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Home My WebLink About20192043EXHIBIT INVENTORY CONTROL SHEET Case USR18-0077 - CHEYENNE CONNECTOR, LLC Tyler Exhibit Page # Submitted By Description CDOT Access Permits Cont. 4) Hostetler [1-17] 5) Jem Ranch, LLC [18-52] 6) Lazy D. Grazing Association [53-72] 7) Lazy D. Grazing Association [73-89] 8) Lazy Two Ranch, LLC [90-108] 9) Michael Palmer [109-143] 10) Schmidt [144-162] BA. 1-185 Applicant 11) Terry Johnson [163-185] CDOT Utility Special Use Permits 1) Hwy 392 mm 120.48 or 6601' west of CR 49 2) Hwy 34 mm 118.43 or 1062' east of CR 51 3) 5138' east of CR 43 mm 158.33 BB. 186-325 Applicant 4) Hwy 85 mm 292 2019-2043 COLORADO STATE DEPARTMENT HIGHWAY OF ACCESS PROCEED CODE CDOT Permit No. 419069 TRANSPORTATION State Highway/Mile 085E Post/Side / 291.987,1Right NOTICE Local Jurisdiction Weld County TO Permittee(s): Ryan 4754 Loveland, Hostetler Valley Colorado Oak Drive 80538 Applicant: Rebecca Cheyenne 370 Lakewood, (303) Van 763-2981 Lieders Gordon Connector Colorado St Pipeline, 80226 Inc 1 a .0 E\Pt EXHIBIT is - n Uniform construction permittee Notice year initiation. the Access from advance on with to with is Proceed date the Section shall hereby Control warning above of permittee be is issue Permit. and authorized 2.3(11)(d), completed valid Devices referenced is this if only required or not Notice applicant for under of in to if State the the at Streets proceed an all referenced Access expeditious Proceed construction, and with Code. during shall access Access Access and the or access be completed. safe Department available construction Permit Permit construction, manner and for has review this Access and prior within not Notice shall expired. in to at state conformance Permits commencing the be to construction highway Proceed. finished Access may be with construction right-of-way Permits within 45 Manual expire days as in in The accordance Highway times shall indicated This one accordance Adequate on All from Both extended the site. Traffic the notify Highways. The Access Permit To Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as This appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Colorado Notice is not Department valid until of signed Transportation by a duly authorized representative of the Department By (X) yll_ Title Assistant Access Manager I Date 05/10/2019 Copy distribution: Required: Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector MICE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit No. 419069 ' STATE HIGHWAY ACCESS PERMIT State 085L Highway / 291.987 No / Mp / Side / Right Permit Fee $100.00 Date of 05/06/2019 Transmittal Region / Section / 4 / 01 Patrol / 20 / Name Local Jurisdiction Weld County The Permittee(s): Ryan Hostetler 4754 Valley Oak Drive Loveland, Colorado 80538 The Applicant(s): Rebecca Lieders Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 (303) 763-2981 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 access is located on US Highway 85, a distance of 5,210 feet north of Mile Post 291 on the west/right Access to Provide Service to: (Land Use Code) 994 - Temporary Construction Access 997 - Agriculture (Size) 1 (Units) Each 1 Each Additional Information: MUNICIPALITY Required only when OR the COUNTY appropriate APPROVAL local authority retains issuing authority. o Signature Print Name ' Date Title Upon herein. the Ail signing construction of this shall permit be the completed permittee agrees in an expeditious to the terms and and safe conditions manner and and shall referenced be finished attachments within 45 contained days from Initiation. being The least used. permittee 48 The hours permitted shall prior notify to access Mike commencing shall Shepherd be completed construction with the in accordance within Colorado the with Department State the Highway terms of and right-of-way. Transportation, conditions of at the (970) permit 381-5143 prior to at 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 conditions. ' Print Name Date , Pe Signature: , k).. be ( C A Cita ( v .:_ 61-)19-D15 - "kill( 4 itscit_ • • Co-Perrnittee Signature: (if applicable) i Print Name Date ' This COLORADO permit is not DEPARTMENT valid until signed OF TRANSPORTATION by a duly authorized representative of the Department. 0 - J ' S . - - nt Name Title Date (of issue) I'( 10 Z py Disatbution: Required: 1. Region 2 Applicant 3.Staft Access Section 4.Central Files Make copies as necessary for Local Authority Inspector MTCE Patrol Traffic Engineer Previous editions sue obsolete and may not be used Page 1 of 3 COOT Form #101 5107 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the teens or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the 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. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 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 extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local Issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4) 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 2.14. Ali materials used in the construction of the access within the highway right-of-way or on permanent easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the 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 the Department or issuing authority to initiate action to suspend or revoke the permit and dose the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the 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 Department and included in the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element fails within two years due to improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T,C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or 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 Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 State Highway Access Permit Attachment to Permit No. 419069 - Additional Terms and Conditions 1 1. If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350- 2148. 2. The Permittee or the contractor shall notify Bruce Bamett 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. 3. The Permittee shall request final Inspection by Bruce Barnett at (970) 350-2147 within 10 days following the completion of access construction, and prior to authorized use. The Permittee or their representative shall be present. 4. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 5. Incorporated as part of this permit are the following: Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No. 101) and its attachments Exhibits: "A" — Access Plan "B" — Vicinity Map 6. 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 be applied for based upon the existing and anticipated future conditions. 7. The Permlttee 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. 8. The 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. 9. It Is the responsibility of the Permlttee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from the CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction- Environmental Guidance webpage at http:, www.dotstate.co.us,environmental Forms as, . FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as: wash water, paint, automotive fluids, solvents, oils or soaps. State Highway Access Permit Attachment to Permit No. 419069 - Additional Terms and Conditions 2 Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CHPHE website at: httl,; °cduhe.state.co.us1w 'PermitsUnit'w?u. 10. 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. 11. The Department inspector may suspend 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. 12. 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. 13. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 14. The Department retains the right to perform any necessary maintenance work in this area. 15. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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 State Highway Access Permit Attachment to Permit No. 419069 - Additional Terms and Conditions 3 Highway. In an emergency, the Department Region Office and the State Patrol shall immediately be notified of possible hazards. 16. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 17. All materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be In accordance with the following Department standard references as applicable. A. State Highway Access Code, 2 CCR601-1 B. Roadway Design Manual C. Materials Manual D. Construction Manual E. Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M.U.T.C.D.) for Streets and Highways and the Colorado Supplement thereto H. A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I. AASHTO Roadside Design Guide J. institute of Transportation Engineer's Trip Generation Manual, 6th Edition Some of the reference materials listed above (A through E) may be purchased from: Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from: The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is: www.cdct. ov 18. 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 CRF Part 1926 — Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment: • Head protection that complies with the ANSI Z89.1-1997 standard; State Highway Access Permit Attachment to Permit No. 419069 - Additional Terms and Conditions 4 • At all construction sites or whenever there Is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn • High visibility apparel as specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2). Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply. 19. Backing maneuvers within and Into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing Into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority. 20. The access shall be maintained In such a manner that will not cause water to enter onto the roadway and will not interfere with the existing drainage system within the State Highway right- of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. 21. The use of this access by the Applicant is only until 03/01/2020. COLORADO Environmental DEPARTMENT Clearances OF Information TRANSPORTATION Summary ► _y PUR. perform encountered environmental OSE work - environmental This related or cultural a to m their.own niary resource Is pernil Inbnded facilities s/dearances permits/clearances ia (such hdonn that entities as Utility, may external Special apply may be required to -their to Use tDeT or activities. In Access certain that Instances. may Permtttees), This be listing entering is Appropriate about not the ail some -Inclusive state local, high*a of the more .. additional state right -of -way' commonly and federal to agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific Re.gulteme activity. Mix' IMPORTANT Result In — Suep Please a nsion Review _ The of Revoitetion Following of Your Information COOT Paint, Carefully-- Or Etiforceinent Failure to Cody Actions With syr Regulatory r k i encies. .- CLEARANCE may • be Colorado contacted Water Environmental Department Quality CONTACTS for additional Control Permitting of Public is information: Division As indicated Website Health (WQCD): and i in tip the Environment wilkwe (303) permiticiearance 6924500 (CDPHE): ado.o t�ci descriptions General information fisted a/ell-permits below, -, the (303) following 692-2035 individuals or agencies • CDOT Water•Quality Program Manager: (303) 7579343 htt.,IM://www.bodot.apSoorarnsienvironrrientalAvakoftvaintaf moremsienvir ertt r-.cvati • • • CDOT Colorado U.S. Omaha Army Asbestos Office Corps District of Project (NE of Archaeology Engineers, CO), Manager. Denver. District and Phil Office Historic Kangas, Regulatory (303) Preservation: (303) 979-4120 Offices: 612-6519 (303) - 666-5216 http:/Mnww:nwwa&scam snWMbsio e ulattory tCol rado.aspx Sacramento hip:/h►,t .opk.usacaertnv.rn Dist. (Westerrn CO), Grand ssionsIRs Junction uIa$arv. Office (970) t* 243-1199 Albuquerque illimijscapast4ticaarrnv.mllii9 District (SE cO), Pueblo itlionslaanutatonero.gramandPsnnIts.aspx Office (719)443-9459 . CDOT. Utilities,. Special Use Access Permitting:303 757-9664 htt- • and j� :8:/IM' r. --;..1ot,t...vlbusinessl _ meat Wit life litillOU IS. - Diisturbance_of wildlife shell be avoided to the niwdmum extent practicable. Entry into areas of known or suspected threatened and the CDOT threatened or endangered Regional or endangered Permitting species are Office spades encountered and habitat Region during will claming require the progress and special Environmental authorization of the pemMtted Manager from work, the shall CDOT work in be permitting the subject contacted office. immediately. area If shall any be halted Authorization Must be provided by CDOT pnor to the continuation of work. Information about threatened or endangered species may be obtained from the COOT website, h p:IIw L dagpWl seam ,en nme h ikilly l�Glihes, or the Colorado Parks and Wildlife .(CPAt) website, ilk :t/wwia. PW. a . . Seam/Pee rarnrae ntOdEn nagra* azox. Additional guidance may be rovided b; the appropriate Plannlnp arid Environmental Manager (RPEM). _ . . Culture$ Resourc q a The applicant must request. a file search of the permit area through the Colorado Office of Arcbaeology and Historic en to:!/litil, Preservation .i':l nr (OAHP), lore .o- Denver, • h : to - ascertain a '' . if Inventory historic or of Mile archaeological permit area resources bye qualified have cultural previously resources been identified specialist may -be necessary, Initlation of per the the permitted recommendation work or are of COOT. encountered If archaeological as the project sites/artifacts progresses, all or work historic In the resourtes subject are area known shall to be halted wrist prior and to the the CDOT Regional provided RPEM. by Contact Permitting CDQT inhumation: prior Office to and the continuation Region Contact Planning the of DAMP work. and for Environmental Additional file.searches guidance Manager at (303) may 866-S216. shall be provided be contacted by the immediately. Regional Permitting .Authorization Office must and be __ Palen � � gM Resources - The icant .. mustrequest a fossil locality file search through �9 the Universityve of Colorado _- Museum, T Boulder ��.� (https:1/ .. Baum.cotorada.aluhasaw loa.Saonto1oct/Mrca ites/po,ida€), and the Denver Museum of Nature and Science (httc ://www.drnns.arals►oiS ce/ ► c is1r t,ar rioa ie titai) to ascertain if paleontological resources have been previously identified recommendation CDOT be Regional In or near of Permitting the by CDOT. CDOT permit if Office area. fossils to and Inventory. the are Region continuation encountered of Planning the permit during of and work. area the Environmental Additional by permitted a qualified work, Manager paleontologist all may work shall be in be the nay contacted subject be by necessary, area immediately. shall Regional per be the halted Authorization and the. must in the provided Permit Special Provisions. prior Contact information: See the museum guidance websites listed provided above for the Paleontological Permttting Collections Office Manager contact information. Contact the CDOT Paleontologlst.for further information at n eLaygm us. or (303) 757.. 9632. The CDOT PalepntoIog t Will not conduct a; oornprehenslvel file search We penden , u of the museums. tiazardous Mateyils1 Solid Wmitir -•The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-i0u, et at, and Reg ons Pertaining to Solid Waste Disposal Sites and Facilities (+6 CCR 140721 prohibit dad waste disposal without an approved 'Certificate of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15401 et al, and the Colorado Hazardous Waste Regulations CCR 1007-3) the .or disposal hazardous (6 prohibit transfer, storage (TSD) of waste except at permitted TSD• sites. There are generated permitted solid etc.) no waste is permitted by facility. or encountered the landfills or hazardous activities -designated during. or of materials the TSD entitles collection performance sites withhin entering contamination point. the of State the .State (e.g., work, (including for Highway the Highway solid permfttee waste, oil Right or Right petroleum shall a of utility of -halt Way. Way or contaminated work Therefore, must construction in be the removed affected all solid company's soil, asbestos, from area or hazardous the ROW own chemicals, and immediately .dumpster). wastes and disposed that If mine contact prewexlsting tailings, might of the -at be a COOT Hazardous Regional Materiais Permitting Manat9ament °ff be for direction Supervrisor. as to 30.3 how 5124524. to proceed. Contact information; Theresa Santangelo-Drei ing, CDOT - - .. b t3estos Sonthlnlna M.ftriats, Apbastot Coriamin dAQ!t • All workon asbestos containing materials (ACM) musttomply Oh the asbestos-oon�inated applicable requirements soli, of the must CDPHE comply Air Pollution with the_ CDPHE Control Hazardous. Division's Materials (APCD) Regulation andWaste 8. 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S eq.lsniu Ltt90 a up pug sjgeolldde paism5ei BMW U0401Plamane isms Ted` PUB Aq euu si uv UogBZ}aotfne uosWed pezpoypne. sndpuEzeti ulsIgo S'i Sselun esawwco 14 uoillfiliodale4 1011BPa ew S11OPJezey se V4Pooe Ja silo Asw uossed. phv. • spnactepj s_ F uopsubbsue$ j 'tin st19 1£os1 Joe!Mec /1s lueWe6DUeyg spepalevy s pJ!neH' 1-0leou s OMNI JO 6199 119 (£0£) ieetuaill •e"oge ellscleM lead Bus $atsegSy 1000 etil wo14 ehgeilere sl epe(a spas uo eouwsep buiwsouoe uusetwojunsuompPv pslsll twed leluewuoJutua 3HdOO Sul epA pessetne eq UBO suogern6ebi ORMAN :Will isemoQ •suowswud-pepeds uuued eta up Pees eq Astu s4uewealnbeJ Jo eouep,n6 ppy .paisenbei Pue OOc Bulaq 4V sp 3Hd00 uopszpog4ne tpity4 xi )OM 941 up PG+Ionul my Aug uep! xllebilpeds lsnw'lined woo {e hue Jot uopeo!idcle etjj •suogetn6e8 Gleam Disposal of Drilling Fluids • Drilling fluids used in operations such as Horizontal Directional Drilling may be classified. as °discharges° or °solid wastes," and In general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid • Waste regulations. Small quantities of drilling fluid solids (less than 1 cubic yard of solids).may be left on -site after either being separated from fluids or after Infiltration of the water, provided: 1) the drilling fluid consists of only water and bento►nits day, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by COOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact in ormation: Contact CDPHE \telephone Ifs limed above). No loua Weeds and hytalve Specks' Pilananitnet Man �- NOXIOUS weeds acid Invasive Species can belourtd by contacting the Colorado Department of Agriculture h sa - a . ok ca ^ 13s, tionlnoxiousweat: t) and the -� ? �. i ' gaslFiSet'a,dQ �sW� i' ,•� i:. In either case, manages Colorado Division of Perks and Wildlife ' �� •r: �r� ��. - s$ .= 3I� � �. � � , ;: . °a ans involvin the control of noxious weeds associated .with the pemilttad.activity" and cleaning of a pment will be required. plume,Washout • Waste' generated *arc concrete Whiffles shell NOTIkt allowed to flow into the drainage ways, Wets, teceiving waters, or in the.000T ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, dralnageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental Program and shall be in accordance to COOT specifications and -guidelines. ,Contact Information: Contact CDPHE or find additional information on the CDOT website::pttcrsaibr. o;.uov!'ousanessld nnsupoon 2°11 nsLn Oct -s� cs sv ns.411$ and rater to the spec►fcations and der revisions for sections 101, 107 and 208. Reporting - Spills shall be contained and cleaned up as soon as epossible.. Spills shall hIOT be washed down into the storm sal drain or buried. All spills shall be reported to the COOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spilt in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1477-518-5608. More information can be found at 1 : /t:rvc's .r Eo y1 -cam- ' 7 33 me=t€nE. - _ &yt1 Tit Fong • Questions or comments about this Information Summit), may be directed to Alex Karma, Program Administrator, COOT Access Management Unit, at (303) 787-9841, Slakaram1@atate.co us,_ _.. • Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation August 2017 A COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snewmett flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is stormwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow into CUOT's storm drain system or directty into a stream, river, lake, wetland or reservoir. Anything that enters CDOT's storm drain system is discharged untreated into the waterways we use for fishing, swimming, and providing drinking water. Ark da « orip ti a jeittN:la fist i.. t;rir/ 401.• , rrt b - rr'" ', lartSt i t„ i; 4":,_. , i; t', � r . , t , 11 ,7, r, v4 4. v ' st•r ;:fltt-qttt;tt.fl;5siL1:►.� fCi.` arttal tir? i►`rjt- . ►.e c .a rw •rrti t ttiu,yrf tut« •'t Tips fur Reporting on illicit Discharge Call the illicit discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae, etc). Obtain information on the vehicle dumping the waste (if applicable). Do not approach I Call •CSP for illicit dumping. if possible, take a photo, record a license plate. Never get too close to the Illicit discharge, it may be dangerous/II For more information on COOT Utility Permits: baps:llwww.cQ09t gavlbusinefrfpermitslutilitie 5pecwlt, e For more information on CDOT Access Permits: https:uwww.codot.govl businesslpermitlaccess permits For more Information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222 303-757-9343 ewer pipet es41.- 3 COLOR A DO Department of Transportation Water (Malay i u tram Industrial Facilities 111eenra. m CDOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment. The permit states that only stormwater can be discharged from CDOT's storm drain system ha i■.r .4katanias SZINTIN OS ft ant pip; Tone 'EASTMAN TOTMRLOCAL WANT WATERSOIN As part of the permit, CDOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program New Development Redevelopment Program Illicit Discharge Program industrial Facilities Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program COLORADO Department of Transportation Control Measures for Industrial Facilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices (8MP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering Into CD0T's storm drain system. Control Measures also include treatment, operating procedures, and practices to control site run off which can include structural and non-structural controls. eat flhUNT1.ET ore toga is IMRE A IMP Paean GOOSE sr gilt W+,►. - ems • PROPERLY eitterrAltietl to compliancel l COOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: ✓ Communications ✓ Cable television ✓ Power ✓ Electricity ✓ light ✓ Heat Gas 1 Oil ✓ Crude Products ✓ Water ✓ Stream ✓ Waste ✓ Stormwater not connected with highway drainage ✓ Similar Commodity COLORADO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. CDOT has put together an Environmental Clearances Information Summary for those applying for a CDOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and Is available at: http: / /www.coloradodot.info/protjrarns/ environmental/ resources/stuidance- standards / Environmental%24Clea rances% z0ln€o%2osummary. pdf COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION issuing authority application acceptance date: instructions: - Contact the Colorado Department of Transportation (COOT) 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 - tf you have any questions contact the issuing authority. - For additional Information see CDOT's Access Management website at hit, Wwww,dotstate.eo.us/AccessPecnits/index,htm 1) Property owner (Permittee) 2) Applicant or Agent for permittee (if different from property owner) Ryan Hostetler Cheyenne Connector Pipeline, Inc Street address 4754 Valley Oak Dr City, state & zip Phone # Loveland, CO 80538-8893 1 303-883.7080 E-mail address Mailing address 370 Van Gordon St City, state & zip Lakewood, CO 80226 -dm ,p•mimimemm.m. Phone # (required) 303-763-2981 E-mail address if available shawn . bates@ tallgrassenergylp . cow 3) Address of property to be served by permit (required) State Highway 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? county subdivision block lot section Weld 5) What State Highway areyou requesting access from? State highway 85 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? 4645 feet 1IN flS ❑ E OW) from: 291 4620 feet itv ■ S DE ❑W) nom:Weld County Road 104 8) What Is the approximate date you intend to begin construction? 4/1/2019 9) Check here if you are requesting a: new access (temporary access (duration anticipated: 4 /1 /19-12/31/19 ) El change In access use El removal of access 4 township 1 16 1 9N 6) What side of the hi hway? �N S ■ E w 1 66W 10) Provide existing property use Commercial MLV site improvement to existing access E2elocation of an existing access (provide detail) 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? no Oyes, if yes - what are the permit number(s) and provide copies: and/or, permit date: a Magellan 12) Does the property owner own or have any interests in any adjacent property? no Oyes, if yes - please describe: 13 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? no j yes, if yes - list them on your plans and indicate the proposed and existing access points. 14) If you are requesting agricultural field access - how many acres will the access serve? 15) II you are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. businessfland use square footage business square footage I 16) If you are requesting residential devetopernent access, what is the type (single family, apartment, townhouse) and number of units? type number of units type 1 i AO - number of units 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 t of passenger cars and light trucks at peak hour volumes Dpeak hour volumes or • average daily volumes. 50 # of single unit vehicles in excess of 30 ft 0 of farm vehicles (field equipment) ft of multi una trucks at peak hour vohcmes Total count of all vehldes Previous editions are obsolete and may not be used Page 1 of 2 COOT Form #137 01110 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 ether access, bordering roads and streets. b) Highway and driveway plan profile_ c) Drainage plan showing impact to the highway right-of-way. d) Map and letters detailing utility locations before and after development in and along the right-of-way. e) Subdivision, zoning, or development plan. 1) Proposed access design. g) Parcel and ownership maps including easements. h) Traffic studies. 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 COOT Utility/Special Use Permit offices or accessed via the CDOT Planning/Construction-Environmental-Guidance webpage http://www.dastatescoaus/environmental/Forms.asp. 2- Ali 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 fcotwear 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: chttp llwww.dot.state.co.us/DesignSupportl>, 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. Applicant or Agent for Perrnittee signature Print name Shawn Bates Dads 12/20/2019 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. 1f apermit is issued, the roe owner, PP g property rtY o er, in most cases, will be listed as the permittee. Property owner signature Print name Date Ryan Hostetler Previous editions are obsolete and may not be used Page 2 012 CDOT Form #137 01110 50 F. MINIMUM NATURAL GRADE NOTES: 4 4 Y • •J • �� ,,_!1 i • • 1 • t • • •.I M :. •0.1 . • • • UNIMPROVED GROUND •, • • ••i • ,• ic • ..•. • • / • . A• ,. epic 10' MIN. 20' MAX. BERM 3' WIDE x 2 HIGH RADIUS = 20' MAX. PLAN VIEW UM r'',v. ' f ' CLEAN ROC K 2'-4" MIN. .1•;" GEOTEXTILE = •• FABRIC AND GEOTEXIILE GRID, AS REQUIRED • PROFILE ✓ 1 •A ,♦ • `•a aw • -:r • /..• - • • e i �_ • w Ibt •. ▪ • 10' 1 EXISTING ROAD PAVEMENT EXISTING ROAD PAVEMENT ti CONTRACTOR TO PROVIDE AND INSTALL CULVERT (18" MIN. FOR CDOT) (15" MIN. FOR WELD COUNTY) 1. ACCESS PADS, AS ILLUSTRATED ABOVE, ARE TO BE INSTALLED ADUACENT TO ALL ROAD CROSSINGS. 2. IF USED IN AGRICULTURAL LAND, ROCK SHALL BE PLACED ON A 3EOTEXTILE FABRIC TO FACILITATE ROCK REMOVAL. 3. SHOULD THE ROCK PAD BECOME INLI-FE.CTIVE FOR REDUCING THE BUILDUP OF MUD AND DIRT AND MINIMIZING TRACKING ONTO THE PAVE ROAD, THE CONTRACTOR SHALL WASH THE EXISTING ROCK ALL SURFACE OR ADD A ROCK FILL LAYER TO THE ACCESS PAD, 4. CONTRACTOR SHALL KEEP ROAD SURFACES CLEAR OF MUD AND DEBRIS. 5. CONTRACTOR SHALL REMOVE ALL IMPORTED ROCK FILL MATERIAL, 3EOTEXT1LE FABRIC AND CULVERT (IF INSTALLED) AND RESTORE THE GROUND TO NATURAL CONTOURS UNLESS OTHERWISE DIRECTED BY COMPANY'S INSPECTOR. 6. CONTRACTOR SHALL MAINTAIN A MINIMUM 2% GRADE AWAY FROM ROADWAY FOR A MINIMUM 20 FEET FROM EDGE OF ROAD. OR**G been IS SUPERSEDED Sr STARDOM SCOPE of WON OR UNE UST. REVISIONS aa. DATE OESCRIFRON T ett a00 +i o V/S4 iMO RIP MIEN 11e ON S 07/`1484 MIES Pot AS aarQ N el . 07/01/ce ea 1eiltnc Ca +e 01;/14/1P NNW Pot OEM Mtn AIM $ 11/20/11 leMES FS MOT et WI of • ,11/1!7/1• PEN Coat NM ass _11aIES TALLGRASS 1� TYPICAL ROAD ACCESS PAD OW1E: 11/20/18 APPROVED BY: KT.5.Ase CST- P -t 000-!1146 SH. 1 O 1 arinisir M1ckO1C1 EYMtgrr /6•," Vtrm ont\ TEMPORARY ACCESS ROAD EXHIBIT MIN ESN IV Pl. RIVAL, PROJECT CENTERLINE TEMPORARY ACCESS ROAD PARCEL BOUNDARY 143.42 FT 321.77 AC Descriptin. A seventy 170J foot wide strip of fond to be used os temporary construction Ingress/egress. Roadway may be upgraded or developed as deeded for specified troffic. Note; this exhibit does not represent o boundary survey and Is intended to portray occest; rood use only. PROPER" OF: HOSTETLER RYAN L CHEYENNE CONNECTOR PIPEUNE WELD COUNTY, COLORADO Aft 70046 _ SCALE: 1" • 0.14' DATE: 1/4/2019 DRAWING NO.174 / CO -WE -975.000 DRAWN $Y: st 1 CHECKED BY: AL REV_ EX% -1 I a IF uS° COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED CDOT Permit No. 419041 State Highway/Mile Post/Side 085E /300.577/Left Local Jurisdiction Permittee(s): Applicant: Jem Ranch LLC PO Box 546 Rebecca Lieders Evansville, Wyoming 82636 Cheyenne Connector Pipeline, Inc (307) 234-3619 370 Van Gordon St Lakewood, Colorado 80226 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By (X) l/`, j.-� -.._-- Title Assistant Access Manager Date 04/02/2019 Copy distribution: Required: Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector MTCE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT CDOT Permit No. 419041 State Highway No / Mp /Side 085L / 300.577 / Left Permit Fee $100.00 Date of Transmittal 03/29/2019 Region / Section / Patrol / Name 4/01/20 Local Jurisdiction Weld County The Permittee(s): Jem Ranch LLC PO Sox 546 Evansville, Wyoming 82636 (307) 234-3619 The Applicant(s): Rebecca Ueders Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 is hereby granted permission to have an access to the state highway at the location noted below. The access shad be constructed, maintained and used In accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked by the issuing Authority If at any time the permitted access and its use violate any parts of this permit The issuing authority, the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location: This access is located approximately 3045 feet north of mile marker 300 on the west/left side of State Highway 85 at approximately mile point 300.577. Access to Provide Service to: (land use Code) (Size) 994 - Temporary Construction Access 298 988 - OlUGas Field 16 Additional Information: (Units) ADT Each This permit is for temporary use only. The access must return to it's original use In Its entirety by no later than 01/3012020. A tracking pad is required to be installed outside of CDOT ROW. No cleated equipment is allowed on the roadway without positive protection measures. MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Date Title 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 pemdttee shall notify Bruce Bamett with the Colorado Department of TransportaSon, 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 conditions. Pmmit�ee,Signature: Print Name Co-Parmldoo Signature: (if applicable) Print Name _ Date Date 3fagl )19 This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION Sigr tore , P nt Name Tide Date (of Issue) '✓1 fA4t, 551 ASS 4 ct < Yl aitiLik- t' Copy Distribution: Required: Make copies as necessary for: Previous editions ans oWo and may not be used 1.Region 3.Staff Access Sedan Local Authority Inspector Page 1 of S CDOT Farm 0101 5107 2.Applicant 4.Central Files MiCE Patrol Traffic Engineer State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the 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. