the public comment period. If you have questions about the Mined Land Reclamation Board and Office's review and decision or appeals process, you may contact the Office at (303) 866-3567. -6 - Certification: As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following terms and conditions: 1. All necessary approvals from local government have been applied for (Section 34-32.5-111(1)(a)(IX)); 2. This entire mining operation will not affect more than 30 acres; 3. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made structure(s) located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator (Section 34-32.5-115(4)(e), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be submitted to the Office prior to the decision date.) 4. No mining operation will be located on lands where such operations are prohibited by law (Section 34-32.5-115(4)(0, C.R.S. 1984, as amended); 5. As the applicant/operator, I do not have any mining/exploration operations in this state of Colorado currently in violation of the provisions of the Colorado Land Reclamation Act for the Extraction of Construction Materials (Section 34-32.5-120, C.R.S. 1984, as amended) as determined through a Board finding. 6. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32.5-111,C.R.S., of the Colorado Land Reclamation Act for the Extraction of Construction Materials. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32.5-123, C.R.S. Signed and dated this _ day of /fia/ e -h , 202 Ames Construction, Inc. Applicant/Operator By: Title: Senior Vice President If Corporation Attest (Seal) By: Corporate Secretary or Equivalent Town/City/County Clerk State of l "cm o ZLA ao ) ) ss. County of 1f)., tam 5 ) The foregoing instrument was acknowledged before me this 1 day of (VAC�c'eAn a0 a by—Tce.n: Ls Lc as <3 e ra,c2Nce of raZ3 nsTCZuozzzoc\Zib,c• CATHERINE ANN HARRISON NOTARY PUBLIC STATE OF COLORADO NOTARY ID 1 997401 471 6 My Commission Expires August 21, 2021 Notary Public My Commission expires: "l a‘ 1 o.0 a SIGNATURES MUST BE IN BLUE INK Hello