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 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 extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4] 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the 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 easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the 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 the Department or issuing authority to initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the 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 Department and included in the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element fails within two years due to improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or 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 Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO Department of Transportation Office of the Executive Director 4201 East Arkansas Ave, Suite 262 Denver, CO B0222 RELEASE MEMORANDUM To: All CDOT Employees From: Shailen P. Bhatt, Executive Director Re: Updated Procedural Directive 602.1 "ADA and PWFA Accommodation Procedures" Date: June 16, 2017 1. Name of Updated Procedural Directive: PD 602.1 "ADA and PWFA Accommodation Procedures" 2. Date of Directive Superseded: April 14, 2015 3. gxecutive Summary: PD 602.1 provides information regarding CDOT's provision of reasonable accommodation to employees, or applicants for employment, with disabilities. This PD has been updated to incorporate requirements from the Pregnant Workers Fairness Act, passed in 2016, which requires employers to provide to employees or applicants for employment reasonable accommodation for health conditions related to pregnancy, physical recovery from childbirth, or a related condition, to perform essential functions of the job, unless the accommodation would impose an undue hardship on CDOT. 4. Effective Date June 16, 2017 5. Office to Contact with Questions: ADA Program Administrator, Division of Human Resources. 4291 E. :i.rtr, ?A �U, . 3322y .133:' 9nS COLORADO DEPARTMENT OF TRANSPORTATION Subject ADA and PWFA Accommodation Procedures O POLICY DIRECTIVE X PROCEDURAL DIRECTIVE 602.1 Effective 6.16.17 Supersedes 4.14.15 Originating Omee Division of Human Resources I. PURPOSE Title 1 of the Americans with Disabilities Act (ADA) requires the Colorado Department of Transportation to provide Reasonable Accommodation to individuals with disabilities who are Employees, or applicants for employment, except when such accommodation would cause an undue hardship. The Pregnant Workers Fairness Act (PWFA) requires the Colorado Department of Transportation to provide Reasonable Accommodations to an Employee or applicant for employment, for health conditions related to pregnancy, physical recovery from childbirth, or a related condition, to perform the essential functions of the job, unless the accommodation would impose an undue hardship on the employer's business. Discrimination and Retaliation concerns under the ADA and PWFA are addressed under Policy Directive 600.0 (Equal Employment Opportunity and Affirmative Action) and Procedural Directive 600.6. (Internal Discrimination Complaint Procedures). See also Procedural Directive 12.1 (Workplace Accommodations for Nursing Mothers) for procedures in compliance with the Workplace Accommodations for Nursing Mothers Act. H. AUTHORITY CDOT Executive Director pursuant to § 43-1-105, C.R.S. Rules 4-6, 9-3 and 9-5 of 4 CCR 801-1, Personnel Board Rules and Personnel Director's Administrative Procedures Americans with Disabilities Act of 1990, 42 U.S.C. § 12101 (1990) (hereinafter "ADA"), as amended 29 C.F.R. Part 1630 29 C.F.R. § 1602.31 (record keeping) Rehabilitation Act of 1973, 29 U.S.C. § 701 (1973), as amended Page 1 of 7 Number ADA and PWFA Accommodation Procedures 602.1 U.S. EEOC Enforcement Guidance: Reasonable Accommodation and Undue Hardship under the Americans with Disabilities Act (https://www.eeoc.gov/laws/guidance/enforcement_guidance.cfm) § 24-34402, et seq., C.R.S. §24-34-402.3, C.R.S. (Pregnant Worker's Fairness Act) 3 CCR 708-1, State of Colorado Civil Rights Commission Rules and Regulations III. APPLICABILITY This Procedural Directive applies to Employees and Job Applicants for all employment -related operations and services of CDOT, as well as to all CDOT building facilities, divisions, regions, offices and branches. IV. DEFINITIONS "Americans with Disabilities Act (ADA)" shall refer to Title I of the Americans with Disabilities Acts of 1990 and the ADAAA of 2008 which require the Department to provide equal employment opportunities for individuals with disabilities. As one of the requirements of the ADA and ADAAA, Reasonable Accommodation will be provided to individuals with disabilities who are qualified and employed by the Department or who are applicants for employment, absent undue hardship. "ADA Coordinator" shall mean the person or persons designated and trained by the Division of Human Resources in the ADA and PWFA requirements to take a lead role in conducting an Interactive Process with an Employee or Job Applicant. The list of ADA Coordinators can be found on the CDOT intranet (http://intraneidot.state.co.us/employees/ee-rights/ada-content). "Appointing Authority" for purposes of this Procedural Directive shall mean the person or persons designated to handle personnel matters or make hiring decisions. "Department" or "CDOT" shall mean the Colorado Department of Transportation pursuant to § 43-1-101, C.R.S. "Disability" shall mean a physical or mental impairment that substantially limits one or more major life activities; a record of such impairment; or being regarded as having such an impairment. "Employee" shall mean any individual who is employed with CDOT in a temporary, permanent, part-time or full-time capacity. Volunteers are not considered an "Employee" for application of this procedural directive. "Hiring Process" shall mean any aspect of the process to fill an employment position including Page 2 of 7 ADA and PWFA Accommodation Procedures wow NwiOo 602.1 the application, interview, written test, or other type of job demonstration. "Interactive Process" shall mean the process by which an individual will request and/or participate in discussions with the Department for an accommodation; the Department will determine whether requirements are met, whether an accommodation is reasonable and can be provided, and examine potential alternative accommodations. "Job Applicant" shall mean any individual who has submitted an application for employment with the Department as well as any current Employee seeking promotion or transfer with the Department. "Reasonable Accommodation" shall mean any change in the work environment or in the way processes are customarily done that enables an individual with a Disability or an individual who falls under the PWFA to enjoy equal employment opportunities. A Reasonable Accommodation may include job restructuring, leave, modified or part-time schedule, modified policies, reassignment, or variations thereof. "Unfilled Position" for purposes of this Procedural Directive shall mean a position for which funding has been established, approved by the Department, and that the Department intends to fill. V. PROCEDURE A. General Requirements I. In the following areas of employment, the Department shall comply with the ADA and PWFA requirements concerning the provision of Reasonable Accommodation: a) That is required to ensure equal opportunity in the Hiring Process; b) That enables an individual with a Disability or who has health conditions related to pregnancy, physically recovering from childbirth, or related condition, who is qualified to perform the essential functions of the position held or desired; and c) That enables the Department's Employees with disabilities or who has health conditions related to pregnancy, physically recovering from childbirth, or related condition, to enjoy equal benefits and privileges of employment as are enjoyed by other similarly situated Employees without disabilities or do not have health conditions related to pregnancy, physically recovering from childbirth or related condition. Benefits and privileges of employment shall include, but are not limited to, Department -sponsored: (1) training, (2) services such as cafeteria, lounges, auditoriums, and (3) parties or other social functions. 2. The Department, through the ADA Coordinator, will initiate an Interactive Process Page 3 of 7 ADA and PWFA Accommodation Procedures Nereid 602.1 with an Employee or Job Applicant, or his/her personal representative, to assist with the ADA or PWFA Accommodation Procedures. The Interactive Process may include the following as determined on a case -by -case basis: a) Act upon receipt of a request for an accommodation or information identifying a need; b) Determine whether the individual has a Disability as defined by the ADA; c) Determine whether the individual with a Disability is qualified (1) satisfies the requisite work experience, education, and other job related requirements for a position; and (2) can perform the essential functions of the position with or without a reasonable accommodation. d) Identify a Reasonable Accommodation, or potential undue hardship. 3. The Department is not required to provide an accommodation that would cause an undue hardship. Undue hardship means significant difficulty or expense in, or resulting from, the provision of the accommodation. Whether a particular accommodation will cause an undue hardship is determined on a case -by -case basis. The resources and circumstances of the Department as the employer will be considered in relationship to the cost or difficulty of providing a specific accommodation. An individual assessment and evaluation will be conducted through the Interactive Process by an ADA Coordinator with the recommendation to an Appointing Authority, who shall make the final determination. 4. When a Workers' Compensation process parallels the accommodation process, the Risk Management Unit will provide the necessary information to the ADA Coordinator concerning requests related to Employees also involved in Workers' Compensation claims. Workers' Compensation Injury/Illness shall mean a work -related injury or a work -related illness, as defined in the Colorado Workers' Compensation Act. B. Procedures Related to Accommodating Job Applicants and the Hiring Process 1. Human resources shall provide a Job Applicant with information as to whom to contact for an accommodation either in the job announcement or by additional notification in the Hiring process. 2. During the selection process, Job Applicants will be notified of the different aspects of the Hiring process (i.e., interview, written exam, or job demonstration, etc.). Human resources will inform the Job Applicant that if he or she requires an accommodation to participate in the process, he or she must inform human resources within a reasonably established time period prior to the administration of that aspect of the Hiring Process. If a Job Applicant has an obvious Disability or discloses information which indicates a possible need for an accommodation, human resources will initiate communication to Page 4 of 7 stow ADA and PWFA Accommodation Procedures Mahe 602.1 determine if an accommodation is required. If an accommodation is required, an ADA Coordinator will conduct an Interactive Process with the Job Applicant with a Disability for the Hiring Process. During the Interactive Process, the Department may identify a Reasonable Accommodation that will allow the Job Applicant equal opportunity during the Hiring Process. 3. After a conditional job offer is made, an ADA Coordinator may conduct an Interactive Process with the selected Job Applicant with a Disability or with an applicant who has a health condition related to pregnancy, is physically recovering from childbirth, or a related condition, to determine if the essential functions of the specific position can be performed with or without a Reasonable Accommodation. During the Interactive Process, the Department may identify a Reasonable Accommodation that will allow the selected Job Applicant to perform the essential functions of the specific position. C. Procedures Related to Accommodating Employees 1. For performance of job duties, an Employee with a Disability or a health condition related to pregnancy, physically recovering from childbirth or a related condition, should request an accommodation from his or her supervisor or manager or ADA Coordinator for all employment -related requests. A list of ADA Coordinators are posted on the CDOT intranet (http://intranet.dot.state.co.us/employees/ee-rights/ada-content). 2. The supervisor or manager will notify the ADA Coordinator of any request or receipt of information regarding a potential need for accommodation. The ADA Coordinator shall be the main point of contact for an Employee's request for accommodation. 3. The ADA Coordinator will conduct an Interactive Process with an Employee to determine if the essential functions of his/her position can be performed with or without a Reasonable accommodation. 4. During the Interactive Process, a Reasonable Accommodation that meets the needs of the Employee may be identified. A Reasonable Accommodation will be provided to allow an Employee with a Disability to perform the essential functions of his/her position. For employees covered by the PWFA, a temporary transfer to another position that meets the request for accommodation will be considered. 5. Reassignment is a form of Reasonable Accommodation for an Employee with a Disability (ADA only) who is qualified, made as a last resort, and is required only after it has been determined that: a) There are no effective accommodations that will enable the Employee to perform the essential functions of his/her current position; or b) All other accommodations would cause undue hardship. Page 5 of 7 stiyaa ADA and PWFA Accommodation Procedures wrist 602.1 However, if both the Department and the Employee voluntarily agree that a reassignment is preferable to remaining in the current position with some form of Reasonable Accommodation, the Department may consider reassignment for an Employee. The Department will follow the process described in the Guide to determine a reassignment of an Employee. A reassignment can only made to an Unfilled Position for which the Employee meets the minimum qualifications. 6, Prior to contemplation of an administrative discharge of an Employee in accordance with State Personnel Board Rules and Personnel Director's Administrative Procedures, the Appointing Authority is required to consult with the ADA Coordinator to determine whether the ADA applies, and if so, whether the Employee can be reasonably accommodated. 7. For benefits and privileges of employment, the Department will conduct an Interactive Process with an Employee. Employees with disabilities or who fall under the PWFA will be provided a Reasonable Accommodation in order to gain access to and have an equal opportunity to participate in the same benefits and privileges of employment afforded to similarly -situated Employees without disabilities. Benefits and privileges of employment shall include, but are not limited to, Department -sponsored: (a) training, (b) services such as cafeteria, lounges, auditoriums, and (c) parties or other social functions. D. Record Keeping 1. Any information regarding the Job Applicant or Employee, including medical information and the final letter of determination, obtained as part of an examination or inquiry for determining a Disability or Reasonable Accommodation under the ADA or PWFA is protected and confidential. All documents shall be kept in a separate, confidential ADA or PWFA file with limited access for the duration of employment at CDOT or for 2 years from the date of the making of the record or the personnel action involved, whichever occurs later, pursuant to 29 C.F.R. § 1602.31. 2. All ADA Coordinators will maintain records to demonstrate compliance with the ADA and PWFA requirements in accordance with state and federal requirements. For tracking and reporting requirements, a Statewide ADA Administrator will administer the ADA and PWFA program and prepare reports as necessary. 3. If the Department is notified of a charge of discrimination or pending litigation relating to the ADA or PWFA decision, the records must be maintained for two years after expiration of the eligible list or until the litigation and/or charges are resolved, whichever occurs later. Page 6 of 7 Subject ADA and PWFA Accommodation Procedures 602.1 VI. IMPLEMENTATION PLAN The Division of Human Resources will offer training on the ADA and PWFA, the Department's program and accommodation process to all Appointing Authorities, designees and direct reports, and ADA Coordinators. In order to conduct the Interactive Process, an ADA Coordinator must be certified by the Statewide ADA Administrator. The Office of Policy and Government Relations shall post this Procedural Directive on the CDOT intranet as well as on the CDOT public announcements. VII. REVIEW DATE This Procedural Directive shall be reviewed on or before June 2022. Shailen P Executive CJ10 v7 Dat of Approval Page 7 of 7 COLORADO DEPARTMENT OF TRANSPORTATION Environmental Clearances Information Summary PURPOSE - This summary is intended to inform entities external to CDOT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility Special Use or Access Permittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not all-inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT - Please Review The Following Information Carefully - Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies. CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website ApsarywnAtc-te"sado.gov/pacific/cdpheiall-permits • CDOT Water Quality Program Manager: (303) 757-9343 https://www.codot.gov/proqrams/environmental/water-quality • CDOT Asbestos Project Manager: Phil Kangas, (303) 512-5519 • Colorado Office of Archaeology and Historic Preservation: (303) 866-5216 • U.S. Army Corps of Engineers, District Regulatory Offices: Omaha District (NE CO), Denver Office (303) 979-4120 http://www.nwo. usace.army_mil/Missions/RequlatnryProgram/Colorado aspx Sacramento Dist. (Western CO), Grand Junction Office (970) 243-1199 http://www.sek.usace.armv.mil/Missions/Regulaiory.aspx Albuquerque District (SE CO), Pueblo Office (719)-543-9459 http://www.spa. usace.army.miWWMissions/RegulatorjprogramandPermits.aspx • CDOT Utilities, Special Use and Access Permitting: (303) 757-9654 https://www.codot.gov/b inessipermits Wildlife Resources - Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. If any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species may be obtained from the CDOT website, http://www.codot.gov/programs/environmental/wildlife/guidelines, or the Colorado Parks and Wildlife (CPW) website, http://www.cpw.state.co.us/learn/Pages/SOC-ThreatenedEndangeredList.asex. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources - The applicant must request a file search of the permit area through the Colorado Office of Archaeology and Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously been identified (http://www.historycolorado.orq/oahp/file-sears`-). Inventory of the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file searches at 303 866-5216. Paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder (httes://cumuseum.colorado.edu/research/paleontologv/vertebrates/po ides), and the Denver Museum of Nature and Science (http://www.dmns.orq/science/collections/earth-science-collection ) to ascertain if paleontological resources have been previously identified in or near the permit area. Inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Off ce and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: See the museum websites listed above for Paleontological Collections Manager contact information. Contact the CDOT Paleontologist for further information at n icol e .peave yci2 state.co.us or (303) 757- 9632. The CDOT Paleontologist will not conduct a comprehensive file search independently of the museums. Hazardous Materials, Solid Waste - The Solid Wastes Disposal Sies and Facilities Act C.R.S. 30-20-100, et al, and Regulations Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved Certificate of Designation (a landfill pemmi:). The Colorado Hazardous Waste Act C.R.S. 25-15-301 et al, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) p-ohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the CDOT Regional Permitting Off ce for direction as to how to proceed. Contact Information: Theresa Santangelo-Dreiling, CDOT Hazardous Materials Management Supervisor: (303: 512-5524. Asbestos Containing Materials, Asbestos Contaminated Soil - All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work done in asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's (HMWMD) Solid Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation August 2017 Info: Waste authorization Additional 5519, CDPHE or Regulations. information Theresa is APCD being The and Santangelo-Dreiling, requested. concerning application HMWMD Additional Regulations clearance for any CDOT guidance on can CDOT permit be or accessed must requirements projects specifically via is may the available CDPHE identify Supervisor: be specified from Environmental any the (303) ACM CDOT in the 512-5524. involved Asbestos permit Permitting in special the Project work provisions. Website Manager for which listed (303) Contact above. 512- Hazardous Materials Management Transportation of Hazardous Materials - with an Permit No Motor the described, exemption, person Utilities United from Safety may the Commission: States packaged, approval Carrier Colorado offer Department or Administration, or accept marked, registration Public (303, a Utilities 894-2868. of hazardous labeled, Transportation has US Commission. DOT and been material in for regulations condition issued. inter- for Contact and transportation Vehicles for intra-state at shipment Information: 49 requiring CFR, in HAZMAT as commerce Part required a placard, For 171. or unless The must that hazardous authorized obtain authorization Registration person authorization is material by and (3031 registered applicable must and more 969-6748. info in conformance be requirements, a State properly call Colorado HAZMAT the classed, or Public Federal Discharge of Dredged or Fill Material - 404 Permits Administered By the U.S. Army Corps of En,gineers, and Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps minor 401 Control wetlands. for of impacts. it water information Engineers is Division possible quality For about at 404 are example, that certification (303) permits various either what 692-3500. there a type types from are "general" of required is the 404 of a 404 nationwide CDPHE or permit "individual" for permits, the discharge permit including be is required for also of utility permit dredged nationwide line would required. contact activities be or information required. Contact fill permits, (nwp materials #12). the if which above). into an appropriate Depending individual waters are Contact issued 404 Corps of for upon the the permit activities District CDPHE United the specific is States, required, Regulatory with Water relatively circumstances, including section Quality Office There WQCD 404 may Working on or in any stream or its bank - more by In Colorado yards CDOT order or and/or cover upstream vary to and Department 2) protect within a intermittent CPW, natural and downstream existing yards can of preserve Natural streams be accessed stream upstream of the Resources. providing the state's or or project at its downstream https://www.codot.gov/programs/environmental/ fish banks live A measured and stream water or wildlife tributaries, beneficial of is the defined by valley resources project; it to may as fish length. 1) and/or from be and represented necessary The actions wildlife; 4) segments CPW that and/or to by a of may obtain solid 3) streams application, wildi4 segments obstruct, blue a 4.. Senate having line Kielines. as of diminish, on streams wetlands per Bill USGS 40 guidelines destroy, certification supporting 7.5' present quadrangle agreed change, within from 25% upon modify, the maps; or 200 100 or «. Stormwater Construction Permit {SCP) and Stormwater Discharge From Industrial Facilities - concrete Discharges at (303) batch 692-3500. of stormwater plants - require Website: runoff a from CDPS .hips://www.colorado.gov construction Stormwater sites Permit. disturbing pacific/cdphe/wq-construction►-yeneraf-peimir Contact one Information: acre or more - or Contact certain the types CDPHE of industrial Water and Quality naps.iic:oio►aao.govipac►ticicaprieiwq-commerce-ano- facilities, Control such as Division industry-permits. Construction Dewatering (Discharge or Infiltration) and Remediation Activities - Discharges Activities contact of Discharge water the CDPHE encountered Permit. WQCD Contact during at (303) 692- excavation information: 3500. or For Applications work For in wet Construction and areas Instructions require (CDPHE a and Construction Remediation website): https://vwvw.coiorado.gov/pacificicdphe/wq-construction-genera-nermits. Dewatering Activities or Discharge Remediation Permits, may Dewatering Municipal Separate Storm Sewer System (MS4, Discharge Permit - within municipality Discharges system Water those that Quality or Quality municipalities, that from may within Control is the have -statutes) subject the storm been Right Commission are to and sewer municipalities an established subject subject of the MS4 Way systems CDOT (WQCC) to to permit, (ROW) inspection MS4 MS4 under MS4 required of regulations, the must larger Permits Regulations that Permit CDOT obtain issued # of COS go such with to: - the municipalities, by facility municipality's (https:i/www.cotoraoo.ccovipacitic/cdpheiwgcc-regulations-and-policies-and-water- 000005 and MS4 nttps:i/www.coaot.aov/programs/environmental/water-auality/stormwater-proorams.htmi. the applicable CDPHE. Permits, CDPHE should contact MS4 provisions and WQCD. from permit. the the For of municipality All the CDOT facilities discharges Colorado highway that regarding lie to Water drainage within the stormwater CDOT Quality the system boundaries highway Control related that Act, drainage lies of clearances the a owner comply by to (https://www,codot.gov/programs/environmental/water-quality/document. at (303) 692-3500 ). Discharges for a listing For CDOT-related are of Contact or go to the https://www,colorado.gov/pacific/cdphe/wq-municipal-ms4-pe1mus. CDPHE Water Quality Control Division General Prohibition — Discharges - All discharges Prohibited and sediment. are discharges subject Contact to include, Information: the provisions but of are not Contact the limited Colorado the to, CDPHE substances Water Water Quality such Quality as Control wash Control Act water, and Division the paint, at (303 Colorado automotive t 692-3500. Discharge fluids, solvents, Permit Regulations. oils or soaps General Authorization - Allowable Non-Stormwater Discharges - Illicit Unless riparian flows, to air stormwater conditioning Discharge otherwise CDPHE PDD identdied systems and condensation, at: wetlands, Water https://wwvv.couut.quv,proyrarrts) are ground by CDOT allowed water irrigation and flow or without infiltration the from WQCD water, a Colorado firefighting to as separate significant sources Discharge storm uncontaminated activities. envuronmentauwater-quaiuyrstormwaier-programs.titrni. of sewers, pollutants Permit Allowable discharges springs, to System non-stormwater the from footing waters permit: potable drains, of landscape the discharges water water State, irrigation, sources, line the can flushing, following be diverted foundation found Contact flows discharges stream under drains, from Information: uncontaminated habitats The Quality Control Division (telephone #'s listed above). Erosion and Sediment Control Practices - where For to activities CDOT a stormwater requiring permit CDOT a Specifications Bid Stormwater Plans is Standard not required, Office 107.25, Specifications Construction at (303) all ), reasonable 208, All disturbances 757-9313) 213 Permit, 212-217 and measures erosion 216 should require and (httos:fiwww.codot,00v! control should requirements be taken to ')usiness/designsupport/2011-construction-specifications/2011-Specs/2011-specs-book erosion will minimize be specified erosion in and that sedimentation permit. In situations according Standard a 623. be used stabilization The CDOT to plan, native seeding Erosion Control controls or and and landscape Stormwater restore disturbed design Quality plan according Guide vegetation. to (available applicable from the design Environmental Clearances Information Summary Page 2of3 Colorado Department of Transportation August 2017 Disposal of Drilling Fluids - Drilling infiltration in CDOT a listed should other pit, permit of and fluids facilities small above). type drilling be of are the requirements used pumped of quantities not that man-made fluid water, in likely specifically operations solids or provided: of vacuumed polymer to (Utility, or (less pose natural such accept than 1) a the additives nuisance Special from as waterway 1 such cubic drilling Horizontal the Use, wastes. that to construction yard fluid future is or are prohibited of consists Access Directional Disposal solids) approved work area, in Permits, by may of only the Drilling removed of Water for drilling be area, use etc.). left water may Quality in 3) on from fluids and drinking the -site Contact be solids classified the into Control bentonite after State storm water Information: are either and/or covered as Highway clay, well drains, "discharges" Solid being drilling; or, if storm and Right 2) the or of sewers, Waste separated required the area Contact "solid Way, solids restored regulations. wastes," and roadside for CDPHE from are disposed proper fully as fluids required (telephone and ditches contained Small drilling in of or general, at after or quantities properties, by permitted any #'s Noxious Weeds and Invasive Species Management Plan -- Noxious Weeds and Invasive Species guidance can be and required. found the management by contacting Colorado plans involving Division the Colorado the of control Parks Department of and noxious Wildlife of weeds (http://cpw.state.co.us/aboutus/Pages/RS-NoxiousWeeds.aspx). Agriculture (https://www.colorado.gov/pacific/agconservation/noxiousweeds) In either will case, be associated with the_permitted activity and cleaning of equipment Concrete Washout - from Waste ROW. state and on and generated shall Concrete waters, the refer CDOT be in to drainageways, the from waste accordance website: specifications concrete shall https://www.codot.gov/business/designsu_pportf2011-construction- to activities be and COOT placed inlets. and shall in specifications their a Concrete revisions temporary NOT be washout allowed concrete and for guidelines. sections shall to flow washout 101, only into Contact be the facility performed drainage Information: and must as ways, specified be Contact inlets, located by receiving the CDPHE a CDOT or waters, minimum Environmental find cifications/2011-Specs additional or in the of 50 information feet Program CDOT 107 and 208. Spill Reporting - All and Spills CDPHE spills Regional or shall shall that at be 1-877-518-5608. be may Maintenance contained reported otherwise and to present the Supervisor. cleaned More CDOT an information immediate up Illicit as Spills Discharge soon on can highways, danger as possible. be Hotline found to into the at at Spills public (303) waterways, ;ttps://www.coioradc,govipacificicdpheiemergency- shall 512-4446 shall NOT reported be (4H20), spill washed in as the by down highway calling well into as 911, the right-of-way the storm Regional and shall also drain Permitting exceeding be reportinorline. or buried. Office 25 to gallons, the any be reported About This Form - Questions or Unit, comments at (303) about 757-9841, this alex.karami@state.co.us. Information Summary may be directed to Alex Karami, Program Administrator, . CDOT Access Management Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation August 2017 COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowmett flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is stormwater runoff a problem? Storrnvvater can pick up debris, chemicals, dirt and other pollutant and flow Into CDOT's storm drain system or directly into a strewn, river, lake, wetland or reservoir. Anything that enters COOrrs storm drain system is dtsctiarged untreated into the waterways we use for fishing, swimming, and providing drinking water. Qetd v d :j it din, than+. • *Ad wiser, mt :ors ritssfeue ItvragC. , @ stodge, garbage. tral, 6intcal w,*ste, biologic:41 nutrient, tnolopiral 4wateci;li, radioactive material, heat, pH. wrecked or d4scardea equipment, rack, uttid, any industrial, Tips far Reporting an illicit Discharge Call the illicit discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identity characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach! Call 'CSP for illicit dumping. if possible, take a photo, record a license plate. For more information on CDOT Utility Permits: htt. s. www.codot. ov;business_ pei mits_utilitle scneri fuse For more information on CDOT Access Permits: https:; j www.codot.gov%business j*milts' access ep rmits For more information on CDOT Water Qwlfty Program: Water a„ality Program Manager 4201 E. Arkansas Ave. Shumate Budding Denver, Colorado 80222 303-757-9343 COLO ago Department of Transportation Water Coedit% 'Grogram 1ncltistrlal Facilities Vregram COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment The permit states that nnty storrnwater can be discharged from coon storm drain system warp— - dant drier RI MiwMSlnu TOTNE LOCAL TRIATILERT PLANT MESON As part of the permit, COOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program New Development Redevelopment Program Illicit Discharge Program Industrial FadIliles Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program COLORADO Department of Transportation Control Measures for Industrial Facilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices (&MP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into CDOVs storm drain system. control measures also Include treatment, operating procedures, and practices to control site run off which can include structural and non-structural controls. Coital; AU IDIOM 6Ilan AIMP PPIESIXO *ar�o Sacral INOISSIEDI In annpgaell COOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: ✓ Communications I Cable television ✓ Power ✓ Electrldty ✓ Light ✓ Heap Gas ✓ O0 ✓ Crude Products ✓ Water ✓ Stream ✓ Waste ✓ Ston water not connected with highway drainage ✓ Similar Commodity COLORADO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to COPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are Instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. COOT has put together an Environmental Clearances Information Summary for those applying for a CDOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: htto://www.coloradodot.info/ ro rams / environmental/resources/ uidance- standardsf Environmentat%2OClearances% 2olnfo%20Summa r t . ► .cif State Highway Access Permit Attachment to Permit No 419041- Additional Terms and Conditions 1 1 If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350- 2148 2 The Permittee or the contractor shall notify Bruce Barnett 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 3 The Permittee shall request final inspection by Bruce Barnett at (970) 350-2147 within 10 days following the completion of access construction, and prior to authorized use The Permittee or their representative shall be present 4 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 5 The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments 6 Incorporated as part of this permit are the following Application for Access Permit (CDOT Form No 137) Permit (CDOT Form No 101) and its attachments Exhibits "A" — Access Plan "B" — Vicinity Map "C" -- Seeding 7 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 be applied for based upon the existing and anticipated future conditions 8 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 9 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 Attachment to Permit No. 419041- Additional Terms and Conditions 2 10. 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 permit and be available on the site during construction. 11. 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. In the event a signal is warranted in the future, CDOT will not participate in any fashion with that signal installation, including financially. 12. The Department will not participate in any costs related to the design and installation of a traffic signal, should one be warranted or approved at this access location or any other serving this development. 13. The 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. 14. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from the CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction- Environmental Guidance webpage at htto://www.dot.state.co.us/environmental/Forms/asp. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as: wash water, paint, automotive fluids, solvents, oils or soaps. Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted State Highway Access Permit Attachment to Permit No. 419041- Additional Terms and Conditions 3 stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CHPHE website at: http://cdphe.state.co.us/wq/PermitsUnit/wqu. 15. 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. 16. 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 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. 17. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Allyson Mattson at the Greeley Traffic Office, (970) 350-2148 to obtain the Landscaping Permit. 18. 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. 19. The Department inspector may suspend work due to: 1) Noncompliance with the provisions of this permit; 2) Adverse weather or traffic conditions; 3) Concurrent highway construction or maintenance in conflict with permit work; 4) Any condition deemed unsafe for workers or the general public. The work may be resumed upon notice from the Department Inspector. 20. 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. State Highway Access Permit Attachment to Permit No. 419041- Additional Terms and Conditions 4 21. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 22. The Department retains the right to perform any necessary maintenance work in this area. 23. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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. 24. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 25. All materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable. A. State Highway Access Code, 2 CCR601-1 B. Roadway Design Manual C. Materials Manual D. Construction Manual E. Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M.U.T.C.D.) for Streets and Highways and the Colorado Supplement thereto H. A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I. AASHTO Roadside Design Guide J. Institute of Transportation Engineer's Trip Generation Manual, 6th Edition Some of the reference materials listed above (A through E) may be purchased from: Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from: State Highway Access Permit Attachment to Permit No. 419041- Additional Terms and Conditions 5 The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is: www.cdot.gov 26. 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 CRF Part 1926 —Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment: • Head protection that complies with the ANSI Z89.1-1997 standard; • At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn • High visibility apparel as specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2). Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply. 27. 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. 28. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 29. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority. 30. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department. 31. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. State Highway Access Permit Attachment to Permit No. 419041- Additional Terms and Conditions 6 32. Permittee is authorized to utilize flaggers for ingress and egress of drilling rig vehicles in a convoy fashion. A copy of the approved traffic control plan and a current, signed CDOT Form #0568 must be present on the job site at all times for inspection. 33. Construction traffic control devices, when not in use, shall be removed or turned away from traffic. Devices must be stored outside of the roadway clear zone per the latest AASHTO guidelines. 34. Cattle guards are not permitted in State Highway right-of-way. 35. If State Highway right-of-way fence exists or is proposed, the Permittee must contact Bruce Barnett at the Greeley Traffic Office, (970) 350-2147 prior to removal or installation. The Permittee will be required to obtain a highway right-of-way fence agreement for a special fence if the Permittee desires to remove the existing standard highway fencing in this area. When it is necessary to remove any highway right-of-way fence, the posts on either side of the access entrance shall be securely braced with approved end posts and in conformance with the Department's M-607-1 standard, before the fence is cut to prevent slacking of the remaining fence. All posts and wire removed shall be returned to the Department. 36. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highway right-of-way. 37. All required access improvements shall be installed prior to the herein authorized use of this access. Failure to do so will result in the appropriate legal action from the Department, up to Permit Revocation. 38. The access shall be constructed and maintained as per Exhibit "A". 39. The access shall be constructed at 20 feet wide with a 20 foot radius. 40. 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. 41. The Permittee is required to install a tracking pad on private property to mitigate the effects of mud and other debris being tracked onto the State Highway system. Should debris tracking onto the highway be a problem, CDOT will contact the Permittee who shall clean the highway within 24 hours of CDOT contact. Appropriate traffic control shall be used per the M.U.T.C.D. State Highway Access Permit Attachment to Permit No. 419041- Additional Terms and Conditions 7 42. The access shall be surfaced immediately upon completion of earthwork construction and prior to use. 43. Surfacing of the access shall be completed as per Exhibit "A". 44. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. Full panel concrete replacement is required for any concrete work. 45. The new State Highway pavement shall slope on the same plane as the present pavement surface. 46. 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. 47. The access shall be constructed and maintained in such a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. 48. 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. 49. This access located approximately 3045 feet north of mile marker 300 on the west/left side of State Highway 85 at approximately mile point 300.577 must be returned in its entirety to the original use by the agreed upon date on the front of this permit. Removal shall include, but is not limited to, the return of the highway right-of-way 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. The right-of-way must be restored to the original condition on this date using the included seeding mixture. Revegetation efforts must be continuously monitored until they are accepted by the CDOT Access Inspector. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Issuing authority application accepta-� Instructions: - Contact the Colorado Department of Transportation (COOT) 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. Please or print type - Complete - Submit - If you - For additional th s form (some questions an application for each access have any questions contact the information see CDOT's may nct apply affected. issuing authority. Access Management to you) and attach all website at http://www.dat.state.co.us/AccessPermits/1ndex.htm necessary documents and Submit it to the issuing authority. 1) Property owner Jea Ranch (Permittee) LLC 2) Applicant or Agent for perrnittee (if different from property owner) Cheyenne Connector Pipeline, Inc Street address PO Box 546 Mailing address 370 Van Gordon Street City, state & zip Evansville, WY 82636 Phone# 307-234-3619 City, state & zip Lakewood, CO 80228 Phone#(requlred) 479-306-8807 E-mail address E-mail address if available rebeccalseders@aummitresourcealand.con 3) Address of property to be served by permit (required) State Highway 85 4) Legal description county Weld 1 of property: tf within jurisdictional subdivision 1 limits of Municipality, block A. city and/or County, tot which one? section 1 32 jii township range I 5) What State Highway are you requesting access from? 6) What side of the hi hway? S to to Hi gh way 85 al N S E ■ 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? -i u 4 feel I N � S �] E W) from: 300 1321 " feet NIN []S QE �"� from: Weld County Road 122 8) What is the approximate 4/1/2019 date you intend to begin construction? 9) Check here if you are requesting a: new access fl temporary access (duration anticipated: 4/1./19-12/31/19 ) improvement to existing access change in access use removal of access Q"elacatiort of an existing access (provide detail) 10) Provide Agricultural existing property use access point 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? no la yes, if yes - what are the permit number(s) and provide copies: and/or, permit date: 12) Does the property owner own or have any interests in any adjacent property? no is yes, if yes - please describe: NW4 /NW4SK4 I8W4SW4 /N23W4 Sec 32 , Twn 11N , Rag 66W 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? a no • yes, if yes - list them on your plans and indicate the proposed and existing access points. 14) If you are requesting agricultural field access - how many acres will the 15.09 AC access serve? 15) If you are requesting commercial business/land use or Industrial access please indicate the types and number of businesses and provide the floor area square footage of each. square footage business square footage 16) If you are requesting residential developement access, what type is the type (single number of units family, apartment, townhouse) and number of units? type number of units 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 N of passenger cars and light trucks at peak hour volumes II of multi unit trucks at peak hour volumes III peak hour volumes or CI average daily volumes. 2 5 X of single unit vehicles in excess of 30 fl. it of farm vehicles (red equipment) Total count of all vehicles .A Y. Previous editions are obsolete and may not be used Page 1 of 2 COOT Form ##137 01/10 18) Check with a) Property b) Highway c) Drainage d) Map development the issuing authority map indicating and driveway plan showing and letters in detailing and along to determine other plan impact utility the which the bordering highway of the following right-of-way. before and roads documents are required and streets. after e) Subdivision, f) Proposed g) Parcel h) Traffic i) Proof to complete the review of your application. zoning, or development plan. access design. and ownership maps including easements. studies. of ownership. access, profile. to locations right-of-way. 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://www.dot.state.co.us/DeslgnSupport/>, 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. i Applicant or Agent for Permittee signature Print name Date Rebecca Liedera 1/23/2019 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 pP by all owners -of -interest unless stated in writing. 9 If apermit is issued, the property P P Y owner, in most cases, will be listed as the permittee. Property owner signature i r i ith A E /1Vt-E4,(44-k Print name t. �- Date 1?/17, --.C/ e? //7 Previous editions are obsolete and may not be used Page 2of2 CDOT Form #137 01/10 Tract No TAR 082B TEMPORARY ACCESS EASEMENT This Temporary Access Easement ("Agreement") is made by and between JEM Ranch, Inc , whose address is PO Box 546, Evansville, Wyoming 82636, (hereinafter referred to as "Grantor"), whether one or more, and Cheyenne Connector Pipeline, Inc., a Colorado corporation, its subcontractors and assigns, hereinafter referred to as "Grantee", whose address is 370 Van Gordon Street, Lakewood, Colorado 80228 Grantor hereby grants to Grantee the non-exclusive right and temporary access easement to utilize, a Fifty Foot (50') wide strip of land for access over Grantor's real property which is described as follows SECTION 32, TOWNSHIP 11 NORTH, RANGE 66 WEST, 6Th PM NW4INW4SE4/SW4SW4/N2SW4 Said 50' temporary access road/easement is located approximately as shown on the vicinity map marked Exhibit 'A' and attached hereto 1 Grantee shall pay Grantor the sum of $ 500 00 for the temporary access road 2 The temporary use and easement herein granted is for the purpose of ingress and egress to Grantee's pipeline right of way and construction project 3 The right of ingress and egress includes vehicles and heavy equipment, including but not limited to 18 -wheel trucks transporting pipe and heavy equipment to be used during Grantee's pipeline construction 4 The term of this Agreement is for the duration of Grantee's pipeline construction and property restoration activities 5 Within a reasonable period after the completion of Grantee's use under this Agreement, Grantee will restore the 50' access strip to as good a condition as existed immediately prior to Grantee's use insofar as is reasonably practicable 6 Grantee is authorized to obtain any required roadway permits on Grantor's behalf --- Signature page to follow — 1 of 2 By: _ Title: IN WITNESS WHEREOF, Grantor has hereunto set its hand this day of , 2019. GRANTOR: JEM Ranch, Inc. C: I'll /7 t STATE OF i ) i 11 Ct ) COUNTY OF ilia tyt J7 ) ss On this day of t ), in the year 2019, before me, the undersigned notary public, �, ►,�. i as r -•�: r�_ . • r for JEM personally appeared Ranch, Inc., known to me to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. In Witness Whereof, I hereunto set my hand and official seal. The foregoing instrument was acknowledged before me this . day of , 2019. My commission expires: 2 of2 • L • r ublic • I11111111111111111111111I11111111IIIBII1111111111111 !I 0627660 06N6fi009 01 46P Weld County, CO 1 of 1 R 6.00 D 0A0 Steve Moreno Clerk 8 Recorder 850 QUITCLAIM a EEI≥ JAMES E MORRISON, JR_ a manned man, Grantor, of Natrona County, and State of Wyoming, for and in consideration of 1 en Dollars and other good and valuable constderatton in hand paid, receipt of which is hereby acknowledged, CONVEYS AND QUITCLAIMS to JEM RANCH, INC , Grantee, whose address is 60259 Highway 85, P O Box 3, Garr, CO 80612, all of lus interest in the following -described real estate, situate in Weld County and State of Colorado, hereby releasing and waiving all rights under and b3 virtue of the homestead exemption laws of the State, to -wit - Parcel 1 All that part of the NE'/. of Section 32. Township 11 North, Range 66 West of the 6th P M , lying West of the right of way of Highway #85 over and across the same. Parcel 2 The SE% of the SW'/ and all that part of the South Yi of the SE% lying West of the Center Line of U S Highway #85 as now located in Section 32, Township 11 North, Range 66 West of the 6th P M Parcel 3 All that part of the NE% of the SE'/. of Section 32, Township 11 North, Range 66 West of the 6th P M , described as follows Commencing at the Southwest comer of the said NE% of the SE'/. of said Section 32, thence East along the South line of the said NE1/4 of the SC1/4 to the point where said South line intersects the West line of the County mad or auto highway running through said Section, thence Northwesterly along the said West km of said County road to where said West line intersects the North line of said NE% of the SE1 /4 , thence West to the Northwest corner of the NE1/4 of the SE'/4, thence South along the West line of the NF,'/+ of the SE1/4 to the place of beginning. E cept rights of way conveyed by deeds recorded at Book 373, page 306, Book 779. page 186, Book 779, page 216. Except parcels conveyed by deeds recorded at Book 1469, page 145, and Book 1469, page 146, Subject to an casement recorded at Book 1605, page 526, All In Weld County records r WITNI'SS my hand this / day of fi7 — STATE OF WYOMING COUNTY OF NATRONA )ss , 2009 E, fileritt4A;(11._ J.01ES E MORRISON, JR This Instrument was acknowledged before me on the k* day of /ncib 2009, b JAMES E M!t.ISON, JR. vtfl My Commission Expires •44(jilt, 4411^1 8k)0? NOrARYPUBI PROJECT ACCESS ROAD DETAIL WELD COUNTY, COLORADO I I T AR .. 4 0 1000 2000 1000' UNE 1'PE POOPOIMO AMINE NIOPOSE0 sor+rvwo .cat Pwwast o 'OS w0MK SPC Pt WOW A r.w.t DO:000e C aRrtANOa r,ro.oala eorrss *WC acno , uc . iore n tot OP noAO oaca a. PROPOSED 3Q' PE CHEYENNE CONNECTOR PIPELINE PROJECT ACCESS ROAD DETAIL cluisfv, 216 WEST 6TH AVENUE STIUW .TER, OK 76074 v►4ONP (toy) inta00 FAX: (406) irboc 2 CHEYENNE CONNECTOR PIPELINE, INC. 140 VAN GORDON ST. LAKFiWOC1D. CT) IW2E fltOtiE:(1D1p44OFA14 VI'1 If ofV REVISIONS S em OPIUM aft OOZED a PLOT o.rt ilatf wrClsCrrvr 23 18 JLP 5 a 5/23/18 N.T.S was a rqp MaD/ 0083 -NF 9 16 MEGa 5815 5 -AR -K 1 SHEET NO. 035 OF 038 EXHIBIT "A" - SIMPLE ACCESS DESIGN Define: SURFACING: R.O.W Width of access exclusive of radii Radii Profile Angle if other than 90° Surfacing -- material type (asphalt, grading, concrete class, total thickness, individual mat thickness for asphaltic materials) Curb and gutter type/dimensions/material Permanent signing or pavement markings necessary Drainage features — culvert type and size (no RCP in ROW), no increased runoff to ROW Special or unusual features Any landscaping in ROW S.H. No. \G5 Width 4 10' ii„ew fl"1? rr eV111111 grr e--e--110400) --e--h"u40i) J r White Line Center Line z TEMPORARY ACCESS ROAD EXHIBIT I I PROJECT CENTERLINE TEMPORARY ACCESS ROAD PARCEL BOUNDARY 1583.52 FT 206.79 AC aarateaft "'` ifte « isolation' a sose+sty {701 foot wide ship of land to be used as ternpornry consirJc flan irpressiepre►s. Rooms•� ay be upgraded or developed as needed for specified traffic. This eARibit does rot ropresent o boundary survey and is Intended to portray v.cecs rQor4 vse only. _-S PROPERTY OF: JEM RANCH INC CHEYENNE CONNECTOR PIPELINE WELD COUNTY, COLORADO AFE 70066 SCALE: 1" = 0.13' DATE: 3/20/2018 AFFECTED TRACT NUMBER: JEM RANCH INC DRAWING NO.80 / TAR -073 DRAWN BY: SH CHECKED 8Y: AL REV. Seed Mix 1 - Elevation: Mid Temperature: Warm Humidity: Average Grasses EXHIBIT "C" A4 1. Big Bluestem —15% (3.6 lbs/acre) 2. Fringed Brame — 10% (1.5 lbs/acre) 3. Sand Lovegrass — 10% (0.2 lbs/acre) 4. Green Sprangleroot — 10% (0.6 lbs/acre) S. Little Bluestem — 10% (1.4 lbs/acre) 6. Sandberg Bluegrass — 10% (0.3 lips/acre) 7. Prairie Junegrass — 10% (1.3 lbs/acre) 8. Sideoats Grama — 10% (2.2 lbs/acre) Forbs15hrubs/Flowering 1. Yellow Spiderflower — 6% (2.1 lbs/acre) 2. Desert Verbena — 3% (0.2 lbs/acre) 3. Palmer Pestemon — 3% (0.2 lbs/acre) 4. Sulpher-Flower Buckwheat — 3% (0.5 lbs/acre) Seeding Application: Drill seed 0.25" to 0.50" into the topsoil. In areas that are not accessible to drill, hand broadcast at triple the above rate and rake 0.25" to 0.50" into the topsoil. Mulching Application: 1.5 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre. Note: Hydroseeding and/or Hydromutching will not be allowed. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED CDOT Permit No. 419062 State Highway/Mile Post/Side 085E / 303.546/Left Local Jurisdiction Weld County Permittee(s): Applicant: Lazy D. Grazing Association 12609 County Road 120 Rebecca Lieders Carr, Colorado 80648-9603 Cheyenne Connector Pipeline, Inc (970) 381-5397 370 Van Gordon St Lakewood, Colorado 80226 (303) 763-2981 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By n (X) / , ��-q71//�1-- Title Assistant Access Manager Date 05/10/2019 opy dis ution: Required: Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector MTCE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT CDOT Permit No. 419062 State Highway No / Mp / Side 085L / 303.546 / Left Permit Fee Date of Transmittal 1 Region / Section ! Patrol / Name Local Jurisdiction $100.00 04/23/2019 4/01/20 Weld County The Permittee(s): Lazy D. Grazing Association 12609 County Road 120 Can-, Colorado 80848-9803 (970) 381-5397 The Applicant(s): Rebecca Lieders Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 (303) 783-2981 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 access is located on US Highway 85, a distance of 2,882 feet north of Mile Post 303 on the westileft side. Access to Provide Service to: (Lend use Code) 994 - Temporary Construction Access 997 - Agriculture (size) 8.83 (Units) Acres 1 Each Additional Information: MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. _— -----_- Signature Print Name Date Title _. i 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 Bruce Barnett with the Colorado Department of Transportation, 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 conditions. Pe+e' Signature: y`'� _/) Print Name / Date / ee L LA 4ri'e_�-{ S i fain/5 C/o -Pe Signature: (if applicable)...et&IO Print Dates) This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION Signature P Name i Title Date (of issue (R/17)--714/71"-----' n VIA Acc I-. kcce iw slto/W, py Dptlbutlon: rcequrreo: 1.Region 2Applicant Make copies es necessary tor. 3.Staif Access Section Local Authority Inspector 4.Central Files MICE Patrol Traffic Engineer PrwAoua ridden* are obsolete and may not be used Page 1 of 3 COOT Form #101 5107 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 80 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the 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. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the Internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 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 extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction Is anticipated, and include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. My person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4] 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the 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 easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from Initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the 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 the Department or issuing authority to initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the 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 Department and included in the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required spedfications of design or materials. If any construction element falls within two years due to improper construction or material specifications, the permittee shall be responsible for all repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. B. The permittee shall provide construction traffic control devices at ail times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or 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 Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which Is allowed in the permit shall be repaired immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, Its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact tie local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or Issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee Is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications In which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO DEPARTMENT OF TRANSPoRT'AliON Environmental Qranos.lnbn__ Summary PURPOSE perform encountered environmental work - environmental related This or cultural. summary to their resource own permits/dearances is intended facilities permits/clearances to inform (such that within; as Utility, may eider Special apply maybe to required -their i to Use or activities. in OT' Aces certain that instances. may Petmittees.), This listing be entering is Appropriate about not the all-inclusive state some local, highway of the - state more additional d and commonly federal #o agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific Re. uirements activity. IMPORTANT May Reautt h�Suspenslon - Please Review or Revocation The Following of Your Information COOT Per, Parr*, Carefully Or EtlbreernentActions — Failure to Comply With Q�- Regulatory rJ.Igenc#es, _4 CLEARANCE may • be Colorado . contacted Water Environmental Department CONTACTS Quality for additional Conbt Permitting of Public l • information: Division As Indicated Website Health (WQCD): and N•to In the Environment -itwein (303) permit/clearance 692-3500 (CDPHE): vi descriptions General ciajcaot information listed all -oat below, as it$ the (303) following 892-2035 individuals or agencies • CDOT Water Quality Program Manager: (303) 757-9343 a ...a.c . -,� .,E,tr �r- ti v!ro�-. �" �,4 � � �K: '.mss • ..; - i l,-. • • • COOT Colorado U.S. Omaha htto://v,ww.awc.ucac*.arrcy.miiV?Lcs:or, Army Asbestos Office Corps District Project of (NE of Archaeology Engineers, CO), Manager. Denver. and District Phil Office Historic Kangas, Regulatory (303) � Preservation: cu (303) 979-4120 Offices: ryc:• 612-5519 oitr/{'. (303) 866-5216 lorodotasrm ..i'�..� Sacramento Disc. (Western CO), Grand Junction Office (970) 243-1199 tglf wIzw.O!c.usace.a ya t ?:; i nsi e l >ri Albuquerque ilkw',rv.k:ixtt District sace.ormv.i (SE. CO), nil/ Pueblo cis: Office �� ii (713}643-9459 torvP. r n'i rntta.aipx +,, CDOT UtliWe®,.Special Uss and Aeons Permitting: (3031757-9664 iitti sJla .c dot.�:wlousirjess� �rs . V1�1 d Resources � • Disturbance of wildlife stall be avoided to the maximum extent practicable. Entry i�._. to areas of known or suspected threatened _ or endangered species habitat veil require special authorization from the COOT permitting office. If any threatened and Authorization the CDOT or endangered must Regions be provided Permitting -species by are COOT Office encountered and prior to Region the during continuation Planning the progress end of Environmental work, of the Information permitted Manager about work, than threatened work be in the contacted or subject endangered immediately. area shall species be halted may be obtained from the CDOT webslte, ilito://www.aarlotgovI0rogranskinviranmentAliwildilfelaultlitolinag, or the Colorado Parks and Wildlife p (CPW) website, . ' � � ;, Jlk 4.y .. � o: ��.�-�.��.��-3. • arrah� �� :��C~Thr •..: �t , -��E �no� �1��.� � •p� Additional . guidance may be rovided by th, a ap;rojariate ReAion.PIanni '� anti Erniirtnnerstal . cultural Resource, - The applicant mud request a file search Of the pertnit area through the Colorado Office Archaeology of and Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously been identified (b ://tjnid.;:: 4zhra10a . - a a crch). Inventory of the permit area by a qualified cultural resources specialist may be lnttiatton necessary, of per the the permitted recommendation work or are of encountered coot if archaeological as the project sites/artifacts progresses,. all or historic work in the resources subject are area known shall to be exist halted prior and to the the CDOT Regional provided RPEM. by Contact Permitting CDQT Information: prior Office to and the continuation Region Qonct Planning the of QAHP work. and for Environmental Additional file.searches guidance at Manager (303) may shall 866.5216~ be provided be contacted by the immediately. Regional Permitting Authorization Office must and be f olegntp)pp1ca R.esQur - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder (h#i;//twi i -Jlcim Anains.cra aurhi. :reIt os' col yt ' .:.u/rn ai eareimlpal: -3Tadanc onto. iilectio lvar :&) b to ies! ascertain )4cleajg if paleontological and the Denver resources Museum of have Nature been previously and Science Identified recommendation CDOT Regional In or near Permitting of the CDOT. permit If Office fossils area. and Inventory are Region encountered of Planning the permit during and area Environmental the by permitted a qualified work, Manager paleontologist all -work shall in Pe the contacted may subject be necessary, area immediately. shall per be the hatted Authorization and the In must Manager the be Permit provided Special Information, by .COOT Provisions, prior Coact to the Contact continuation Informant" CDOT Paleontologist of work. See the Additional for museum guidance websites may listed be at provided above by for the Paleontological Regional Permitting Collections Office contact the further Information ettat. m .�.,, - "zergo or (303) 757- 9632. The COOT Paleontologjst.wlil not conducttoomprehansive file search independently_tthe museums. Hazard ,fir, rla!e,.. oIid W • The Solid Wastes Disposal sSites and Facilities Act C.R.S. 30-20-100, et al, and Regulations I Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved ppro+red Certificate of Regulations Designation (6 (a CCR landfill 1007-3) permit). prohibit The the Colorado transfer, Hazardous storage Waste or disposal Act (TSD) C.R.S. 25-15-301 of hazardous et al, waste and the. except Colorado at permitted Hazardous TSD sites. Waste There are generated permitted solid etc.) no waste Is permitted encountered by facility or the hazardous landfills activities or designated during or materials TSD of the entities collection perforMance sites entering contamination within point the of the State (e.g., work, State (Including for the Highway Highway solid permittee waste, oil or Right Right petroleum shall a of utility of Way: halt Way- Therefore, must or construction contaminated work in be the removed affected ail solid company's soil, or from asbestos, area hazardous the and own ROW chemicals, immediately dumpster). wastes and disposed Mine that If contact pre-existing might tailings, of the at be a • CDOT Hazardous Regional T.. Materials Permitting Management _ _ T office -for direction S�[ en4son 'ice—�. as t30,3) to how 512-5024.. to proceed. •err Contact Information: Theresa Sentan gSoeDreltng, CDOT *Co ies__ M I tm Eater cis. Ail altos C minatod 8o j R RI work on asbestos containing materials (ACM) must Comply With the as applicable ntarnlnated requirements soil, of must the CDPHE comply_ Alr with Pollution the .Control CDPHE Hazardous. Division's (APCD) Materials Regulation a Il aete 8. Disposal Management of visions ACM, and (HMwMD work done Solid in Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation August 2017 Infix Mate authorization Additional CDPHE Regulations. information is APCD being The -and requested. concerning application HMIWMD Additional Regulations clearance for any COOT guidance gin can permit ;DST or be accessed must requirements protects s via the is available telly may CDPHE -identify be from specified Environmental any the ACM In COOT the invoked permit Asbestos Permitting In special the Project Website war#c -provisions. Manager for listed which Contact above. (303) 512- 555518 or Theresa Santen eto-Dreiiina Hazardous Materials .Mane) amain Super or J.39_3) 612-5524. .person .T--. L�-P a ?ranaooltafion of Ftanrdous Materlais -•Ho may offer or accept a hazardous material for tn3nsportatlon iii commerce unless that hazardous person is material registered must in conformance be properly classed, with .the described, United States packaged, Department marked, of labeled, Transportation and in condition regulations for at 49 CFR, Part 171: The shipment as required or -authorized obtain authorization Registration authorization by applicable and 303 more 969-6746. and requirements; a info State call Colorado the HAZMAT Federal or Public an Permit exemption, Motor Utilities from Safety the Commission: approval Carrier Colorado AdMInistration, or registration Public 894-2868. Utilities has US Commission. been DOT issued. for inter- Vehicles Contact and intra-state lnformatlon: requiring HAZMAT a placard, For must T� _ Dred� Mliat 404 Permits Administer$ . r am., �pharus of rFill ai — iv ttr .V•8, , _Co Encl era r; , Water Quagv Certifications IssuerappHE WQCp - Corps of Engineers 404 permits are required for the discharge of dredged nationwide line would activities be or required. fill permits, materials- (nwp #12). If which an into Individual are Depending waters Issued of 404 the for upon ectivitles permit United the is specific States, with required, relatively circumstances, including section minor 401 wetlands. It impacts. water is possible There quality For that are certification example, various either there a types "general" from Is the of a 404 nationwide or CDPHE permits, Individual* WQCD permit Induding 404 is for permit utility required. contact information Contact the above appropriate . Contact Corps the District CDPHE Regulatory Water Quail Office Control for information Division at about (303J what 6924500. type of 404 permit may be required also _ Workine on or In arty to eri1 bank - In order to protect and presents the state's flth and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary to obtain solid 3) streams application, segments blue a Senate having line of as on per steams wetlands Sill USGS 40 guidelines certification 7.5' supporting present quadrangle agreed -within from 25% _upon the or 200 maps; Colorado More yards by COOT and/or cover upstream and Department 2) within Intermittent CPW, or 100 downstream can of yards Natural streams be upstream accessed Resources. providing of the or project at downstream h'tl live i A measured b stream water wt beneficial of is the by et. defined project valley ,1j to as length. fish Q 1) and/or and represented slenvirohnistttall. The wildlife; 4) segments CPW and/or by a of . "::tti�q uldeIIn . - +r $0Fmwater Construction knit 1SCPI and Stormwater Dlschar e7rom Indus Feclttt • Dlscther+ges of sterrnwater runoff from construction sites disturbing one acre or mare - or certain types of industrial facilities, such as concrete batch plants - require a CDPS • Stormwater Permit Contact lnfonnatlon: Contact the COPHE t Water and Quality ��ti •�:llc Control fora Division at (303) �.koc 692-3500. 'ire' Website: t�, � ,� ►^.nom • • �! ✓ gcRAd 1 io-he/► S c<onstn 7 chaste }� sn aj)ti yy • � s t P . novitr : y% c' ��'.71 iT►I {Ki'f.�'v+�Ji „ Iii � a nd- )ndustrx-peirnits. Construction Dewaterintiajechuste or jnffi on) and Remediatlop ActivItles - Discharges of water encountered during Information: excavation 3500. For or AppiicatlOns work For In Construction wet and areas instructs Dewatering may require, iCDPHrE and a Construction Remedlation websitei: --'._= .... Dewatering Activities s:/lvwv,r..�torado�Qc or Discharge Rernadlatlon Permits, ,21.. Activitles +. ; contact /c Discharge the CDPHE natr,enerakpern Permit. wtt WQCD Contact at (303) 692- . MJnicIDaJ §eoarate Storm Sewer ..r SWUM, (MSC p1 chpme P i% - Discharges from the storm sewer systems of larger facility municipalities, by municipality's the the applicable CDPHE. should contact and MS4 provisions WQCD. from permit. the the For municipality of All COOT facilities the discharges Colorado highway that regarding lie to Water drainage within the starmwater COOT Quality the system boundaries highway Control that related Act, lies drainage of dearanoes the a within municipality system Water those that Quality or municipalities, that may within Control is have subject the been Right Commission are to an established of subject Way MS4 (WQCC) to permit (ROW) MS4 under the Permits must Regulations that owner comply issued of such with • r`'. slitAnivv.c olorado.• ov/ estrus ?laity • criatiors o-ocic a�-an -' a tar u 'ft .. ion) and the CDOT i IS4 Permit # COS - 000005 (i-f :~:IN .f o .gcrJ/omcgnrnt eavi rrer#galAttatlr-cw.litviciov.gr lit). Discharges are subject to Inspection by CDOT and MS4 CDPHE. Pests, Contest or go to the httpS:il CDPHE ystnw.> Water doxiati..cificbdoea Quality Control Division t^sop at i (303) iaai 6924500 tnsd .grtniti. for a -listing For of CDOT-related municipalities MS4 required regulations, to obtain go to: • .. i sth Azttiot ov/ ro•ramsf: u; • r ' MS/water- t i t /stet ;y ter. • r`•� n html Generaf-Prohlhtlon.— Dteclutraes - All discharges are subject to the provisions- of the Colorado Water Quality Gantt! Act and the Colorado automotive 692-3500. Discharge itulds, solvents, Permit Regulations. oils - or soaps and Prohibited sediment. discharges Contact include, Information: but -- are Contact not limited the = to, CDPHE substances Water such Quality as wash Control water, Division paint, at _22_ - - - __ _ - = . -General Authorization • Allowable Non-Stormwater DlsCharges • Unless otherwise identified .by COOT or the WQCD as significant sources Discharge storm uncontaminated activities. of sewers, pollutants Permit Alllowable discharges System springs, nonestomiwater to the footing waters permit from potable drains, of landscape the discharges State, water water Irrigation, sources, line the can following flushing, be diverted foundation found flows discharges stream from under drains, Illicit riparian flows, to air Discharge stormwater uncontaminated conditioning habitats POD systems and condensation, at: ground wetlands, are :than allowed water irrigation and *.,v.rt�t: flow without infiltration from water, vhor�aorarnsl. a firefighting Colorado to separate sn9iroM antaVkwat --opalit/s rni ate rogrems.l ml. • Contact Information: The CDPHE Water Quality Control Division (telephone • 'We listed -above). Jrosion 410 Sediment Contrial.Pliottites I- Fit actfrides resoling a Stormwater Construction Permit, oration- Until tequtrerhertts Will minimize to specified erosion in that and permit. sedimentation in situations where according a to COOT stormwater Standard permit is- Specifications not required, 107.25, ail reasonable 208, 213 and measures 218 should t be tiociot,t taken tw/ to -, bus►in s/ st nsuoport1201'l- ors 'donts; saif tlonst2011.-Speesi' :11 c _ t; •.. } Ali disturbances require a stabilization plan, nape seeding or landsc ape design plan according to applicable COOT Standard Specifications 212-217 and 623. The COOT Erosion erosion Control controls and and Stormwater restore disturbed Quality Guide vegetation! (available from the Sid _ - Plans Office at (303) 75;t-9313) should be used to design Environmental Clearances Information Summary Page 2ofS Colorado Department of Transportation August 2017 Disposal Qf Dirlllinn Fluids - Dn'lling fluids used in operations such as Horizontal Directional Drilling may beedi ssifted as °discharges' or `solid of Way, sewers, Waste separated required regulations. and roadside wastes,` from for disposed proper and ditches fluids Small drilling in of or general, at or after quantities properties, permitted any infiltration other should facilities of small type drilling of be the of pumped that quantities man-made fluid water, specifically solids or provided: of vacuumed polymer or (less natural accept than 1) the from waterway 1 additives such cubic driidng the construction wastes. that yard fluid is prohibited are of consists Disposal solids). approved area, by may of removed of Water only for drilling be water use left Quality in from fluids on and drinking -site the into Control bentonfte after State storm Water either Highway and/or clay, well drains, Solid being or, drilling; storm if Right . 2) the solids area restored Cow CDPHE are fully as required (telephone contained in by COOT Vs a Bated pit, and permit above): are not requirements likely to (Utility, pose a nuisance Special Use, to future or Access work In the. Permits, area, etc.). 3) the Contact solids are covered Information: and the. Spedes _ Nb*Jous Weeds Ind Invasive Sorittliannement Plan - Noxious Weeds- end Invasive durdanoe can be found by contacting the Colorado Department of Agriculture On-, r NIL •• * cread w 1 J g,:01:. . '-') and the Colorado Division of Parks and Wildlife (-Ettie7.. •?).:.,:119.;„*".- . i.,.:: s-: , ,cje RSNo:d us1'1 r -,,:. •9x). In either case, Management plans involving the control of noxious weeds associated.wlth the permit ac tvtti and cleaning of equjpment will be required. Can waters, 1Naah or In the CDOT - Waste ROW. generated Concrete front waste concrete shall adtivitles be placed shall in a temporary NOT be allowed concrete to flour washout I frito the facility drainage and ways, must be meets, located tacitlytnit a minimum Environmental of 50 Program feet from state and shalt waters, be in drainageways, accordance to caas:/hwv and COOT inlets. specificaations Concrete washout and sguidelines. sha only Contact be performed `4-C information: as specified Contact `- by the CDPHE CDOT or find additional Information on the CDOT website: r. t4 vii i i1am 1 , aiicia tic al :. ! ,-, ,�,�, w. .. ficliti 6A-,: r . �i 1- I and refer to the sp scifiic�ons and their revisions for sections 101 107 and 208. Spills SOME NOT be _ Soul Renorttnct - shall be contained and cleaned up as soon as possible. shad washed down into the storm drain Permitting exceeding or buried. Office 25 gallons, Aft and spills Regional or shall that be may Maintenance reported otherwise to the Supervisor. present COOT an illicit immediate Spills Discharge on highways, danger Hotline to into the at (303) wad, public 512-4446 shall any be *(4142O), spill reported in the as by calling well highway as 911, the right-of-way and Regional shall also be reported to the CDPHP at 1-877-518-5508. More information can be found ate: m• nvzmIcr ? + ,4 , f .3- weir:* raoor1}sl c4fifSa . . • ` About GIs Paten - Questlorts or comments about this Idfornteaon Summitry may be di eded II Ilex Kai poognarn Administrator, .COOT ACC SS Management Unit, at (303) 757-9841 alex.loe I , state.co.us: Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation August 2017 COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowmen flows over the ground. impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is stormwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow Into CDOTs storm drain system or directly Into a stream, river, lake, wetland or reservoir. Anything that enters dots storm drain system is discharged untreated into the waterways we use for fishing, swimming, and providing drinking water. Tips for Reporting an llltdt Discharge Call the illicit discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach l Call *CSP for illicit dumping. If possible, take a photo, record a license plate. Never get too close to the Illicit discnarge, it may be dangerous/II For more information on CDOT Utility Permits: http , Lwww.codotgovlbusinesWpermitslutili�t'e sspecialuse For more information on COOT Access Permits: htt_.ps. jwww.codot.govibusinessjpermitsJaccess permits For more information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222 303-757-9343 'COLORADO Department of Transportation Water Ctia11P t ri gram Industrial facilities erg cram COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment. The permit states that only stormwater can be discharged from CDOT's storm drain system No simarpipasefr • TOME n S ad...t,. drain Sect ado Ian Pim mTKaoaL WATIRBODY As part of the permit, CDOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program New Development Redevelopment Program Illicit Discharge Program Industrial Facilities Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program ii COLORADO Department of Transportation Control Measures for Industrial Facilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices (BMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into COOTS storm drain system. Control Measures also Include treatment, operating procedures, and practices to control site run off which can include structural and non-structural controls. . SIT WE, GAUNTLET MSS I MSS, ear . &et. OTIS et MUM OP FUR 1;1 V slit— ilittansge in wwplisncell CDOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: if Communications ✓ Cable television ✓ Power ✓ Electricity ✓ tight ✓ Heat Gas t oil ✓ Crude Products ✓ Water ✓ Stream ✓ Waste ✓ Storrnwater not connected with highway drainage f Similar Commodity COLt ER to D Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. COOT has put together an Environmental Clearances Information Summary for those applying for a COOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: http://www.coloradodotinfo/ilrozrarns/ environmental/ resources/ tt lidance- standards/Environmental%20C tearances% 2Qinfo%20$ummarv.pdf State Highway Access Permit Attachment to Permit No. 419062 - Additional Terms and Conditions 1 If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350- 2148. 2 The Permittee or the contractor shall notify Bruce Bamett at (970) 350-2147 at least two working days prior to beginning any access improvements or construction of any kind within the State Highway nght-of-way Failure to comply with this requirement may result in revocation of this permit. 3. The Permittee shall request final inspection by Bruce Barnett at (970) 350-2147 within 10 days following the completion of access construction, and prior to authorized use. The Permittee or their representative shall be present. 4. 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. 5 The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 6. Incorporated as part of this permit are the following: Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No. 101) and its attachments Exhibits. "A" — Access Plan "B" — Vicinity Map 7. 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 be applied for based upon the existing and anticipated future conditions 8 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. 9. 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 10. 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 State Highway Access Permit Attachment to Permit No. 419062 -Additional Terms and Conditions 2 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 permit and be available on the site during construction. 11. All costs associated with any reconstruction of this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. In the event a signal is warranted in the future, CDOT will not" participate in any fashion with that signal installation, including financially 12. The 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 13 it is the responsibility of the Permlttee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details The ECIS may be obtained from the CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction- Environmental Guidance webpage at http://www.dot.state.co.uslenvironmental/Forms/asp FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as. wash water, paint, automotive fluids, solvents, oils or soaps. Unless otherwise identified by COOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit• landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins For additional information and forms, go to the CHPHE website at. State Highway Access Permit Attachment to Permit No. 419062 - Additional Terms and Conditions 3 http.//cdphe.state.co us/wo/PermitsUnit/wuu. 14. 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. 15 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 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. 16 Landscaping and site construction shall not obstruct sight distance at any State Highway access point Landscaping within the State Highway right-of-way requires the Permrttee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other approved system The Permittee shall contact Allyson Mattson at the Greeley Traffic Office, (970) 350-2148 to obtain the Landscaping Permit. 17 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. 18. The Department inspector may suspend 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 19 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. 20. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs 21. The Department retains the right to perform any necessary maintenance work in this area. State Highway Access Permit Attachment to Permit No. 419062 - Additional Terms and Conditions 4 22. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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. 23 Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 24 All materials, equipment, Installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable. A. State Highway Access Code, 2 CCR601-1 B. Roadway Design Manual C. Materials Manual D. Construction Manual E Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G Manual on Uniform Traffic Control Devices (M.0 T.C.D.) for Streets and Highways and the Colorado Supplement thereto H. A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I. AASHTO Roadside Design Guide J. Institute of Transportation Engineer's Trip Generation Manual, 6th Edition Some of the reference materials listed above (A through E) may be purchased from: Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from. The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is. www.cdoteov 25 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 State Highway Access Permit Attachment to Permit No 419062 - Additional Terms and Conditions 5 CFR Part 1910 — Occupational Safety and Health Standards and 29 CRF Part 1926 — Safety and Health Regulations for Construction At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment' • Head protection that complies with the ANSI Z89 1-1997 standard, • At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI 241-1999 standard will be worn • High visibility apparel as specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2) Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply 26. 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. 27. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight 28. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement Backing into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority. 29 Traffic detours or lane closures will not be allowed, unless pre -approved by the Department 30. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. 31 Construction traffic control devices, when not in use, shall be removed or turned away from traffic, Devices must be stored outside of the roadway clear zone per the latest AASHTO guidelines. 32. Cattle guards are not permitted in State Highway right-of-way 33. If State Highway right-of-way fence exists or is proposed, the Permittee must contact Bruce Barnett at the Greeley Traffic Office, (970) 350-2147 prior to removal or installation. The Permittee will be required to obtain a highway right-of-way fence agreement for a special fence if the Permittee desires to remove the existing standard highway fencing in this area When it is necessary to remove any highway right-of-way fence, the posts on either side of the access entrance shall be securely braced with approved end posts and in conformance with the State Highway Access Permit Attachment to Permit No. 419062 - Additional Terms and Conditions 6 Department's M-607-1 standard, before the fence is cut to prevent slacking of the remaining fence. All posts and wire removed shall be returned to the Department. 34 Any access construction shall be completed In an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highwarright-of-way 35. All required access Improvements shall be installed prior to the herein authorized use of this access. Failure to do so will result in the appropriate legal action from the Department, up to Permit Revocation. 36. The access shall be constructed as a minimum as per Exhibit "A". Upon completion of the construction the access shall be returned to as good or better condition. 37. If necessary, the access shall be reconstructed 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. 38 No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching. Full panel concrete replacement is required for any concrete work. 39. If frost, water, or moisture is present in the subgrade, rio surfacing materials shall be placed until all frost, water, or moisture is gone or removed 40. The access shall be reconstructed and maintained in such a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way Drainage to the State Highway right-of-way shall not exceed historical rate of flow 41 Ali 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. 42 The use of this access by the Applicant is only until 03/01/2020 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION 1Issving authority application acceptance date: y/� // L Instructions: - Contact the Colorado - Contact the issuing - Complete this form Department of Transportation (COOT) authority to determine what plans and other (some questions may not apply to you) or your local documents and attach government to determine your issuing authority. are required to be submitted with your appon. all necessary documents and Submit it to the issuing authority. Please print - Submit an application for each access affected or type - U you have any questions contact the - For additional information see C0OT's Issuing arthoniy. Access Management website at httpl/www.dot.state.coasJAcceasPermilsrmdexittm 1) Property ' 2) Applicant Agent for owner (Permitbee) Lazy Z) Grazing Association or permfttee (if different from property owned Cheyenne Connector Pipeline, Inc Street address Mailing address 12609 County Road 120 370 Van Gordon Street tCity, City, state & zip Nunn, CO 30648--9603 Phone # 970-381-5397 state & rip Lakewood., CO 80228 phone # (required) 479-306-8807 E-mail address lazydcli me grati 1. coza E-mail address rsbecca1ieders ff available c sum trasourcaslad . cos 3) Address of property to be served by permit (required) US Highway 65 4) county Legal description of property: If within jurisdictional subd,'vfston bra limits of Municipality, k city and/or County, k1 which one? seaian township range We', d I j I 17 1 JUN i 6611 5) What State Highway are you requesting access from? 6) What side of the highway? _ IV State Highway 85 Q S OE • W 7) How many feet is the proposed access from the nearest mile post? r How many feet is the proposed access from the nearest cross street? 2875 303 2246 IN Weld County Road 128 feetINIIs0EUw from: teat ill SDEp)from: 6) What is the approximate date you intend to begin construction? 4/1 /2019 _ __ 9) Check here It you are requesting a:Ei new access Cj emporary access (duration anticipated: 4/1/19-12/31/19 ) Ill improvement to existing access change in access use is removal of access flelocation of an existing access (provide detail) 10) Provide Agricultural existing property use access point 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? ti no D 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? 11 no 13 yes, if yes - please describe: Sec 20 -Two 11N -Rog 66 w (South) Art14 Sec, B --Two 13.N-Rnq 6611 (North) 13) Are there other existing or dedicated public streets, roads, highways or access easements bartering or within the property? Xi no • yes, if yes - list them on your plans and indicate the proposed and existing access points. 14) If you are requesting agricultural 15.44 AC field access - how many acres will the access serve? 15) If you are requesting commercial or industrial access please Indicate the types and number of businesses and provide the floor area square footage of each. business/land use _ square footage __ business square footage family, 16) if you are requesting residential developement access, what type is the type (single apartment, townhouse) number of units type and number of units? number of units I __ 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. s of passenger cars and Eifttt tucks at peon hour vdumea mutt! un?1 crud as peak how volumes Indicate if your counts are lid t]peakhourvotucnes or javerage daily volumes. SC 25 it & engte unit vehicles in excess of 34 ti E c of farm veldt* equipment) 9 Total count of all vehicles 9 a Previous editions are obsolete and may not be used Page 1 of 2 CDOT Fonn 0127 01110 Co4oe-99(. a 18) Check with the issuing authority to determine which of thefolawmg documerds we required to cor mtete the review of your apprd:8bon. a) Property map indicating other access, bordering roads and streets b) Highway and driveway plan pmfde. c) Drainage plan stowing impacttothetdghway right-of-way d) Map and letters detailing utility locations before and after development !nand afongthe nghtoFway e) Subdivision, zoning, or development plan i) Proposed access design. g) Parcel and ownership maps including easements. h) Traffic studies 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 administenng 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://vnivw.dot.state.co.usfenvIronmentaUFonns.aeo 2- All workers within the State Highway right of way shall comply with their employer's safety and health polices/ 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, heanng protection, respirators, gloves, etc.) shall be worn as appropriate for the work being performed, and as specified in regulation. At a minimum, all workers m 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 289.1-1997 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 Amencan 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: ‹htto://wtvw.dot.state.co.us/ClesionSupport/>, 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 erjury 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. Applicant or Agent for Permittee signature Print name Rebeccc-, :riodyrs Date 2/4/2019 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 wntten 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 pernittee. Properlyownersignatuie Print name Previous sedans are obsolete and may not be need Page 2 of 2 COOT Fomi @757 01/10 NATURAL GRADE NOTES: 50 FT MINIMUM 10' MIN UNIMPROVED GROUND Ayr}+� .e` i ill:a X- .?AA fs_ 1 BERM 3' WIDE x 2" HIGH RADIUS = 20' MAX PLAN VIEW 50 FT MINIMUM CLEAN ROCK FILL 2'-4" MIN GEOTEXTILE -� FABRIC AND GEOTEXTILE GRID, AS REQUIRED PROFILE 1r 1 10' EXISTING ROAD PAVEMENT 10' EXISTING ROAD PAVEMENT I' CONTRACTOR TO PROVIDE AND INSTALL CULVERT (18" MIN FOR CDOT) (15" MIN FOR WELD COUNTY) 1 ACCESS PADS, AS ILLUSTRATED ABOVE, ARE TO BE INSTALLED ADJACENT TO ALL ROAD CROSSINGS 2 IF USED IN AGRICULTURAL LAND, ROCK SHALL BE PLACED ON A GEOTEXTILE FABRIC TO FACILITATE ROCK REMOVAL 3 SHOULD THE ROCK PAD BECOME INEFFECTIVE FOR REDUCING THE BUILDUP OF MUD AND DIRT AND MINIMIZING TRACKING ONTO THE PAVED ROAD, THE CONTRACTOR SHALL WASH THE EXISTING ROCK FILL SURFACE OR ADD A ROCK FILL LAYER TO THE ACCESS PAD 4 CONTRACTOR SHALL KEEP ROAD SURFACES CLEAR OF MUD AND DEBRIS 5 CONTRACTOR SHALL REMOVE ALL IMPORTED ROCK FILL MATERIAL, GEOTEXTILE FABRIC AND CULVERT (IF INSTALLED) AND RESTORE THE GROUND TO NATURAL CONTOURS UNLESS OTHERWISE DIRECTED BY COMPANY'S INSPECTOR 6. CONTRACTOR SHALL MAINTAIN A MINIMUM 2% GRADE AWAY FROM ROADWAY FOR A MINIMUM 20 FEET FROM EDGE OF ROAD REVISIONS DATE DESORPTION BY #Y(CJ.PPR 02/77/0* 2 a7/17/0E ISSUED FOR ROOM REVISED PER OIERT C01ma11E ENO RE730E REID= RLVKm PAR CORK F1PILGE ROOM PER CO= RO7 RDORED POE 090E PRO. Fe FEI m E71 a i 4 a a 07/0I/D5 0a/Ivia 11/20/Ia 11/10/18 s w re OI 009 TALLGASS t DRAWING DEPICTED IS SUPERSEDED Br WRIER STkm7JID, SCOPE OF WORK Oft EDC: UST maxxotasas 'awe. TYPICAL ROAD ACCESS PAD DATE. 11/20/18 SCALE. N.T.S. IAPPROVED BY CST -P -1000-A145 SH 1 0 1 L'Xftr iT II °L-Hc0(Z TEMPORARY ACCESS ROAD EXHIBIT GRAZING PROJECT CENTERUNE TEMPORARY ACCESS ROAD PARCEL BOUNDARY 1369.93 FT 644.52 AC Description: A seventy (70) foot wide strip of land to oe used as temporary construction ingressfegress. Roodwoy may be upgraded a developed as needed for specified bottle. Note: This eAttJt does not represent a boundary survey and is intended to portray access road use only. PROPERTY OF: LAZY D GRAZING ASSN CHEYENNE CONNECTOR PIPEUNE WELD COUNTY, COLORADO Ai! 70066 SCALE 1" as 0.13'1 DATE: 3/20/2018 *EfiCiiD TRACT N*MIEt 0:1111/41-996.000 DRAINING NO.73 /TAR -0i7 CHECf ED RY: AL REV. t L COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED CDOT Permit No. 419068 State Highway/Mile Post/Side 085E / 304.412/Left Local Jurisdiction Weld County Perrnittee(s): Applicant: Lazy D. Grazing Association Rebecca Lieders 12609 County Road 120 Carr, Colorado 80648-9603 Cheyenne Connector Pipeline, Inc (970) 381-5397 370 Van Gordon St Lakewood, Colorado 80226 (303) 763-2981 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By 4'1(1(. — (X) � Title Assistant Access Manager Date 05/10/2019 opy arsvrnutron. —Required: Region (original) Applicant Staff Access Section Make copies as necessary tor. Local Authority Inspector MTCE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT CDOT Permd No. 419068 State Highway No / Mp / Side 0851 / 304.412 / Left Permit Fee $100.00 Date of Transmittal 05/06/2019 1 Region I Section / Patrol / Name 4/01/20 Local Jurisdiction Weld County i The Permittee(s): Lazy D. Grazing Association 12809 County Road 120 Carr, Colorado 80648-9603 (970) 381-5397 The Applicant(s): Rebecca Ueders Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 (303) 763-2981 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 duty appointed agents and employees shalt be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit Location: The access is located on US Highway 85, a distance of 2,176 feet north of Mile Post 304 on the west/left side. Access to Provide Service to: (Land Use Code) Additional Information: 994 - Temporary Construction Access (size) 6.83 997 - Agriculture 1 (Units) Acres Each MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature j Print Name Date The Upon the signing of this permit the permittee agrees to the terms and conditions and referenced attachments contained herein. Ail 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 Bruce Barnett with the Colorado Department of Transportation, at (9T0) 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 conditions. Permittee Signature: Print Name t Date t I-CGf LA Q4E'tr' ael9e((4 Liect- r5 gJ`% /c0.19 Co Permlttee Signature: applicable) Print Name Date This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION Sign t tpre Print Name Title Date (of issue) Copy Distribution: Required: 1.Region 2.Appticant Make ironies as necessary for. 3.8taft Access Sector Local Authority inspector 4.Ceniral Files MICE Petrol Traftic Engineer Previous edition, are o ... : and may not be used Page 1 of S CDOT Fonn 1101 5107 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the 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. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, If the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 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 extension. When the permittee is unable to commence construction within one year after the permit Issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and indude a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4) 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the 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 easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the 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 the Department or issuing authority to Initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the 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 Department and included In the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or Improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element fails within two years due to improper construction or material specifications, the permittee shall be responsible for aN repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4.104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or 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 Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -In -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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. Within unincorporated areas the Department will keep access everts clean as part of maintenance of the highway drainage system. However, the permittee Is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 COLORADO DEPARTMENT OF 1*ANSPORTA1ION Environmental Clearances Information Summary . PURPOSE - Ni summary is intended to inform entities external to COOT that may be entering the state highWay right-of-by/ay to perform work related to their own facilities (such as Utility, Special Use or Access Pennittoes), about some of the more commonly encountered environmental pen-nits/dearances that may apply to.their activities. This listing is not all-inclusive - additional environmental or cultural resource perrnitsldearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT — Please. Review The Following Information Carefully— Failure to Comply With Regulatory Re.gulrem s Ma Reselt In_Suspension.or Revocation of Your COOT Permit, Or Enforcement Ammons B1: Other Agencies. CLEARANCE CONTACTS • As Indicated in the permit/clearance descriptions lamed below, the following htdIVIduets or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 6924500 Environmental Permitting Webs#te tos:ll l c�lora o.�,tryl rl tcdbh La t • CDOT Water Quality Program Manager. (303) 757-9343':/1► ivsri. d , cgs om i:.; miler n • CDOT Asbestos Project Manager Phil Kangas, (303) 512-5519 • Colorado Office of Archaeology and Hlstaric Preservation: (303) 868-5216 • U.S. Army Corps of Engineers, District Regulatory Offices: Omaha District (NE CO), Denver Office (303) 979-4120 hftp:I/snwv,.ntvo.usec≥.ar ny.rnllk tssions/R®Qu voryPrbgr °nlColorecio,asox Sacramento Dist. (Westem CO), Grand Junction Office (970)*243-1199 hbiiM .w.soft.ussc6.ari y.mill\4'issi - ogu ory pmt Albuquerque District (SE CO), Pueblo Office _(719)L5 43-9459 htto://ww ,spa.us ca.arrny.miliNl lAeg cr!skiin ryP oa�rarnanci 'a its. apA • . CDOT UtiIIdes ..Specie! Use and Access Permitting: c303 57-9654 r s'.1 tint ct.92v1 1Afi l ResQuaiare - Dlsturbance.of wildlife shall be avoided to the maximum extent practicable. Entry Into areal of Ithown or suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. if any threatened or endangered species are encountered during the progress. of the permitted work, work in the subject area shall be haled and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by COOT prior to the continuation of work. Information about Neatened or endangered species may be obtained from the CDOT website, hlzo:Thtroovera;ottiovipmgrornairviiorimantalhalkilifefouiciarsras, or the Colorado Parks and Wildlife (CPW) website, http:II . . w.s ' .c.tixr :.sr 1P~ct OC Thr rig ric :natal i!Jst.asp.. Additional guidance may be ed the approtpdate Re on PIGS, end Emilronmetotal Manager (RPEM). T ufural sources - The � � applicant must requeet a file search of the permit area through the Colorado Office of Arehaebiogy and Historic Preservation (OAHP), Denver, to ascertain V historic or archaeological resources have previously been identified ,..;elf" ttier."-/yoolori:d.it.onioatho qu alified ,� � �,. o��hgtirl3-search}. Inventory of the permit area by a cultural resources specialist may be necessary, per the rscornnnendation of COOT. if archaeological sites/artifacts or historic resources are known to exist prior to the inftiatton of -the permitted work or are encountered as the project progresses, all work in the subject area shall be hafted and the COOT Regional Perrnitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional P.ennitting Office and RPEM. Contact Information: Contact the OAHP far file.searches at 303' 866-5216. ' 1 PaleoftlQ1pg� J 1tesou s - The applicant moat request a fossil locality file search. through the University of Colorado Museum, Boulder {hftos:Ik :museum .ridk redo. riufr arth/pieo oslvlvertratas/ool3c i ), and the Denver Museum of Nature and Science cittim mv.crane,oiaiscier. eitol fiche ar«h4adenoacollo., lone) to ascertain if paleontological resources have been previously identified in or nearthe permit area. Inventory of the peranit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are. encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted Immediately. Authorization must be provided by COOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office In the Permit Special Provisions. Contact it onnatlon: See the museum webeites listed above for Paleontological Collections Manager contact information. Contact the CDOT Paleontologist for further information at arlc,.ryolvevr5itla or (303) 757- 9632. The COOT Paleontologist will not conduct a n i rehe ns{ve file. search inde rend Hof the museums. _ ,431zarcloSaierlatet Sq d Waste - The Solid Wastes Disposal Sates and Facilities Act C.R.S. 30-20-100, Mel, and Regulations Pertaining to Solid Waste Disposal Sites end Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved Certificate of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15-301 et at, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way, Therefore, all solid or hazardous wastes that might be generated by the activities of entitles entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point.(e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum caritarr)inated soli, asbestos, chemicals, mine tailings, etc.) is encountered during- the perforMance.of work, the permittee shall -halt work in the affected area and immediately contact the CDOT Regional Permitting office for direction as to how to proceed. Contact Information: Theresa Santangelo .DreAing, CDOT Hazardous Materials Mitirsement Su ervlsar. Apt5'124fae„ . _ass Asbestos Contslnino _ilals.`Asb�estos Coritapinitgd Soli" Ail workon asbestos containing materials (ACM) must comply with the applicable requirements of the CDPIE Air Pollution Control Division's (APCD) Regulation 8, Disposal of ACM, and work done in as taaninated soil, must con Ip�with the CDPHE Hazardous Materials and Waste Mana: ement Division's (HMWMD. Solid Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation August 2017 c .3 oh OsE 1.tf9g tqd§2am >.,0Moij mO.a me Ps E o 1.. ;t1 E i a820 4 „act, o4 l c� 8g2° c��- C rMZ 0! U �!I8 i!gla i4141 L!aa ��VoQ N c E ries a M r" 6gk!wg cry lig; 'glib ilit p E s .Epici tiagnIgui>8, tie . sei.) thltg Efwgut! E, 6r2rd161°1 ' Ite:"5.81§i Ems. I lit !Mil! 1 zS$c�.-2 §Fa -.gip Cm6lzs II1Jij 1e III1E§ mE,t IMPo c RE .2 21 ItI . . 1144 t1?..0 sPag3roRQd 4taj. vs ;A IiA wte c316go. Q m 1 2co C Q � E ;� 21.> ElO �2 �L e;IregkC 16078W Lodi lgi.: N‘g 03812iI°: ' � E Ih1! c dt rMika('GtEO tt1 _ S c fl =-gym+- a8Ka, DtSg.C58;48suEoS E‘ E tN k dissecig n MEI giaq .co( :c alsooca° ..L tccasa m s!Rig.. alEgnt a EcRendsten to 0 4 PEP wItg.74 Jr ". o � E � , s e�i s >' ginal› gts2, .a .._ O !gl To .a 'fi t 48 Os M. EE .C i§g 1§1'Q 1111 o 03 g:a a § C . fA 0;a2t° C o° ai t.4%, to= 'Sw C fau 81= !gi ES ii; Q t 1 ig e •0 C g `g il° AA -i g o s 41.2. 13 2 ht8i re fiRai.al 82E.Atai -igi 2- 0-cm- ealE41.4§0m_- 4§614 SR (.54,R2E12 IA 01cwctag 111111:51511114 gplar=08 °° -E AwRg wEl, milEEUG2circf.. .flIg � E Eft8 $cU E ocoQ 1"8 ° �m .ggEi®A°ME�� D:Icw v Et r5 tiV8 loog84 6a.=u v Oam 0 0e0 C tig moE a ms45,9 RsEg8 ota flh Srat” ad mita ic Ucoat-c •-eta'a C� o EE E -off lEi 8. SC a �o U E8 11/ 0 �E m ` S(3.4! *� U:-' lb11; .a a 8' U �.v ad r M; V An is -4 ego U o` we) Jic 'no, 813 fts c as '0 i.-a U 8gp fig 11 now a a t) _n: sEt L =g ass c8 121. mat ass Iti r U E-5 14i list! 10„. P If IL aiR w -004 a 4 ,cs $.oCla xtot-FmaCox a s. of licIlg4 2=.8cog ni's" nt-tEtao.c vgpt itc:1129 sof hp° 8 t . g C ma 6 5 E8g _g$r=1. io‘.4`-• 0irkfk3 to - tor1 t5lig chs.'W s, 3z tE$ i SS ea 'Weal o m l . e' g. si r ?WV qi 14% 102_ raw. 06 c' Ilagt m E N �- r" en r Q�V10F1aNe guisag %. 3 r Spv hi, g: es.E. 1.19 he; 11, Im9s• oV Q lent Vc Q .o 0 Z c 181 on sw ofrs ig -2 gra Ai ,.. O. oco ow e s le ai 2; e es o -21 Fel 63 va, 84E tail gg s-22 tame: felg 18§ fie O .0 w ci Gal Colorado Department of Transportation Tis t�sposal of Drilling Fluids Drilling fluids used in operations such as Horizontal Directional Drilling trey bedassifled as "discharge*. or solid wastes," and in general,should be pumped ar vacuumed from the canshuction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantities of drilling fluid solids (less than cubic yard of solids) may be left on -site after either being separated from fluids or after infiltration of the water, provided: 1) the drifting fluid consists of only water and bank:nite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely b pose a nuisance to future work in the area, 3) the solids are covered and the area restored as required by CDOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: contact CDPHE (telephone Ws listed above: , . • . Noxious Weeds and 1 1 �� e, ill ilaeagernent Plat -;• Naodous Weeds and Invasive Species guidance can be found by *oontacting the Colorado Department of Agriculture . hft :1Mtvw.coloredc. Dv ct icon TV lion oxiwssdz) and the Colorado Division of Parks and Wildlife (httb:rT pw stat$.co.4&ab_ acs/RS-No:gousW s.E.cpx), In either case, management ts involving the cont of noxious weeds a .with the activity cleaning .of equipment will be reguiod • • ConcreteyV • Waste generated from concrete activities Skill NOT tie allowed to flow Into the drainage ways, inlets, receiving �ii �i..li\ill Waters, or In the.CDOT ROW. Concrete waste shall be placed In a temporary concrete washoutfacilityand must be located a - minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the COOT Environmental Program and shall be in accordance to CDOT specifications and.guldellhee. Contact Information: Contact CDPHE or find additional information on the CDOT website: h ►:/ttivv t.vibusin daionsupno 201.1-ranatruc•Aocillefstoi-46/20 0 •: s and refer to the s2edficatiOns and their revisions for sons 101 1.07- end 208. Spt#� Reooe#inq - Splits shall be contained and cleaned up as soon as pos 1ble. Spills shall NOT be washed down Into the storm drain or buried. All spills shall be reported to the CDOT fiiicit Discharge Hotline at (303) 512-4445 (41{20), as well as the Regional Permitting Office and Regional Maintenance Superviso-. Spills on hi Into waterwa highways, ys, any spiv in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1-877.518-5606, More information can be found at h, jata.ksinfiaaarere .�. . About This Form -.Questions. . or cOmments about'tbis Informition Sumntryarney be directed to Alex Kararril, Program Administrator, COOT Access. Management that. S (303) 757-9841 el@etete.00 use Cva Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation August 2017 COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowrneit flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is ctorrnwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow Into CD0'T's storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters COOT% storm drain system is discharged untreated into the waterways we use for fishing, swimming, and providing drinking water. M •. r••• • Selltro, t rry,J1 • t eti:ty r ... r . cif AiJ►r i.•^t, i•1� �tC �' •'%/in'f! *li�J-1 • ,`6 d RQ'," • tit? ? tr ^-T Cu :.' . •N `'°y,feef t. nit*. svz4 rir t,. r - .a i Tips for Reporting an Illicit Discharge Call the illicit discharge hotline at 4303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach! Call'CSP for Illicit dumping. If possible, take a photo, record a license plate. /�Gjl/itil?S$ . Never get too close to the Illicit discharge, it may be dangerousill For more information on CDOT Utility Permits: httys:j; www,codot.&Qvlbuiinessipermitslutititie ,cspecialuse For more information on CDOT Access Permits: fhttps:/Jwww,codot.acv/businessipermitswaccess permits For more information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222 303-757-9343 COLORADO Department of Transportation Water CualiP 1 ri Qr am Industrial Iactiltles rrnrani COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (M54} from the Colorado Department of Public Health and Environment. The permit states that only stormwater can be discharged from CD0T's storm drain system mar pip, aet ••,1 ID THE WASTOOAT* TREATIAf NT PLANT cottlk Mario TOM LOCAL wATcbr As part of the permit, CDOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program New Development Redevelopment Program Illicit Discharge Program Industrial Facilities Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program ;r•. COLORADO Department of Transportation Control Measures for Industrial facilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices IBMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into CDOTs storm drain system. Control Measures also include treatment, operating procedures, and practices to control site run off which can include structural and non-structural controls. MEIKEA row J\'; 6NEUAti►P NUM? snot Lti SSWR n1EKLu ftsI n r� STK MA CIONIERLI r In aompiiancell CDOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: Communications ✓ Cable television ✓ Power ✓ Electricity ✓ Light ✓ Heat Gas ✓ Oil ✓ Crude Products ✓ Water ✓ Stream ✓ Waste ✓ Storrnwater not connected with highway drainage I Similar Commodity 4. . •� •... 'lows lag . r - rwti j - .. r • 1' •re, • 4 t •.. • illrik. • }.. .. 44.-rri - COLOR ADO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work In the state highway right-of-way will require some type of environmental permit or clearance for that work. CDOT has put together an Environmental Clearances Information Summary for those applying for a CDOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: http: / /www.cotoradodot.info/proirams/ environmental/ resources/ Ruidance- standards/Environmenta l%2OCtearances% Zolnfo%20Summar v. pdf State Highway Access Permit Attachment to Permit No. 419068 - Additional Terms and Conditions 1 1. If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350- 2148. 2. The Permittee or the contractor shall notify Bruce Barnett 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. 3. The Permittee shall request final inspection by Bruce Barnett at (970) 350-2147 within 10 days following the completion of access construction, and prior to authorized use. The Permittee or their representative shall be present. 4. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 5. Incorporated as part of this permit are the following: Application for Access Permit (COOT Form No. 137) Permit (COOT Form No. 101) and its attachments Exhibits: "A" -- Access Plan "B" — Vicinity Map 6. 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 be applied for based upon the existing and anticipated future conditions. 7. 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. 8. The 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. 9. It is the responsibility of the Permittee to determine which environmental clearances andjor regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from the COOT Permitting Offices or may be accessed via the CDOT Planning/Construction- Environmental Guidance webpage at nnrrfwww not state rn I Pnlr!rnnmpn+ t (Crrr,. 'ast -, FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as: wash water, paint, automotive fluids, solvents, oils or soaps. State Highway Access Permit Attachment to Permit No. 419068 - Additional Terms and Conditions 2 Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CHPHE website at: http:!/rr1ohn.state.co,uslwq Permitslinttjwgt. 10. 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. 11. The Department Inspector may suspend 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. 12. 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. 13. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 14. The Department retains the right to perform any necessary maintenance work in this area. 15. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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 State Highway Access Permit Attachment to Permit No. 419068 - Additional Terms and Conditions 3 Highway. In an emergency, the Department Region Office and the State Patrol shall immediately be notified of possible hazards. 16. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 17. All materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable. A. State Highway Access Code, 2 CCR601-1 B. Roadway Design Manual C. Materials Manual D. Construction Manual E. Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M.U.T.C.D.) for Streets and Highways and the Colorado Supplement thereto H. A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I. AASHTO Roadside Design Guide J. Institute of Transportation Engineer's Trip Generation Manual, 6th Edition Some of the reference materials listed above (A through E) may be purchased from: Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from: The Public Records Corporation 1666 Lafayette Street Po Box 18186 Denver, CO 80218 (303) 832-8262 The website address is: wvvw.cdot.gov 18. 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 CRF Part 1926 — Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment: • Head protection that complies with the ANSI 289.1-1997 standard; State Highway Access Permit Attachment to Permit No 419068 - Additional Terms and Conditions 4 • At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn • High visibility apparel es specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2). Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply. 19. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way In forward movement Backing into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority. 20. The access shall be maintained in such a manner that will not cause water to enter onto the roadway and will not interfere with the existing drainage system within the State Highway right- of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow. 21 The use of this access by the Applicant is only until 03/01/2020 Please print or type I COLORADO DEPARTMENT OF TRANSPORTATION HIGHWAY ACCESS PERMIT APPLICATION f issuing authority applic on acceptance date: 1.1 7 p3 ig 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. - Submit an application for each access affected. - If you have any questions contact the issuing authority. - For additional information S99 CDOTs Access Management website at http://Www.dotestatetcoteus/Acces4Pernits/Index.htm 1) Property owner (Permitter()) Lazy D Grazing Association Street address 12609 County Road 120 City, sus & zip Phone # Nunn CO 80648-9603 E-mail address azycieint@gmai1.com 970-381-5397 2) Applicant or Agent for perrnittee (if different from property owner) ..leeJl enne Connector Pipeline, Inc Mailing address 370 Van Gordon Street City, stale & zip Phone # (required) Lakewood, CO 80228 479-306-8807 E-mail address if available rebeccalieders@summitresourcesland.com 3) Address of property to be served by permit (required) 67889 US Highway 85 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? ca4Jnty subdivision block Weld 1 5) Wiat State Highway are you requesting access from? State Highway 85 lot section 6) What side of the hi hway? teen* 11N N S l jE ■ W air 66W 7) How many feet is the proposed access from the nearest mile post? How many feet is the proposed access from the neared cross street? 500 feetRN ■SQEUW)from: Al?Y304.4y 6836.15 few�N ❑S 8) What is the approximate date you intend to begin construction? 4/1/2019 9) Check here if you are requesting a: new access [temporary access (duration anticipated: 4 /1 /19-12 /31/19 ) change in access use ('""removal 01 access ■ E [Iv,/ from: Weld County Road 128 improvement to existing access elocation of an existing access (provide detail) 10) Provide existing property use Agricultural access point 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? no Ai yes, if yes - what are the permit number(s) and provide copies: and/or, permit date: 12) Does the prope owner awn or have any interests in any adjacent property? rpo ft yes, if yes - please describe: sec 17-T'wn 11N-Rng 66 W(South)/NW4 /NW4 Sec 8-Twn 11N-Rng 66W (North) 13) Are there other existing or dedicated public streets, roads. highways or access easements bordering or within the property? no $ yes, if yes - list them on your plans and indicate the proposed and existing access points. S 14) If you are requesting agricultural field access - how many acres will the access serve? 6 83 AC 15) It 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 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 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning Is two counts, .s of multi unf trucks al peak haw volumes I 25 Total count of all vehicles 9't Previous editions are obsolete and may not be used Page 1 012 COOT Form #137 01/10 indicate If your counts are # of passenger cars and fight trucks al peak hour volumes Upeak hour volumes or a average daily volumes. 50 # of single unit vehicles In excess of 30 f1. # of farm vehicles (Held equipment) 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. b) Highway and driveway plan profile. c) Drainage plan showing impact to the highway right-of-way . d) Map and letters detailing utility locations before and after development in and along the right-of-way. e) Subdivision, zoning, or development plan. f) Proposed access design. g) Parcel and ownership maps including easements. h) Traffic studies. 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 htto://www.dot.state.co.us/environmentaUForms.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 app ly. 3- The Permittee is responsible for complying with the Revised Guidelines that have been adopted by the Access Board under the American Disabilities Act (ADA). These guidelines define traversable slope requirements and prescribe the use of a defined pattern of truncated domes as detectable warnings at street crossings. The new Standards Plans and can be found on the Design and Construction Project Support web page at: chttp dIwww.dot.state.co.us/Des i knSupportl>, 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 wiedge true and complete. I understand receipt of an access permit does not constitute permission to start access construction work. Applicant or Agent for Permittee signature Print name Date Rebecca Lieders 2/4/2019 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. Property owner signature Print name Date Previous editions are obsolete and may not be used Page 2 of 2 COOT Form #'137 0110 NOTES - a UNIMPROVED GROUND 50 FT MINIMUM -�` - 'ry` '''' r :�4.'4VY• , t' . b : • • . • � Nrr��:.•� Y•! �� :l PLAN VIEW 50 FT. MINIMUM GEOTEXTILE FABRIC AND GEOTE CIILE GRID, AS REQUIRED BERM 3' WIDE x 2" HIGH RADIUS = 20' MAX. EXISTING ROAD PAVEMENT EXISTING ROAD PAVEMENT PROFILE CONTRACTOR TO PROVIDE AND INSTALL CULVERT (18" MIN FOR COOT) (15" MIN FOR WELD COUNTY) 1 ACCESS PADS, AS ILLUSTRATED ABOVE, ARE TO BE INSTALLED ADJACENT TO ALL ROAD CROSSINGS 2 IF USED IN AGRICULTURAL LAND, ROCK SHALL BE PLACED ON A GEOTEXTILE FABRIC TO FACILITATE ROCK REMOVAL. 3 SHOULD THE ROCK PAD BECOME INEFFECTIVE FOR REDUCING THE BUILDUP OF MUD AND DIRT AND MINIMIZING TRACKING ONTO THE PAVED ROAD, THE CONTRACTOR SHALL WASH THE EXISTING ROCK FILL SURFACE OR ADD A ROCK FILL LAYER TO THE ACCESS PAD 4 CONTRACTOR SHALL KEEP ROAD SURFACES CLEAR OF MUD AND DEBRIS 5 CONTRACTOR SHALL REMOVE ALL IMPORTED ROCK FILL MATERIAL, GEOTEXIILE FABRIC AND CULVERT (IF INSTALLED) AND RESTORE THE GROUND TO NATURAL CONTOURS UNLESS OTHERWISE DIRECTED BY COMPANY'S INSPECTOR 6 CONTRACTOR SHALL MAINTAIN A MINIMUM 2% GRADE AWAY FROM ROADWAY FOR A MINIMUM 20 FEET FROM EDGE OF ROAD MOON DEPICTED IS SER'ErsEn® Br MITTEN STANDARD, SCOPE OF WORK OR LINE LM REVISIONS DATE CESCRP11DN BY 22 BY 119 d CCLCDIPPR OWED FOR EEO= MISER PER CLEW 03kti0E1 2 3 4 S 07/13/0' Cr 1m 00/13/10 11/20/10 ROM PER COOK P URE ROBED PER COW Tel RE.100n PER COPT MI OS EN CES TALLGRASS e1; TYPICAL ROAD ACCESS PAD OATS 11/20/18 IAPPROYED 2111 - SCALE N.T. OST-P-1000-M45 SH 1 OF 1 PEEtCV L --M X!41 R. t "A" https://mail,google.com/mail/u/Of#inboxJritXJRgxXKVmQhgLRXJvgwPjvtPgnmmXWNTMGvxsjhDgxDhKcgwjsrNWLdZDcFbNHldBrhS?projector1 &m... 1 /1 COLORADO STATE DEPARTMENT HIGHWAY OF ACCESS PROCEED TRANSPORTATION CODE CDOT Permit No. 419061 State Highway/Mile 085E Post/Side / 300.52/Left NOTICE Local Jurisdiction Weld County TO Perm Lazy Two ittee s ( ) Ranch Applicant: LLC PO Box 546 Rebecca Lieders Evansville, Wyoming 82636 Cheyenne Connector Pipeline, Inc (307) 234-3619 370 Lakewood, Van Gordon Colorado St 80226 (303) 763-2981 permittee is hereby authorized to proceed with access construction within state highway right-of-way in The accordance with the above referenced State Access Permit and this Notice to Proceed. Highway 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 Control Devices for Streets and Highways. Traffic All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days indicated from initiation. on the The Access permittee Permit. or applicant shall notify the Department prior to commencing construction as Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. following items shall be addressed prior to or during construction as The appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By Title Date (X) This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By Date Title (X) Assistant Access Manager 05/10/2019 opy distribution: Required: Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector MTCE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED CDOT Permit No. 419061 State Highway/Mile Post/Side 085E / 300.52/Left Local Jurisdiction Weld County Permittee(s): Applicant: Lazy Two Ranch LLC PO Box 546 Rebecca Lieders Evansville, Wyoming 82636 Cheyenne Connector Pipeline, Inc (307) 234-3619 370 Van Gordon St Lakewood, Colorado 80226 (303) 763-2981 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By I (X) / , !VV"-' Title Assistant Access Manager Date 05/10/2019 Copy distribution: Required: Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector MTCE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT CD0T Permit No. 419061 State Highway No / MP / Side 085L / 300.520 / Left Permit Fee $100.00 Date of Transmittal 04/23/2019 Region / Section / Patrol / Name Local Jurisdiction 4/01/20 Weld County The Permittee(s): The Applicant(s): Rebecca Lieders Lazy Two Ranch LLC Cheyenne Connector Pipeline, Inc PO Box 546 370 Van Gordon St Evansville, Wyoming 82636 Lakewood, Colorado 80228 (307)234-3619 (303) 763-2981 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 thopermit. Location: The access is located on US Highway 85, a distance of 2,743 feet north of Mile Post 300 on the west/left side. Access to Provide Service to: (Land Use Code) (Size) (Units) 994 - Temporary Construction Access 15.09 Acres 997 - Agriculture 1 Each Additional Information: MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature • Print Name Date rj(le 1 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 Bruce Barnett with the Colorado Department of Transportation, 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 conditions. Pee Signature: - C' �-`t_ t. iZLlF. �C6� 1 P Print N e Date -E t.XC.(A 1.._"a -ells 5/71.0/ Co-Permittee Signature: (if applicable) Print Name Date This permit is not valid until signed by a duly authorized representative of the Department COLORADO DEPARTMENT OF TRANSPORTATION Sign re Print Name Title Date (of issue) /4414,4'f\--- M V1/tw -fit s.1: Art< 6441104W , .S -1 (6 / r Copy Dlehtbutlon: Required: 1.Region 2 Applicant Make copies as necessary for. 3.Staff Access Section Local Authority Inspector 4.Central Files MICE Patrol Traffic Engineer Previous edltlons ardobedlete and may not be used Page 1 of 3 CDOT Form #101 b/0) State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code. These are provided for your convenience but do not alleviate compliance with all sections of the Access Code. A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department). When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards. Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit. APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission (of Colorado]. To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature. Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400. The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant. 2. Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority. 3. In submitting the request for administrative hearing, the appellant has the 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. When such committee review is requested, processing of the appeal for formal administrative hearing, 2.9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal. The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently. 4. Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit. PERMIT EXPIRATION 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 extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority. No more than two one-year extensions may be granted under any circumstances. If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the Issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and Include a copy of page 1 (face of permit) of the access permit. Extension approvals shall be in writing. The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days. Any person wishing to reestablish an access permit that has expired may begin again with the application procedures. An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed. CONSTRUCTION 1. Construction may not begin until a Notice to Proceed is approved. (Code subsection 2.4] 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the 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 easements, become public property. Any materials removed from the highway right-of-way will be disposed of only as directed by the Department. All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector. 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way. Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way. A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4. The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met. Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public. 5. Prior to using the access, the permittee is required to complete the 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 the Department or issuing authority to initiate action to suspend or revoke the permit and close the access. If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the 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 Department and included in the permit. The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers. Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials. If any construction element fails within two years due to improper construction or material specifications, the permittee shall be responsible for aN repairs. Failure to make such repairs may result in suspension of the permit and closure of the access. 6. The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M.U.T.C.D. as required by section 42- 4-104, C.R.S., as amended. 7. A utility permit shall be obtained for any utility work within highway right-of-way. Where necessary to remove, relocate, or repair a traffic control device or 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 Department or issuing authority, and at the direction of the Department or utility company. Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately. The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair. 8. In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence. All posts and wire removed are Department property and shall be turned over to a representative of the Department. 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times. The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications. Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions. 10. Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan. 11. By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access. CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1. It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act. The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants. If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required. 2. When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C.R.S., of the Act applies. The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety. Summary suspension shall comply with article 4 of title 24, C.R.S. MAINTENANCE 1. The penmittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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. Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system. However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way. Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance. The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair. Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department. Form 101, Page 3 Waste Regulations. The application for any CDOT peMnit must specifically identil any ACM involved in the werk for which e ili authorization is being requested. Adonel guidance or requirements may be specified in the permit special provisions. Contact Info: CDPHE APCD:and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information goncerninq clearance on CDOT Dialects is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa i elo-DreilinqtHazardous Materials Mana Ferment Supervisor. 1343, 512-5524. Tr�tn fl$ on of iious Ma - No perms may offer or accept a hazardous material for transportation iii cornmerce unless that person Is registered In conformance with the United States Department of Transportation regulations at 49 CFR, Part 171. The hazardous material must be property classed, described, packaged, marked, labeled, and in condition for shipment as authorized by applicablerequirements, Or an exemption, orregistration has been Issurequired or PA approval ed, Vehicles requiring a placard, must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact Information: For authorization and more Info call the Federal Motor Safety Canter Administration, US DOT for inter- and intraestate HAZMAT Registration 09) 9fi8-674a.: Colorado Public Unifies Commission: (303).8942868. pisc t o .of ' red o xcc s �» l:- � t �: � ..1 ► ri a. U Duality Car#iflcattons ued law the PHE - Corps of Engineers 404 permits are required far the discharge of dredged or fill materials into waters of the United States, including wadands. There are various types of 404 permits, including nationwide permits, which are issued for activities with relatively minor impacts. For example, there is a nationwide permit for utility line activities (nwp #12). Depending upon the specific circumstances, it is possible that either a "general" or lndhriduar 404 permit would be required. If an individual 404 permit is required, section 401 water quality certlficatkin from the CDPHE WQCD is also required. Contact the appropriate Corps District Regulatory Office for Information about what type of 404 permit may be required &contaa information above. Contact„he CDPHE Water Q Control Division at X692-3500. World= on or In anirattsern or its birtik - In order to, protect and the state's fish and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, orvary s natural existing stream or its banks or tributaries. it may be necessary to obtain a Senate Bill 40 certification from the Colorado Department of Natural Resources. A stream Is defined as 1) represented by:a solid blue line on USGS 7.5' quadrangle maps; and/or 2).intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 100 yards upstream or downstream of the project; and/or 4) segments of streams having wetlands presentwitthin 200 yards upstream or downstream of the project measured by valley length. The CPW ' application, .as par guidelines agreed upon by CDOT and CPW, can be accessed at �:1l t� r.ca4* cywan; giro , gni if $t,,,prrvatsr Construct on Perm I 81 rmwatvr Dischargefrom rom InduArtal Facilities - Discharges of stonriwater runoff from construction sites disturbing one acne or more - or certain types of industrial facilities, such as concrete batch plants - require a COPS Stormwater Permit Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500. Website: hit ftvw. ota►do:c ti/oacier/cdpnel ern eat i-• and h JI "o . ;.. vl off Inds ctu i3t5, Construct #pn raterfntiWiacha►rap _gar Infiltration) and Remedlation Actikvitio - Discharges of water encountered during excavation or work in wet areas may require a Construction Dewatering or Remediation Activities Discharge Permit Contact Information: For Construbion Dewatering and Remediatlon Activities Discharge Permits, contact the CDPHE WQCD at (303) 892- 3500. For • . = u one and ins tructi ons (CDPHE w ebilte�: h ttoh+rww. cz�Bc o. goti acif of p net uagoi r j�� n _ 1 int Y ithiptclna Segerq Otng Sewer Sv$totn NMIMitcham* Palma - Discharges from the storm sewer systems of larger municipalities, and from the CDOT highway drainage system that des within those municipalities, are subject to MM Permits Issued by the CDPHE WQCD. For facilities that lie within the boundaries .of a municipality that is subject to en MS4 permit, the owner of such facility should contact the municdpaltty regarding stomnwater related clearances that may have been established under that municipality's MS4 peririlt. All discharges to the COOT highway drainage system or within the Right of Way (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act, the Water Quality Control Coinm:ssion (WQCC) Regulations ( os:/lwwng.cooloi o. viot.v $ od :*:. - :;.::: • .:-po s,%`;3ze.., l: aLlfiatt :ec iaii 'wit rte) and the CDOT MS4 Permit # COS - 000f305 ' �..,, - . . , �:, r `' j Discharges �r��,��ri�j..,�do... �.•�l,,�r,�. ;��1 . �* .., . r� � �.-�;��.�!�I�� rig s are subject to inspector by COOT end CDPHE. Center:* the CDPI4E Water Quality Control Division at (303) -3500 for a listing of municipalities required to obtain MS4 Permits, or to ° s� i� �%r%i.` +:._ei elo< �^�: - ;ii . a/1� -kini t i ' '� � � :,�;" . For CDOT related M t ) r (�>� l r y-•ry �..� �} ♦ourt.��f��'':4.(��j-� � �Q. � �� /t�l��_ _...�... - S4 regulations, go to: LZ-�.1 wwwa.:Quit; /p oo e. :t M o'n:uifl h at . e r -Q 1. �V ��' , - ct_l:.�i t_le '.h G+sner$l Proojgbi#on•— Discharge* All discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but are not limited to, substances such as wash water, paint, automotive fluids, solvents, Oils or soaps and sediment. Contact Infon'nation: Contact the CDPHE Water Quality Control Division at 303) 692-3500. General Authorization • Allowable Non -3t mytet r Machu:me) a Unless otherwise:identified by CDOT.or the WQCD as signlfirartit sources of pollutants to the waters of the State, the follOveing discharges to stormwater systems are allowed without a Colorado Discharge PermitSystempermit: landscape irrigation, diverted stream flows, uncontaminated ground water Infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, uncontaminated springs, footing drains, water line flushing, flows from riparian habitats and wetlands, and flow from firefighting activities. Allowable non-storrnwater discharges -can be found under Illicit Discharge PDD at: ' ;o,.. ro{ ..tgoy/p; ;ci, enui►onnse ale rut,4iity1s : apieams. 1mf. Contact Information; The CDPHE Water Quality Control Division (telephone • s os d-i boVe).eel _ E Ig OLARI ijp t c. Eata • ForeactIVIiles req lu'' ring a Stormwater Construction Permit; erosion control requirements will be spedfled in that permit. in situations where a stormwater permit is not -required, all reasonable measures should be taken to minimize erosion and sedimentation according to CDOT Standard Specifications 107.25, 208, 213 and 2t8 @ ewellw ketc eicovi • buslrassidasignssiojpa 01 loom r an`c c WnUor t20t i-&sue.'2011-$2e tack). All disturbances require.a stabilization plan, motive seeding or landscape design plan according to applicable CDOT StSpderd Specilflcations 212-217 and 623. The CDOT Erosion Control and Stormwater Quality Guide (available from the Bid Plana billow at (303) 757.9313) should be used to design erosion controls and restore disturbed ve:.ietation. Environmental Clearances Information Summary Page 2 of 3 Colorado Department of Transportation August 2017 Disposal of Drilling Fluids • Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as adisoharges" or "solid wastes," and'in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway is prohibited by Water Quality Control and/or Solid Waste regulations, Small quantities sties of drilling fluid solids (less than 1 cubic yard of solids). may be left on-si% after either being separated from fluids or after infiltrationof the water, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required for proper drilling properties, small quantities of polymer additives that are approved for use In drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the - area restored. as required by COOT permit requirements (Utility, Special Use, or Access Permits, etc.). Contact infonnation: Contact CDPHE (telephone fie listed aboved: Weeds end Invasive Species NoXlOus Weeds and hwa elve.Species guidance thin be found by contacting the Colorado Department of Agriculture aS.oE ac ''ioPino2Iou ≥Lt) and the Colorado Division of Parks and Wildlife �_ teg, .t _ :.� .a s a e, a° . �4��,� '�:�,, . uc . In: either case management i' .�.s � . .at l la votvin the control of noxious weeds associated.with the f• rmitted activity and cleaning Of equi ant will be required. uired. Conte W • Waste generated from concrete activities Shall NOT be a to flow hlto the drainage ways, Wets, receiving in � washout 8 Y � g . waters, or the CDOT ROW, Concrete waste shall be placed in a temporary concrete facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shag only be performed as specified by the COOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Info meson: Contact CDPHE or find additional information on the COOT webstte: rhos:1krata y.gaYi A aYiS2 f: ≥'(1.-.,-! Q0Or/2' )ii '1 t n"~tr Tti3 • De L is i jk-SievJS end refer to the specifications and their revisit:ins for sections 1.911107. and 208. _. �p Renaruna Spills tall be contained and cleaned up as soon as possible. Spas shy NOT be washed down Into *the storm drain or buried. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (41120), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spins on highways, into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by cling 911, and shall also be reported to the CDPHE at 1-877.518-5608. More information can be found at ; ;:-:/t.l.':: z �_ �. -��1, • .. ,. , E'�"�, 1.:*/".�� :e rl•-ire. About This Form . -Quesdons or comments about this Information Summary may be directed to Alex Karemf, Program Administrator, CDOT Aaoe s. Man = , ement Unit, at (303) 7574841, alexicaramidistate.cause Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation August 2017 COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowrnelt flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is stormwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow into CDOTs storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters CD0Ts storm drain system Is discharged untreated into the waterways we use for fishing, swimming, and providing drinking water. Tips for Reporting an Illicit Discharge Call the illicit discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach, Call'CSP for illicit dumping. tf possible, take a photo, record a license plate. Pi C. s rr1JLrt. Never get too close to the illkit discharge, it may be dangerous!!! For more information on CDOT Utility Permits: https:t1 www.codot Rovl buJinessl_pe rmitsw utilitie s,5pecial. tsg For more information on CDOT Access Permits: httpsliwww.codot.govjbusiness,permits,access permits For more Information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222 303-757.9343 COLORADO Department of Transportation Water Cuallb I 'r* tram Industrial facilities IJroara COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment. The permit states that only stormwater can be discharged from C0OTs storm drain system miner pips eimas . F TOME WASTEWATER TREATMENT PLANT arm as. sin drain tit wet bed. Pips TO Till L0CILL *ATERSOOY M As part of the permit, CDOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program New Development Redevelopment Program illicit Discharge Program Industrial Facilities Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program COLORADO Department of Transportation Control Measures for industrial cacilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices (BMP) during the construction of a fadlity and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into CDOVs storm drain system. Control Measures also include treatment operating procedures, and practices to control site run off which can include structural and non-structural controls. • • <:--•-n AR! TWEE LSTm*ASIP PRESIINIT WINS an gnimPounzvar 8 wins imtwou Imo writ. .. In compliance! COOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following; ✓ Communications ✓ Cable television ✓ Power ✓ Electricity ✓ light ✓ Heat Gas ✓ Oil ✓ Crude Products ✓ Water ✓ Stream I Waste ✓ Stormwater not connected with highway drainage ✓ Similar Commodity COLORADO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. COOT has put together an Environmental Clearances Information Summary for those applying for a COOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: http: / /www.cotoradodot.info/proqrams/ environmental/ resources/ guidance- standards/Environmental%20Ciearances% Zol nfo%lOSummary .�df, State Highway Access Permit Attachment to Permit No. 419061- Additional Terms and Conditions 1. If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350- 2148 2. The Permittee or the contractor shall notify Bruce Barnett 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 3. The Permittee shall request final inspection by Bruce Barnett at (970) 350-2147 within 10 days following the completion of access construction, and prior to authorized use The Permittee or their representative shall be present 4. 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 5 The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 6 Incorporated as part of this permit are the following Application for Access Permit (CDOT Form No. 137) Permit (CDOT Form No 101) and its attachments Exhibits: "A" — Access Plan "B" — Vicinity Map 7 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 be applied for based upon the existing and anticipated future conditions. 8. 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 anse, 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. 9 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 10 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 State Highway Access Permit Attachment to Permit No 419061- Additional Terms and Conditions 2 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 permit and be available on the site during construction 11. All costs associated with any reconstruction of this access are the responsibility of the Permittee This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. In the event a signal is warranted in the future, COOT will not participate in any fashion with that signal installation, including financially 12. The 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. 13 It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details The ECIS may be obtained from the CDOT Permitting Offices or may be accessed via the COOT Planning/Construction- Environmental Guidance webpage at http.//www.dot state.co.uslenvironmental/Forms/asp. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR COOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as wash water, paint, automotive fluids, solvents, oils or soaps Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins For additional information and forms, go to the CHPHE website at State Highway Access Permit Attachment to Permit No. 419061- Additional Terms and Conditions 3 http.//cdphe state co us/wa/PermitsUnit/wqu 14. 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. 15 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 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 16. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to Install a subsurface drain In accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Allyson Mattson at the Greeley Traffic Office, (970) 350-2148 to obtain the Landscaping Permit 17. 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 18 The Department inspector may suspend 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. 19 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. 20. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs 21. The Department retains the right to perform any necessary maintenance work in this area. State Highway Access Permit Attachment to Permit No. 419061- Additional Terms and Conditions 4 22. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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. 23. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 24. All materials, equipment, Installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable A State Highway Access Code, 2 CCR601-1 B. Roadway Design Manual C Materials Manual D. Construction Manual E. Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M.U.T.C.D.) for Streets and Highways and the Colorado Supplement thereto H A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I. AASHTO Roadside Design Guide J. Institute of Transportation Engineer's Trip Generation Manual, 6th Edition Some of the reference materials listed above (A through E) may be purchased from Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is. www cdot gov 25 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 State Highway Access Permit Attachment to Permit No 419061- Additional Terms and Conditions 5 CFR Part 1910 — Occupational Safety and Health Standards and 29 CRF Part 1926 — Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except When in their vehicles, shall wear the following personal protective equipment: • Head protection that complies with the ANSI Z89.1-1997 standard; • At all construction sites or whenever there Is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn • High visibility apparel as specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2). Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply. 26. 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. 27 No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 28 Backing maneuvers within and into the State Highway right-of-way are strictly prohibited All vehicles shall enter and exit the highway right-of-way in forward movement Backing into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority 29. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department 30 Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department 31. Construction traffic control devices, when not in use, shall be removed or turned away from traffic. Devices must be stored outside of the roadway clear zone per the latest AASHTO guidelines. 32 Cattle guards are not permitted in State Highway right-of-way. 33. If State Highway right-of-way fence exists or Is proposed, the Permittee must contact Bruce Barnett at the Greeley Traffic Office, (970) 350-2147 prior to removal or installation The Permittee will be required to obtain a highway right-of-way fence agreement for a special fence if the Permittee desires to remove the existing standard highway fencing in this area. When it Is necessary to remove any highway right-of-way fence, the posts on either side of the access entrance shall be securely braced with approved end posts and in conformance with the State Highway Access Permit Attachment to Permit No 419061- Additional Terms and Conditions 6 Department's M-607-1 standard, before the fence is cut to prevent slacking of the remaining fence All posts and wire removed shall be returned to the Department 34. Any access construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from Initiation of construction within State Highway right-of-way. 35 All required access improvements shall be installed pnor to the herein authorized use of this access. Failure to do so will result in the appropriate legal action from the Department, up to Permit Revocation 36 The access shall be constructed as a minimum as per Exhibit "A". Upon completion of the construction the access shall be returned to as good or better condition. 37. If necessary, the access shall be reconstructed 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 38. No paved surface shall be cut unless specified In this permit. Asphalt removal shall be saw cut to assure a straight edge for patching Full panel concrete replacement is required for any concrete work 39. 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 40 The access shall be reconstructed and maintained in such a manner that will not cause water to enter onto the roadway, and will not Interfere with the existing drainage system within the State Highway right-of-way. Drainage to the State Highway right-of-way shall not exceed historical rate of flow 41. 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 42 The use of this access by the Applicant is only until 03/01/2020. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION ��Ma��lYG{plf�' Issuing authority applies '�- acceptance date: 4,4 943 Instructions: - Contact the Colorado - Contact the issuing Complete this form (some Department of Transportation authority to determine what questions may not (C DOT) plans and apply to you) other or your tonal government to determine your issuing authority. documents are required to be submitted with your appticaiion and attach WI necessary documents and Submit it to the issuing Please print * Submit an application for each access affected. authority. or type - If you have any questions contact the issuing authority. - For additional information see CDOT's Access Management websito at ttttp:/tWwwA4tstate.co,usIAc sPermiisfindeac.htrn 1) Property owner (Permutes) 2) Applcarz or Agent for permittee (ii different from property owner) tar' Two Ranch LIB Cheyenne Connector Pipeline, Ina.: Street address 'Mating address - 1 &v box b4 6 370 Van Gordon Street City, state & zip Evansville, WY 82636 Phone. 307-234-3619 Pity, agate & zip Lakeet--r-Ar4 rn 80228 -Phone 4 (required) 479-306-8807 E-mail E-mail if address address available Lc.reaccassectexmOsumaitresourcesland.com . 3) Address of property to be served by permit (required) Stat.. Highway 85 4) county Legal description of property: if within jurisdictional tuoetsion limits of Municipality, db/ and/or block kit County. which one? swoon lowouldp SW f 5) What Stale Highway are you requesting access from? 6) What side of the hi hway? State Rig way 85 IN (�S II E NW 7) How many feet is the proposed access from the nearest mile post? How feet is the from many proposed access the nearest crass street? J 1321' feat N EIS DE from; Weld County Road 122 3045' _ ` feetIN OBOE OW) from: 300 6) What is the approximate date you intend to begin construction? 4/1/2019 9) Check hero if you are requesting a: new access rill temporary access (duration anticipated: 4 /1 /19-12/31 /1r ) improvement to existing access flthan@e in access use IIrernoval of access elocation of an existing access (provide detail) 10) Provide existing ertrt eel property use HA rail ArmFtsa poir r 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? o oyes, If yes - what are the permit number(s) and provide copies: and/or, permit date: 12) Does the ...: , ownerown or have any Interests in any adjacent property? o g yes, II yes • please describe: WW4 /NW4 SE4 / SW4 SW4 /N2sw4 Sec 32 , Twn 11x , Rag 66W 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? o no • yes, if yes - list them on your plans and indicate the proposed and existing access points. 14) If you are requesting apiculture! field access - how many acres 45.09 AC will the access serve? 15) If you are requesting commercial or industrial access please indicate the types and number of businesses and provide !harbor area square footage of each. buslnessAand use s :ware footle business square footage 1 • 16) If you are requesting residential developemont access, what type is the type (single number of units family, apartment, townhouse) and number of unto? type number of units 1 __ — 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two daunts. Inc oats if your counts are # or passenger owe a+d IS kooks et peek he voltam I of ma unS trudcs at ode hour vohnss 2 5 oak hour volumes or L ,average daily volumes. it of slab wWl vehictes In excess of 30 tt. * 0t farm vehicles (fluid aqV+vR+ent) Total count of all vehicles 91 Previous editions are obsolete end mac net be used Page 1 o12 COOT Form #'137 01/10 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 indica.ing 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:/lwww.datstate.co.us/environmentai/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: dittp://www.dot.state.co.us/DesienSupport/>, then click on Design Bulletins. 4 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. applicant declares under penalty of perjury In the second degree, and any other applicable state or federal The 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. Appficwit or Agent for Permittee signature Print name p, Rebecca Liedere 1 /23/2019 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. Property ..,1 or signature Print name Date 4....-...... a•i.. �� aWas - i s.. Previous editions are obsolete end may not be used Page 2 of 2 COOT Form 0137 01110 FT. MINIMUM U IMPRWED GROUND Na,TuRu. GRADE -� riot IAIN. .. s • :..,a�*4 •cc'•• if;e:71.1 t ,19••r•. PLAN VIEW 50 FL MINIMUM BERM 3' WIDE x 2' NIGH CLEAN - ROCK R!1 50 M IN. BERM Ii. GEOTEXTILE FABRIC AND GEOIFXTIIE GRID, AS REQUIRED PROFILE a <. r-• 4; EXISTING ROAD , PAVEMENT -'M89 f `; 10' DOST1NG ROAD PA CO NTRACTOR 1CD�� DE NOTES: 1. ACCESS PADS, AS ILLUSTRATED ABOVE, ARE TO BE INSTALLED ADJACENT TO DOMING PAVED ROADS AT LOCATIONS IDENTIFIED ON THE CONSTRUCTION DRAWINGS OR AS DIRECTED BY THE COMPANY'S INSPECTOR. 2. IF USED IN AGRICULTURAL LAND, ROCK SHALL BE PLACED ON A GEOTEXTILE FABRIC TO FACILITATE ROCK REMOVAL 3. SHOULD THE ROCK PAD BECOME INEFFECTIVE FOR REDUCING THE BUILDUP OF MUD AND DIRT AND MINIMIZING TRACKING ONTO THE PAVED ROAD, THE CONTRACTOR SHALL WASH THE EXISTING ROCK FILL SURFACE OR ADD A ROCK FILL LAYER TO THE ACCESS PAD. 4. CONTRACTOR SHALL KEEP PAVED ROAD SURFACES CLEAR OF MUD AND DEBRIS. 5. PRIOR TO PERMANENT SEEDING, CONTRACTOR SHALL REMOVE ALL IMPORTED ROCK FILL MATERIAL, GEOTEXTILE FABRIC AND CULVERT IF INSTALLED) AND RESTORE THE GROUND TO NATURAL CONTOURS UNLESS OTHERWISE DIRECTED BY COMP S INSPECTOR. REVISIONS awe OESCRYRCH Br OIKD OPP, Worn "yea serer le , a a , aL mt ; Wren MR MDR Cora IS wafer ;A S CARR DIVIN3 OVICTEMPERSIDED BY WTTW EwcA SCOPE of rec on use us. *TYPICAL TEMPORARY PAVED TALLGRASS � ROAD ACCESS PAD Pnni'i �'-�14ofai MTh Way at -r -1000a sta I SH. I OF I COLORADO STATE DEPARTMENT HIGHWAY OF ACCESS PROC TRANSPORTATION CODE D CDOT Permit No. 419975 i State Highway/Mile 085E Post/Side / 291.993/Left NOTICEC Local Jurisdicion TEE (970) Permittee(s): Michael 1119 Loveland, E. 599-5188 16th Lance Street Palmer 80532 Applicant: Rebecca Cheyenne 370 Lakewood, (303) Van 763-2981 Leiders Gordon Connector Colorado St Pipeline, 80226 Inc Colorado Uniform construction permittee Notice year initiation. the from advance with to is Proceed date the Section shall hereby warning Control above of permittee be is issue Permit. and authorized 2.3(11)(d), completed valid Devices referenced is this if required only or not Notice applicant for of in to if under State the the at Streets proceed an all referenced Access expeditious Proceed construction, with Code. during shall access Access Access and or access the be safe completed. Department available construction Permit Permit construction, manner and has for review this Access and prior within not Notice shall expired. in to at state Permits conformance commencing the be to construction highway Access may be with construction right-of-way Permits within extended site. the 45 Manual expire days in in as indicated The accordance Proceed. finished Highway times shall and This one accordance Adequate on All from Both with Traffic the on Access notify Highways. The Access Permit To Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as This appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title Date This Colorado Notice is not Department valid until signed of by a duly authorized representative of the Department Transportation By (X) i tlict Title Assistant Access Manager Date 05/24/2019 Copy distribution: Required: Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector MTCE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT CDOT Permit No. 419075 State Highway No / Mp / Side 085L / 291.993 / Left Permit Fee $100.00 Date of Transmittal 05/23/2019 p Region / Section / Patrol / Name 4/01 /20 Local Jurisdiction Weld County The Perm ittee(s ): Michael Lance Palmer 1119 E. 16th Street Loveland, Colorado 80532 (970) 599-5188 The Applicant(s): Rebecca Leiders Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 (303) 763-2981 is hereby granted permission to have an access to the state highway at the location noted below. The access shall be constructed, maintained and used in accordance with this permit, including the State Highway Access Code and any attachments, terms, conditions and exhibits. This permit may be revoked by the Issuing Authority if at any time the permitted access and its use violate any parts of this permit. The issuing authority, the Department and their duly appointed agents and employees shall be held harmless against any action for personal injury or property damage sustained by reason of the exercise of the permit. Location: This access is located approximately 5245 feet north of mile marker 291 on the west/left side of State Highway 85 at approximately mile point 291.993. Access to Provide Service to: (La use Code) (Size) 994 • Temporary Construction Access 91 997 - Agriculture (Units) ADT 2.76 Acres Additional Information: This permit is for a temporary access only. The access shall be removed in its entirety by no later than 12/31/2019. No cleated equipment is allowed on the roadway without positive protection measures. A temporary tracking pad shall be installed outside of CDOT right-of- way. MUNICIPALITY Required only when OR the COUNTY appropriate APPROVAL local authority retains issuing authority. Signature Print Name Oath Title L Upon the signing of this permit the permittee agrees to the terms and conditions and referenced attachments contained herein. initiation. being All used. construction The permitted shall access be completed shall be completed in an expeditious in accordance and safe with manner the terms and and shall conditions be finished of the within 45 permit days prior from to least The permittee 48 hours shall prior notify to commencing Bruce Barnett construction with the Colorado within the Department State Highway of Transportation, right-of-way. at (970) 350-2147 at 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 conditions. mm Per to Signature: PrintfName Rae tietLet. L il el cit.irs Date ,. it tc _4//..9O/9 Co-Permittee Signature: (if applicable) Print Name I Date This COLORADO permit is not DEPARTMENT valid until signed OF TRANSPORTATION by a duly authorized representative of the Department. Signit re P nt tA/141AA. Name Title Date (of issue) l ! VIALM7k7v\- Ai 'e A ilitc-C WIV C /7 ' i°1 Copy Distil n: Required: 1.Region 2.Appllcant 3.Staff Access Section 4.Centra' Files Make copies as necessary for: Local Authority Inspector MTCE Patrol Traffic Engineer Previous editions are obMolete and may not be used Page 1 of 3 COOT Form #101 5107 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code These are provided for your convenience but do not alleviate compliance with all sections of the Access Code A copy of the State Highway Access Code is available from your local issuing authority (local government) or the Colorado Department of Transportation (Department) When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit APPEALS 1 Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado] To appeal a decision, submit a request for administrative hearing to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400 The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant 2 Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority 3 In submitting the request for administrative hearing, the appellant has the 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 When such committee review is requested, processing of the appeal for formal administrative hearing, 2 9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently 4 Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a heanng, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit PERMIT EXPIRATION 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 extension When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority No more than two one-year extensions may be granted under any circumstances If the access is not under construction within three years from date of issue the permit will be considered expired Any request for an extension must be in writing and submitted to the issuing authonty before the permit expires The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit Extension approvals shall be in writing The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days Any person wishing to reestablish an access permit that has expired may begin again with the application procedures An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed CONSTRUCTION 1 Construction may not begin until a Notice to Proceed is approved (Code subsection 2 4] 2 The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 214 All materials used in the construction of the access within the highway nght-of-way or on permanent easements, become public property Any materials removed from the highway right-of-way will be disposed of only as directed by the Department All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector 3 The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit 4 The issuing authority and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met Inspectors are authorized to enforce the conditions of the permit dunng construction and to halt any activities within state nght-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public 5 Prior to using the access, the permittee is required to complete the 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 the Department or issuing authonty to initiate action to suspend or revoke the permit and close the access If in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the summary suspension of the permit If the permittee wishes to use the access pnor to completion, arrangements must be approved by the issuing authonty and Department and included in the permit The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials If any construction element fails within two years due to improper construction or matenal specifications, the permittee shall be responsible for all repairs Failure to make such repairs may result in suspension of the permit and closure of the access 6 The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M U T C D as required by section 42- 4-104, C R S , as amended 7 A utility permit shall be obtained for any utility work within highway nght-of-way Where necessary to remove, relocate, or repair a traffic control device or 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 Department or issuing authonty, and at the direction of the Department or utility company Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair 8 In the event it becomes necessary to remove any right- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence All posts and wire removed are Department property and shall be turned over to a representative of the Department 9 The permittee shall ensure that a copy of the permit is available for review at the construction site at all times The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions 10 Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the right-of-way or any adopted municipal system and drainage plan 11 By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1 It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required 2 When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C R S , of the Act applies The Department or issuing authority may summanly suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety Summary suspension shall comply with article 4 of title 24, C R S MAINTENANCE 1 The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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 Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system However, the permittee is responsible for the repair and replacement of any access -related culverts within the right-of-way Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the permittee shall be responsible for such repair Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department Form 101, Page 3 COLORADO DEPARTMENT Clearances OF Information TRANSPORTATION Summary Environmental PURPOSE perform work - related This summary to their is intended own facilities to inform (such entities as Utility, external Special to Use CDOT or Access that may Perrnittees), be entering about the state some highway of right-of-way the more commonly to encountered environmental permits/clearances that may apply to their activities. This listing is not all-inclusive - additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT - Please Review The Following Information Carefully — Failure to Comply With Regulatory Requirements May Result In Suspension or Revocation of Your CDOT Permit, Or Enforcement Actions By Other Agencies. CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • Colorado Department of Public Health and Environment (CDPHE): General Information — (303) 692-2035 Water Quality Control Division (WQCD): (303) 692-3500 Environmental Permitting Website https://www.colorado.cjov/pacific/cdphe/all-permits • CDOT Water Quality Program Manager: (303) 757-9343 https://www.codot.gov/programs/environmental/water-quality • CDOT Asbestos Project Manager: Phil Kangas, (303) 512-5519 • Colorado Office of Archaeology and Historic Preservation: (303) 866-5216 • U.S. Army Corps of Engineers, District Regulatory Offices: Omaha District (NE CO), Denver Office (303) 979.4120 -ttp://www.nwo.usace.arrpy mi►/Missions/RequlatoryProgrnm/Colcrndn aspx Sacramento Dist. (Western CO), Grand Junction Office (970) 243-1199 https/iwww.spk.usace.army.mil/MissionsiReguiatory.aspx Albuquerque District (SE CO), Pueblo Office (719)-543-9459 http://www.spa.usace.army.mi?(Missior ,/RegulatoryProoramandPermits.aspx • CDOT Utilities, Special Use and Access Permitting: (303) 757-9654 https://www.codot.gov/business/(permits Wildlife Resources - Disturbance of wildlife shall be avoided to the maximum extent practicable. Entry into areas of known or suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. If any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species may be obtained from the CDOT website, http://www.codot.00v/programs/env,ronmental/wildlife/guidelines, or the Colorado Parks and Wildlife (CPW) website, r►uup.urwwy3w.cpw.state.co.us/learn/Pages/SOC-ThreatenedEndangeredList.aspx. Additional guidance may be provided by the appropriate Region Planning and Environmental Manager (RPEM). Cultural Resources - The applicant must request a file search of the permit area through the Colorado Office of Archaeology and Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously been identified (nnp:iiwww.historycoioraao.org/oanpitise-searc ). Inventory of the permit area by a qualified cultural resources specialist may be necessary, per the recommendation of CDOT. If archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file searches at (303, 866-5216. Paleontological Resources - The applicant must request a fossil locality file search through the University of Colorado Museum, Boulder (ntips:iicurnuseum.colorauo.eauiresearchipaieontotoQy/veriebratesipolicies), and the Denver Museum of Nature and Science (https/iwww.dmns.org/science/collections/earth-science-collection: ) to ascertain if paleontological resources have been previously identified in or near the permit area. inventory of the permit area by a qualified paleontologist may be necessary, per the recommendation of CDOT. If fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact Information: See the museum websites listed above for Paleontological Collections Manager contact information. Contact the CDOT Paleontologist for further information at nico*n.peavev(state.co.us or (303) 757- 9632. The CDOT Paleontologist will not conduct a comprehensive file search independently of the museums. Hazardous Materials: Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved Certificate of Designation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15-301 et al, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TSD) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entities entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existing solid waste or hazardous materials contamination (including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the permittee shall halt work in the affected area and immediately contact the CDOT Regional Permitting Office for direction as to how to proceed. Contact Information: Theresa Santangelo-Dreiling, CDOT I Hazardous Materials Management Supervisor: (303) 1 512-5524. Asbestos Containing Materials. Asbestos Contaminated Soil - All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Division's (APCD) Regulation 8. Disposal of ACM, and work done in asbestos -contaminated soil, must comply with the CDPHE Hazardous Materials and Waste Management Division's (HMWMD) Solid Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation August 2017 Waste authorization Info: Additional 5519, CDPHE or Regulations. information Theresa is APCD being Santangelo-Dreilincj application HMWMD Additional Regulations clearance for any CDOT guidance can on permit CDOT or be accessed must requirements projects specifically via is the available may CDPHE Supervisor: identify be from specified Environmental any the (303) ACM in CDOT the 512-5524. involved permit Asbestos Permitting special in Project the work provisions. Website Manager for listed which Contact above. (303) 512- The and requested. concerning Hazardous Materials Management Transportation of Hazardous Materials - an Permit No Motor the described, exemption, person Utilities United from Safety the may States packaged, approval Carrier Commission: o"er Colorado or Department Administration, or accept 4303, marked, registration Public 894-2868. a of Utilities hazardous labeled, Transportation has US Commission. DOT and been material in issued. for condition inter- regulations for Contact and transportation Vehicles for intra-state at shipment Information: 49 requiring CFR, in HAZMAT commerce Part as a required placard, 171. For or unless The must that hazardous authorized obtain authorization Registration person authorization is material by (303 registered applicable } must and more 969-6748. in requirements, a info conformance be State properly call Colorado the HAZMAT classed, or Public with and Federal Discharge of Dredged or Fill Material 404 Permits Administered By the U.S. Army Corps of Engineers, and Section 401 — Water Quality Certifications Issued by the CDPHE WQCD - Corps minor Control 401 wetlands. for of impacts. it is water information Engineers Division possible quality There For at about 404 are example, that certification (303 permits various either what 692-3500. there a type types are "general" from of required is the of 404 a 404 nationwide CDPHE or permit for "individual" permits, the discharge permit including be 404 is required for also of utility permit dredged nationwide line would required. (contact activities be or information required. Contact fill permits, materials #12). the If which above;. into an appropriate individual are Depending waters Contact issued of 404 Corps for upon the permit activities District CDPHE United the specific is States, required, Regulatory with Water relatively circumstances, including section Quality Office may WQCD (nwp the Working on or in any stream or its bank - more by In Colorado yards CDOT order or and/or cover upstream vary to and protect Department 2) within a intermittent CPW, natural 100 or and downstream can existing yards of preserve Natural streams be accessed upstream stream of the Resources. providing the state's or or at project its downstream ttps:iiwww.coaon.goviprograms/environmentali fish banks live A stream water and or tributaries, wildlife beneficial of is the by defined resources project; valley it to as may fish and/or length. 1) from be necessary represented and wildlife; 4) The actions segments CPW that and/or by to a of may obtain solid 3) streams application, w'ldlife/ouideiines. segments obstruct, blue a Senate line having of as diminish, on streams per Bill wetlands USGS 40 guidelines destroy, certification 7.5' supporting present quadrangle agreed change, within from 25% upon the or 200 modify, maps; measured Stormwater Construction Permit (SCP) and Stormwater Discharge From Industrial Facilities - concrete Discharges at (303) batch of 692-3500. stormwater plants - require Website: runoff a from CDPS https://www.colorado.gov/pacific/cdphe/wq-construction-general-permits n d construction Stormwater ustry-perm its. sites Permit. disturbing Contact one acre Information: or more - or Contact certain the types CDPHE of industrial Water and Quality https://colorado.gov/pacific/cdphe/wq-commerce-and- facilities, Control such as Division Construction Dewatering (Discharge or Infiltration) and Remedlation Activities - Discharges Activities contact of Discharge water the CDPHE encountered Permit. during Contact at - (303) - l -permits 692- excavation Information: 3500. For Applications or work For in wet Construction areas and Instructions may Dewatering require CDPHE a and Construction Remediation website): Dewatering https://w Activities A. or Discharge R lorado.qov/paL,ific/cdphe/wq-consucrzlon-cr Remediation Permits, WQCD Municipal Separate Storm Sewer System (MS4) Discharge Permit • within Discharges municipality system Water those that Quality or municipalities, that from may within Control is the have subject the storm been Right Commission are to and municipalities sewer an established of subject subject the MS4 Way systems (WQCC) CDOT to to permit, (ROW) inspection MS4 MS4 under MS4 required of regulations, larger Permits the must Regulations that Permit owner by comply to CDOT obtain issued ## of go COS such with to: - facility the (https://www.colorado.qov/pacific/cdphe/wocc-regulations-and-pollees-and-water-qualitv-statutes) municipalities, by municipality's 000005 and MS4 https://www.codot.qov/programs/environmental/water-quality/stormwater-programs.html. the applicable CDPHE. CDPHE should Permits, (https://www.codot.gov/programs/environmental/water-quality/documents). and contact MS4 provisions WQCD. from permit. the the For municipality of All the CDOT facilities discharges Colorado highway that regarding lie to Water drainage the within stormwater CDOT Quality the system boundaries highway Control related that Act, drainage lies of clearances the a at (303) 692-3500 Discharges for a listing For CDOT-related are of Contact or go to the CDPHE ,-ittps://www.colorado.gov/pacific/cdphe/wq-municipal-ms4-permits. Water Quality Control Division General Prohibition — Discharges - All discharges Prohibited and sediment. are discharges subject Contact to include, the Information: provisions but of are not Contact the limited Colorado the to, CDPHE substances Water Quality such Water Quality Control as wash Control Act water, Division and the paint, at Colorado automotive (303) 692-3500. Discharge fluids, solvents, Permit Regulations. oils or soaps General Authorization - Allowable Non-Stormwater Discharges - Unless Illicit to flows, riparian stormwater air Discharge otherwise conditioning uncontaminated habitats The CDPHE PDD identified systems and condensation, at: wetlands, Water https://www.codot.aov/nrogramsl are ground by CDOT allowed water irrigation and or without infiltration flow the from WQCD water, Division a Colorado to firefighting as separate (telephone significant sources Discharge storm uncontaminated activities. mnviror^rental/water-quality/stormwater-programs.html. of sewers, pollutants Permit Allowable discharges springs, System to non-stormwater the footing waters permit: from potable drains, of landscape the discharges water water State, irrigation, sources, line the can flushing, following be foundation diverted found Contact flows discharges stream under drains, from Information: Quality Control #'s listed above). Erosion and Sediment Control Practices - where For to (available activities CDOT a to stormwater applicable requiring the permit CDOT a Specifications Bid Stormwater Plans is Standard not required, Office 107.25, s-uuc) Construction Specifications at (303) all ). reasonable 208, All 757-9313) disturbances 213 Permit, 212-217 and erosion measures 216 should (https://wwv require and control should requirements be taken - ,ciot.gov/ to ..,ii will minimize be specified erosion ,tos/designsuppui in and that Stormwater restore sedimentation permit. Lw design disturbed In Quality situations plan according according Guide vegetation. i 1-construction-pecifications/2011-SpeLs/2011-spot Standard from a 623. be used stabilization The CDOT to design plan, native Erosion erosion seeding Control controls or and and landscape Environmental Clearances Information Summary Page 2 of 3 Colorado Department of Traisportation August 2017 "discharges" Disposal of Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as or "solid wastes," and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of sewers, Waste Way, and roadside regulations. disposed ditches Small of at or quantities permitted any other facilities of type drilling of that man-made fluid specifically solids or (less natural accept than waterway 1 such cubic wastes. yard is prohibited of solids) Disposal by may of Water drilling be left Quality on fluids -site into Control after storm either and/or drains, Solid being storm separated required the solids for are from proper fully fluids contained drilling or after properties, infiltration in a pit, small and of the are quantities not water, likely provided: of polymer to pose 1) a the additives nuisance drilling to that fluid future are consists approved work in of the only for area, water use and in drinking 3) the solids bentonite water are clay, well covered drilling; or, if and 2) the area Contact restored CDPHE as required ;telephone by COOT #'s listed permit above). requirements (Utility, Special Use, or Access Permits, etc.). Contact information: Noxious Weeds and Invasive Species Management Plan — Noxious Weeds and Invasive Species guidance can be found by contacting the Colorado Department of Agriculture (https:/iwww.coioraao.gov/pacific/agconservationinoxiousweeds) and the Colorado Division of Parks and Wildlife (http://cpw.state.co.us/aboutus/PaqesIRS-NoxiousWeeds.aspx). In either case, management plans involving the control of noxious weeds associated with the permitted activity and cleaning of equipment will be required. Concrete Washout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, or in the CDOT ROW, Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, drainageways, and inlets. Concrete washout shall only be performed as specified by the CDOT Environmental find additional Program information and on shall the be CDOT in accordance website: httpsalwww.codot.gov/'business/uessgnsupporv2U11-construction- to CDOT specifications and guidelines. Contact information: Contact CDPHE or specifications/2011-Specs and refer to the specifications and their revisions for sections 101, 107 and 208. Spill Reporting - Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain or buried. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (4H20), as well the Regional Permitting exceeding Office 25 gallons, and Regional or that may Maintenance otherwise Supervisor. present an immediate Spills on highways, danger to the into waterways, public shall any be spill reported in the by calling highway as 911, right-of-way and shall also be reported to the CDPHE at 1-877-518-5608. More information can be found at https:l/www.colorado.gc \Jpacific/cdphe; emergency- t ,c;�ort�na-I�r�� About This Form - Questions or comments about this Information Summary may be airected to Alex Karam', Program Administrator, CDOT Access Management Unit, at (303) 757-9841, alex.karami@state,co.us. Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation August 2017 COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowmelt flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturaly soaking into the ground Why is stormwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow into CDOT's storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters CDOrs storm drain system is discharged untreated into the waterways we use for fishing, swimming, and providing drinking water. (rect a": dui, fir~. cocain waste, uidner,. re#wile, Sewage, scwaC4 ltudgo, g3rba$,c; trath, t1htrrtic.l waits, biologKM nutuent, biological rprate-pat., radioactive material, heal, pH, wrecked oA ("it:.stet p..quipment, rots„ sand. any indugrial, in _awl:spa%, or agr+:.aituras Tips for Reporting on illicit Discharge Call the illicit discharge hotline at (303) 5124426 from a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (If applicable). Do not approach) Call'CSP for illicit dumping, if possible, take a photo, record a license plate. For more information on CDOT Utility Permits: htt.s: www.codot. av ousiness_ ,permits utilitle ssrecialuse For more information on CDOT Access Permits: htt�►c:_1 www.codot.dov business % errnits access permits For more information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222_ 303-7S7-9343 COLO ADO Department of Transportation Water tuellaa% Grcaranu Industrial Eaciiities i)r«i a in COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Erwironrnent The permit states that onty stormwater can be discharged from CDOT's storm drain system 70 MS WASTRIMEU TMEMILOff RANI 43080I bsain gamine din 41161 0' tom LOCAL As part of the permit, CDOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program New Development Redevelopment Program Illicit Discharge Program Industrial Facilities Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program COLORADO Department of Transportation Control Measures for Industrial Facilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices (BMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering Into CST's storm drain system. Control Measures also Include treatment, operating procedures, and practices to control site run off which can in dude structural and non-structural controls. Ti AUUM dTimA Mr y 111110113111110 ISMSr5-pi isnEw IMPrialarn In mmpHaeaeli CDOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: ✓ Communications ✓ Cable television ✓ Power ✓ Electricity ✓ Light ✓ Heat Gas ✓ Oil ✓ Crude Products I Water ✓ Stream ✓ Waste ✓ Stormwater not connected with highway drainage ✓ Similar Commodity COLORADO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to C0PHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-ofeway will require some type of environmental permit or clearance for that work. CDOT has put together an Environmental Clearances Information Summary for those applying for a CDOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: htt.://www.cotoradodot.info/ ro rams/ environmental/resources/ uicfance- standards/Environmental%2OClearances% 20Info%20Summa rite pdt COLORADO Department of Transportation Office of the Executive Director 4201 East Arkansas Ave, Suite 262 Denver, CO 80222 RELEASE MEMORANDUM To: All CDOT Employees From: Shailen P. Blatt, Executive Director Re: Updated Procedural Directive 602.1 "ADA and PWFA Accommodation Procedures" Date: June 16, 2017 1. Name of Updated Procedural Directive: PD 602.1 "ADA and PWFA Accommodation Procedures" 2. Date of Directive Superseded: April 14, 2015 3. Executive Summary: PD 602.1 provides information regarding CDOT's provision of reasonable accommodation to employees, or applicants for employment, with disabilities. This PD has been updated to incorporate requirements from the Pregnant Workers Fairness Act, passed in 2016, which requires employers to provide to employees or applicants for employment reasonable accommodation for health conditions related to pregnancy, physical recovery from childbirth, or a related condition, to perform essential functions of the job, unless the accommodation would impose an undue hardship on CDOT. 4. Effective Date: June 16, 2017 5. Office to Contact with Questions: ADA Program Administrator, Division of Human Resources. 4201 E. Arkansas Ave, Suite 262, Denver, CO 80222 P 303.257.9201 F 303.757.9656 www.codot.gov COLORADO DEPARTMENT OF TRANSPORTATION ❑ POLICY DIRECTIVE X PROCEDURAL DIRECTIVE Subject ADA and PWFA Accommodation Procedures 602.1 Effective 6.1617 Supersedes 4.14.15 Originating Office Division of Human Resources I. PURPOSE Title 1 of the Americans with Disabilities Act (ADA) requires the Colorado Department of Transportation to provide Reasonable Accommodation to individuals with disabilities who are Employees, or applicants for employment, except when such accommodation would cause an undue hardship The Pregnant Workers Fairness Act (PWFA) requires the Colorado Department of Transportation to provide Reasonable Accommodations to an Employee or applicant for employment, for health conditions related to pregnancy, physical recovery from childbirth, or a related condition, to perform the essential functions of the job, unless the accommodation would impose an undue hardship on the employer's business. Discrimination and Retaliation concerns under the ADA and PWFA are addressed under Policy Directive 600.0 (Equal Employment Opportunity and Affirmative Action) and Procedural Directive 600.6. (Internal Discrimination Complaint Procedures) See also Procedural Directive 12.1 (Workplace Accommodations for Nursing Mothers) for procedures in compliance with the Workplace Accommodations for Nursing Mothers Act H. AUTHORITY CDOT Executive Director pursuant to § 43-1-105, C.R.S Rules 4-6, 9-3 and 9-5 of 4 CCR 80I-1, Personnel Board Rules and Personnel Director's Administrative Procedures Americans with Disabilities Act of 1990, 42 U.S C § 12101 (1990) (hereinafter "ADA"), as amended 29 C.F.R Part 1630 29 C.F.R. § 1602.31 (record keeping) Rehabilitation Act of 1973, 29 U.S.C. § 701 (1973), as amended Page 1 of 7 ADA and PWFA Accoaaa IT odation Procedures Number 602.1 U.S. EEOC Enforcement Guidance. Reasonable Accommodation and Undue Hardship under the Americans with Disabilities Act (https•//www.eeoc.gov/laws/guidance/enforcement_guidance.cfm) § 24-34-402, et seq., C.R.S. §24-34-402.3, C.R.S. (Pregnant Worker's Fairness Act) 3 CCR 708-1, State of Colorado Civil Rights Commission Rules and Regulations III. APPLICABILITY This Procedural Directive applies to Employees and Job Applicants for all employment -related operations and services of CDOT, as well as to all CDOT building facilities, divisions, regions, offices and branches. IV. DEFINITIONS "Americans with Disabilities Act (ADA)" shall refer to Title 1 of the Americans with Disabilities Acts of 1990 and the ADAAA of 2008 which require the Department to provide equal employment opportunities for individuals with disabilities. As one of the requirements of the ADA and ADAAA, Reasonable Accommodation will be provided to individuals with disabilities who are qualified and employed by the Department or who are applicants for employment, absent undue hardship. "ADA Coordinator" shall mean the person or persons designated and trained by the Division of Human Resources in the ADA and PWFA requirements to take a lead role in conducting an Interactive Process with an Employee or Job Applicant. The list of ADA Coordinators can be found on the CDOT intranet (http•//intranet.dot.state.co us/employeeslee-rights/ada-content). "Appointing Authority" for purposes of this Procedural Directive shall mean the person or persons designated to handle personnel matters or make hiring decisions. "Department" or "CDOT" shall mean the Colorado Department of Transportation pursuant to § 43-1-101, C.R S. "Disability" shall mean a physical or mental impairment that substantially limits one or more major life activities; a record of such impairment, or being regarded as having such an impairment "Employee" shall mean any individual who is employed with CDOT in a temporary, permanent, part-time or full-time capacity. Volunteers are not considered an "Employee" for application of this procedural directive. iriang Process" shall mean any aspect of the process to fill an employment position including Page 2 of 7 SOi ADA and PWFA Accommodation Procedures Nuenta 602.1 the application, interview, written test, or other type of job demonstration. "Interactive Process" shall mean the process by which an individual will request and/or participate in discussions with the Department for an accommodation; the Department will determine whether requirements are met, whether an accommodation is reasonable and can be provided, and examine potential alternative accommodations. "Job Applicant" shall mean any individual who has submitted an application for employment with the Department as well as any current Employee seeking promotion or transfer with the Department. "Reasonable Accommodation" shall mean any change in the work environment or in the way processes are customarily done that enables an individual with a Disability or an individual who falls under the PWFA to enjoy equal employment opportunities. A Reasonable Accommodation may include job restructuring, leave, modified or part-time schedule, modified policies, reassignment, or variations thereof. "Unfilled Position" for purposes of this Procedural Directive shall mean a position for which funding has been established, approved by the Department, and that the Department intends to fill. V. PROCEDURE A. General Requirements 1 In the following areas of employment, the Department shall comply with the ADA and PWFA requirements concerning the provision of Reasonable Accommodation a) That is required to ensure equal opportunity in the Hiring Process, b) That enables an individual with a Disability or who has health conditions related to pregnancy, physically recovering from childbirth, or related condition, who is qualified to perform the essential functions of the position held or desired; and c) That enables the Department's Employees with disabilities or who has health conditions related to pregnancy, physically recovering from childbirth, or related condition, to enjoy equal benefits and privileges of employment as are enjoyed by other similarly situated Employees without disabilities or do not have health conditions related to pregnancy, physically recovering from childbirth or related condition. Benefits and privileges of employment shall include, but are not limited to, Department -sponsored: (1) training, (2) services such as cafeteria, lounges, auditoriums, and (3) parties or other social functions 2. The Department, through the ADA Coordinator, will initiate an Interactive Process Page 3 of 7 soc a ADA and PWFA Ac ouninodation Procedures Nolte 602.1 with an Employee or Job Applicant, or his/her personal representative, to assist with the ADA or PWFA Accommodation Procedures. The Interactive Process may include the following as determined on a case -by -case basis: a) Act upon receipt of a request for an accommodation or information identifying a need; b) Determine whether the individual has a Disability as defined by the ADA: c) Determine whether the individual with a Disability is qualified (1) satisfies the reqwsite work experience, education, and other job related requirements for a position; and (2) can perform the essential functions of the position with or without a reasonable accommodation. d) Identify a Reasonable Accommodation, or potential undue hardship 3 The Department is not required to provide an accommodation that would cause an undue hardship. Undue hardship means significant difficulty or expense in, or resulting from, the provision of the accommodation Whether a particular accommodation will cause an undue hardship is determined on a case -by -case basis. The resources and circumstances of the Department as the employer will be considered in relationship to the cost or difficulty of providing a specific accommodation. An individual assessment and evaluation will be conducted through the Interactive Process by an ADA Coordinator with the recommendation to an Appointing Authority, who shall make the final determination. 4. When a Workers' Compensation process parallels the accommodation process, the Risk Management Unit will provide the necessary information to the ADA Coordinator concerning requests related to Employees also involved in Workers' Compensation claims Workers' Compensation Injury/Illness shall mean a work -related injury or a work -related illness, as defined in the Colorado Workers' Compensation Act. B. Procedures Related to Accommodating Job Applicants and the Hiring Process 1. Human resources shall provide a Job Applicant with information as to whom to contact for an accommodation either in the job announcement or by additional notification in the Hiring process 2 During the selection process, Job Applicants will be notified of the different aspects of the Hiring process (t e , interview, written exam, or job demonstration, etc.). Human resources will inform the Job Applicant that if he or she requires an accommodation to participate in the process, he or she must inform human resources within a reasonably established time period prior to the administration of that aspect of the Hiring Process if a Job Applicant has an obvious Disability or discloses information which indicates a possible need for an accommodation, human resources will initiate communication to Page 4 of 7 sugeet ADA and PWFA Accommodation Procedures No 602.1 determine if an accommodation is required. If an accommodation is required, an ADA Coordinator will conduct an Interactive Process with the Job Applicant with a Disability for the Hiring Process. During the Interactive Process, the Department may identify a Reasonable Accommodation that will allow the Job Applicant equal opportunity during the Hiring Process. 3 After a conditional job offer is made, an ADA Coordinator may conduct an Interactive Process with the selected Job Applicant with a Disability or with an applicant who has a health condition related to pregnancy, is physically recovering from childbirth, or a related condition, to determine if the essential functions of the specific position can be performed with or without a Reasonable Accommodation During the Interactive Process, the Department may identify a Reasonable Accommodation that will allow the selected Job Applicant to perform the essential functions of the specific position. C. Procedures Related to Accommodating Employees 1 For performance of job duties, an Employee with a Disability or a health condition related to pregnancy, physically recovering from childbirth or a related condition, should request an accommodation from his or her supervisor or manager or ADA Coordinator for all employment -related requests. A list of ADA Coordinators are posted on the CDOT Intranet (http://intranet dot state.co.us/employeestee-rights/ada-content). 2. The supervisor or manager will notify the ADA Coordinator of any request or receipt of information regarding a potential need for accommodation. The ADA Coordinator shall be the main point of contact for an Employee's request for accommodation. 3. The ADA Coordinator will conduct an Interactive Process with an Employee to determine if the essential functions of his/her position can be performed with or without a Reasonable accommodation 4. During the Interactive Process, a Reasonable Accommodation that meets the needs of the Employee may be identified. A Reasonable Accommodation will be provided to allow an Employee with a Disability to perform the essential functions of his/her position. For employees covered by the PWFA, a temporary transfer to another position that meets the request for accommodation will be considered. 5. Reassignment is a form of Reasonable Accommodation for an Employee with a Disability (ADA only) who is qualified, made as a last resort, and is required only after it has been determined that: a) There are no effective accommodations that will enable the Employee to perform the essential functions of his/her current position; or b) All other accommodations would cause undue hardship Page 5 of 7 ADA and PWFA Accommodation Procedures Number 602.1 However, if both the Department and the Employee voluntarily agree that a reassignment is preferable to remaining in the current position with some form of Reasonable Accommodation, the Department may consider reassigmnent for an Employee. The Department will follow the process described in the Guide to determine a reassignment of an Employee. A reassignment can only made to an Unfilled Position for which the Employee meets the minimum qualifications 6. Prior to contemplation of an administrative discharge of an Employee in accordance with State Personnel Board Rules and Personnel Director's Administrative Procedures, the Appointing Authority is required to consult with the ADA Coordinator to determine whether the ADA applies, and if so, whether the Employee can be reasonably accommodated. 7. For benefits and privileges of employment, the Department will conduct an Interactive Process with an Employee. Employees with disabilities or who fall under the PWFA will be provided a Reasonable Accommodation in order to gain access to and have an equal opportunity to participate in the same benefits and privileges of employment afforded to similarly -situated Employees without disabilities. Benefits and privileges of employment shall include, but are not limited to, Department -sponsored (a) training, (b) services such as cafeteria, lounges, auditoriums, and (c) parties or other social functions D. Record Keeping 1 Any information regarding the Job Applicant or Employee, including medical information and the final letter of determination, obtained as part of an examination or inquiry for determining a Disability or Reasonable Accommodation under the ADA or PWFA is protected and confidential. All documents shall be kept in a separate, confidential ADA or PWFA file with limited access for the duration of employment at CDOT or for 2 years from the date of the making of the record or the personnel action involved, whichever occurs later, pursuant to 29 C.F.R. § 1602 31 2. All ADA Coordinators will maintain records to demonstrate compliance with the ADA and PWFA requirements in accordance with state and federal requirements. For tracking and reporting requirements, a Statewide ADA Administrator will administer the ADA and PWFA program and prepare reports as necessary, 3 If the Department is notified of a charge of discrimination or pending litigation relating to the ADA or PWFA decision, the records must be maintained for two years after expiration of the eligible list or until the litigation and/or charges are resolved, whichever occurs later. Page 6 of 7 sutied ADA and PWFA Accommodation Procedures VI. IMPLEMENTATION PLAN The Division of Human Resources will offer training on the ADA and PWFA, the Department's program and accommodation process to all Appointing Authorities, designees and direct reports, and ADA Coordinators. In order to conduct the Interactive Process, an ADA Coordinator must be certified by the Statewide ADA Administrator. The Office of Policy and Government Relations shall post this Procedural Directive on the CDOT Intranet as well as on the CDOT public announcements. VII. REVIEW DATE This Procedural Directive shall be reviewed on or before June 2022. Shailen Executive C1)6(911O lrQ y0 Date of Approval Page 7 of 7 State Highway Access Permit Attachment to Permit No 419075 - Additional Terms and Conditions 1 1 If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350- 2148 2 The Permittee or the contractor shall notify Bruce Barnett 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 3 The Permittee shall request final inspection by Bruce Barnett at (970) 350-2147 within 10 days following the completion of access construction, and prior to authorized use The Permittee or their representative shall be present 4 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 5 The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments 6 Incorporated as part of this permit are the following Application for Access Permit (CDOT Form No 137) Permit (CDOT Form No 101) and its attachments Exhibits "A" — Access Plan "B" — Vicinity Map "C" -- Seeding 7 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 be applied for based upon the existing and anticipated future conditions 8 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 9 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 Attachment to Permit No. 419075 - Additional Terms and Conditions 2 10. 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 permit and be available on the site during construction. 11. 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. In the event a signal is warranted in the future, CDOT will not participate in any fashion with that signal installation, including financially. 12. The Department will not participate in any costs related to the design and installation of a traffic signal, should one be warranted or approved at this access location or any other serving this development. 13. The 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. 14. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from the CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction- Environmental Guidance webpage at httpjA_Aiww.dot.state.co.uslenvironrnental/Formsjasp. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as: wash water, paint, automotive fluids, solvents, oils or soaps. Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted State Highway Access Permit Attachment to Permit No. 419075 - Additional Terms and Conditions stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CHPHE website at: http:/jcdnhe.state.co.us/wq/PermitsUnit/wqu. 15. 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. 16. 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 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. 17. Landscaping and site construction shall not obstruct sight distance at any State Highway access point. Landscaping within the State Highway right-of-way requires the Pernittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with COOT Standard M-605-1 or other approved system. The Permittee shall contact Allyson Mattson at the Greeley Traffic Office, (970) 350-2148 to obtain the Landscaping Permit. 18. 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. 19. The Department inspector may suspend work due to: 1) Noncompliance with the provisions of this permit; 2) Adverse weather or traffic conditions; 3) Concurrent highway construction or maintenance in conflict with permit work; 4) Any condition deemed unsafe for workers or the general public. The work may be resumed upon notice from the Department Inspector. 20. 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. State Highway Access Permit Attachment to Permit No 419075 - Additional Terms and Conditions 4 21 Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs 22 The Department retains the right to per -form any necessary maintenance work in this area 23 Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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 24 Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition) 25 All materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable A State Highway Access Code, 2 CCR601-1 B Roadway Design Manual C Materials Manual D Construction Manual E Standard Specifications for Road and Bridge Construction, latest edition F Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M U T C D ) for Streets and Highways and the Colorado Supplement thereto H A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I AASHTO Roadside Design Guide J Institute of Transportation Engineer's Trip Generation Manual, 6th Edition Some of the reference materials listed above (A through E) may be purchased from Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from State Highway Access Permit Attachment to Permit No. 419075 - Additional Terms and Conditions 5 The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is: www.cdot.gov 26. 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 CRF Part 1926 — Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment: • Head protection that complies with the ANSI Z89.1-1997 standard; • At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn • High visibility apparel as specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2). Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply. 27. 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. 28. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 29. Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority. 30. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department. 31. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. State Highway Access Permit Attachment to Permit No 419075 - Additional Terms and Conditions 6 32 Construction traffic control devices, when not in use, shall be removed or turned away from traffic. Devices must be stored outside of the roadway clear zone per the latest AASHTO guidelines. 33 Cattle guards are not permitted in State Highway right-of-way. 34 If State Highway right-of-way fence exists or is proposed, the Permittee must contact Bruce Barnett at the Greeley Traffic Office, (970) 350-2147 prior to removal or installation The Permittee will be required to obtain a highway right-of-way fence agreement for a special fence if the Permittee desires to remove the existing standard highway fencing in this area When it is necessary to remove any highway right-of-way fence, the posts on either side of the access entrance shall be securely braced with approved end posts and in conformance with the Department's M-607-1 standard, before the fence is cut to prevent slacking of the remaining fence All posts and wire removed shall be returned to the Department 35 The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highway right-of-way 36 All required access improvements shall be installed prior to the herein authorized use of this access Failure to do so will result in the appropriate legal action from the Department, up to Permit Revocation 37. The access shall be constructed and maintained as per Exhibit "A" 38 The access shall be constructed at 25 feet wide with a 20 foot radius 39 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 40 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 41 The Permittee is required to install a tracking pad on private property to mitigate the effects of mud and other debris being tracked onto the State Highway system Should debris tracking onto the highway be a problem, CDOT will contact the Permittee who shall clean the highway within 24 hours of CDOT contact Appropriate traffic control shall be used per the M U T C D 42 The access shall be surfaced immediately upon completion of earthwork construction and prior to use State Highway Access Permit Attachment to Permit No 419075 - Additional Terms and Conditions 7 43 Surfacing of the access shall be completed as per Exhibit "A" 44 No paved surface shall be cut unless specified in this permit Asphalt removal shall be saw cut to assure a straight edge for patching Full panel concrete replacement is required for any concrete work 45 The new State Highway pavement shall slope on the same plane as the present pavement surface 46. 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 47 The access shall be constructed and maintained in such a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way Drainage to the State Highway right-of-way shall not exceed historical rate of flow 48 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 49 This access located approximately 5245 feet north of mile marker 291 on the west/left side of State Highway 85 at approximately mile point 291 993 must be removed in its entirety by the agreed upon date on the front of this permit Removal shall include, but is not limited to, the return of the highway right-of-way 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 The right-of-way must be restored to the original condition on this date using the included seeding mixture Revegetation efforts must be continuously monitored until they are accepted by the CDOT Access Inspector COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Issuing authority application acceptance date: i Instructions: Contact Colorado Department Please or print type - - Contact - Complete - Submit - If you the the this an have issuing application any form authority (some questions for each of Transportation to determine questions may access contact the issuing not affected. what apply authority. plans to (COOT) and other you) or your local documents and attach government to determine your issuing are required to be submitted all necessary documents and Submit with authority. your application. ft to the issuing authority. - For additional information see CDOTs Access Management website at http://www.dot.state.co.usJAccessPentnits/Index.htm 1) Property owner (Pennittee) Michael Lance Palmer 2) Applicant or Agent for permittee (if Cheyenne Connector Pipeline,_ different from property owner) Inc. Street address 1119 E 16th Street Mailing address 370 Van Gordon St City, state & zip Phone # City, state & zip Phone # (required) Loveland, CO 8053 970-663-6299 Lakewood, CO 80226 303-763-2981 E-mail address E-mail address If available rebeccalieders@summitresourcesiand.com 3) Address of property to be served by permit (required) State Highway 85 4) Legal description of property: if county subdivision within jurisdictional limits of Municipality, block city and/or lot County, which one? Weld I 1 section 1 17 J9N township J66W range 5) What State Highway State Highway are you requesting access from? 85 I 6) What side of the hi hway? DN S D E ■ 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? 4645 feet IN I S D E W) from: 291 4620 feet UN ■ S DE DW) Weld County Road 104 from: 8) What is the approximate June 3, 2019 date you intend to begin construction? 9) Check here if you are requesting a: al new access [temporary access (duration anticipated: 6/1/19-12/31/19 ) MI improvement to existing access change in access use removal of access [elocation of an existing access (provide detail) 10) Provide existing Agricultural property use 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 number(s) and permit provide copies: and/or, permit date: 12) Does the property owner own or have any interests in any adjacent property? is no II yes, if yes - please describe: 13) Are there other existing or dedicated public streets, roads, highways or access easements bordering or within the property? a no S yes, if yes - list them on your plans and indicate the proposed and existing access points. 14) if you are requesting agricultural field access - 2 . 76 AC how many acres will the access serve? 15) If you are requesting commercial or industrial business/land use access please indicate the square footage types and number of businesses and provide the business floor area square footage of square each, footage I 1 1 1 16) If you are requesting residential developement access, what type is the type number of (single family, apartment, townhouse) and number of units? units type number of units 1 I _1__ I 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning Is two counts. indicate it your counts are foot passenger cars and ight trucks at peak hour volumes # of mutti unit trucks at peak hour volumes peak hour volumes or El average daily volumes. 50 4 --; N of single unit vehicles in exceea of 30 ft. 8 I of farm vehicles (field equipment) 8 Total count of all vehicles 91 Previous editions are obsolete and may not be used Pagel of 2 CDOT Form 4137 01/10 '81 (312O4 with 'ha iS8uL'wj aulhovd) iv Wartime ntn'�5 of ore 1 ibra try deu mores are requrnd b, carnp!_w_ etc e. w el Vrry tvpScadixt 4, Pr"+Aerl r n `{ hng cowl-ae..asc beldame Tom and armada c1 Si bdioaicn. rums, ar acvals rne-it ci Fighes yardr-r.v.vaj pan colitis r) Proms scamdoskr l IxmntgePieurte c 'rivedto the hiphwy ittt-ur wety yt Parcel Pu'th 0wnSfri31 raga fCaairrg eeeunerca di NW and leaart astaikr Miley bcabcrts betecr arid stir 17,1 i ro-pik s1utbea Cane rtme t on and atom ma WTI -of -way it Proel d oatneretici 1 it Is the applicant's roSsOf1stbllltyr to bonded hate to their actrrrhes Such clearances may include Corps of permits, or ecological, arctvesoiogeat, historical or cultural Infarmaeon Summary presents contact in omtation tar agencies prclibded discharges, and may be alatamed from Regional CDOT Planning ^Conspruction•Envlronrnern&V- aid' autos weopage 2- All workers wlihin the State titgh'nteyr right of way shell procedures and all applicable US Occupational Safety knitted to the appticabte sections ct 29 CFR Part 1910 - Occupational - Safety and Health Regulations for Canslrucfig , Personal protective equipment Ce g. head protection, luotwear, 'Impacts, gloves, etc ? shall be worn es appropriate for minimum, OM woticers in the State Highway right of way, protective equipment- High vielblhy apparel as specified accompanying the Notice to Proceed related to this permit that complies with the ANSI 299,1-1997standard; and at feet, workers shall comply with OSHA a PPE requwemerits 1926 96. If rural, such footwear shall meet the requirements Where arty of the above referenced ANSI standards have ?Milk 3- The Pertnittee is responsible for complying with the Revised under the Anaencan Drasbrlrltee Act (ADA) These guldeltnes use of a defined pattern of truncated domes es detectable can be found an the Design and Construction Project Support cittlay.l etw i9L o.t88iDesignSuppart'b than click egerecses and obrtesn all en ire mnentai Engineers 404 Fermis Or Calerado Dischawge resource clearances The CDOT Environmental adniirllstcnng caftan clearances, COOT Lady/Special Use Permit offices htto-Ainstro.dorLstate.co.usienverottmeidal/Forms.ase clearances that apply Perms System Clearances informatrorl about or acoasysa via the bompty wIth their empddyer's safety and health paiiclesi and Health AdminIstration (OSHA) regulations - including, but not Safety end Health Standards and 29 CFR Pan 1926 high visibility apparel, safety glossas, helaring prat lion the work hung performed and as specified m regulation At a except when in their vehicles shall wear the following peened In the Tratlic Control provisions of the documentation Cat a minimum, ANSE,tcFA 107-1999, class 21, head protection all construcdon sites or whetrever there is danger of lntury to far toot protection par 29 CFR 1910 136 1926 96. and of ANSI Zai-1969 been revised, the most recent version of the standard shall Gradelines that have been adopted by the Access board define traversable slope requirements and preserve the warnings at street crossings The new Standards Plans and web page at; on Design Bulietrn5 If an across permit r6 issued to you, it will state the term? and conditions for Is use Any changes in the use of the permitted access not consistent with the terms and conditions listed on the permit May he oorfidt ,ed a violation of the permit The applicant declares under penalty of fpaltry a In the second degree, and any other a Icabls state or federal laws, that all Informationptevtded cat Millions fans and submitted etiedlments are to the best at their irrrgtsledge true and corttplatti. I understand receipt at an access permnit does not cgnetttute perrmi@eipvt to stint excess construction work_ .i.nI'/� kr F�,�rmmca sjnerirF3 ` CC. \...t--a-g-'1.4,4 4 Firrsv drc I Rebecca Lueders 'Zak 'la 5/172019 If ine applicant le not the darner of the property we require this application also to be signed by the property owner or their legally surnamed repfe:nraave (or outer acceptable written evince) This signature shall constitute agreement with this vOcation by all ammers-al-interest unless stated in writing Ira permit et Issued the properly owner, in mast Case, , will be listed as the platitudes PilVerty %WWI SVIS11.411 I,Phr4r snr !— / 1..,"Lr',�,_) f f/42r`1✓L rs-'-y - 4V/2 P4vipua millions arc otepsoar grid roar not Or and Page 2ed2 GMT Farmssa7 atte 4457307 Pmt: 1 of 6 1,38.00 Cary Keppee,eClark annd Recorder , Weld County, CO all' NFATIVAINNINIMA911iVIRiVVEN Ell Ill Tract No: CO -WE -976.000 PIPELINE EASEMENT THIS PIPELINE EASEMENT ("Agreement') is made this 21st day of December 2018, from Michael Lance Palmer, whose address is 1119 East 16th Street, Loveland, Colorado 80538 ("Grantor whether one or more), to Cheyenne Connector Pipeline, Inc , a Colorado corporation, whose address is 370 Van Gordon Street, Lakewood, Colorado 80228 ("Grantee") The parties agree as follows 1 Grant For and in consideration of Ten Dollars ($10 00) and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Grantor hereby grants, sells, conveys and warrants unto Grantee, its successors and assigns, a perpetual exclusive easement to survey (including, but not limited to, civil, environmental, geotechnical, and cultural surveys), construct, maintain, clear, inspect, test, upgrade, operate, repair, replace, modify, reconstruct, mark, monitor, patrol, protect, abandon in place or remove, one pipeline not to exceed thirty-six inches (36'), and all related equipment and appurtenances, below and/or above ground, necessary or convenient for the transportation or transmission of oil, natural gas (including, without limitation, natural gas liquids), petroleum products, water, hydrocarbons and any other substances, and any products, derivatives, combinations or mixtures of any of the foregoing, including but not limited to, meters, regulators, valves, launchers/receivers, vent pipes, line markers, taps, rectifiers, alternating current mitigation, cathodic protection, fiber optic communication lines, including enclosures for the aforesaid appurtenances (the pipeline(s) together with such appurtenances are collectively referred to herein as, the 'Pipeline' and the foregoing rights and those provided to Grantee hereunder are collectively referred to herein as the °Easement Rights"), in, on, over, under, or through the real property situated in Weld County, State of Colorado, being described as follows TOWNSHIP 9 NORTH, RANGE 66 WEST 6TH PM SECTION 17 A tract of land being a portion of the East half of Section 17, Township 9 North, Range 66 West of the 6th Principal Meridian, County of Weld, State of Colorado, being more particularly described in that certain Warranty Deed from Victor A. Michael, Jr to Michael Lance Palmer, dated May 2, 2016 and recorded May 3, 2016 at Reception No 4200325 in the Clerk and Recorder's Office of Weld County, Colorado 2 Easement Location The real property subject to the Easement Rights (the "Easement Lands') is comprised of a permanent easement area fifty feet (50') in width (the "Permanent Easement Area"), a temporary easement area of an additional seventy-five feet (75') in width together with any additional temporary work space (collectively, the 'Temporary Easement Area") as each is more particularly described and/or depicted on Exhibit "A" in the event the Pipeline is constructed and the centerline of such Pipeline, as constructed, is in a different location than contemplated by Exhibit °A", Grantor and Grantee hereby agree that the width and/or location of the Permanent Easement Area as identified on Exhibit °A" will be modified as necessary in Grantee's reasonable discretion to facilitate the width as contemplated herein and the relative location of the Pipeline within the Permanent Easement Area (such as constructed location shall constitute the Permanent Easement Area for purposes of this Agreement) In the event of a modified Permanent Easement Area, Grantee may (in its discretion), and Grantor hereby authorizes Grantee to, record a Memorandum and Notice of Pipeline Location along with an as -built survey describing and/or depicting such modified Permanent Easement Area and/or the initial Pipeline 1 of 5 4467307 Pages' 2 of 6 Car1v Koppp1ee,3Clerk aannd Recorrdar,,3Wield County, CO III NraVIRWICI 'iiikhg'15%ifilli1iliHi MI III 3 Use The Grantor reserves the right to cultivate, use and occupy the Easement Lands for any purpose consistent with the rights and privileges herein granted and which, in the sole opinion of the Grantee, will not interfere with or endanger any of the Pipeline facilities therein or otherwise impair the use by Grantee, its agents and/or contractors of such Pipeline facilities and/or the Easement Lands Grantor shall not, nor shall it allow others ailing by or through Grantor to, excavate or otherwise alter the ground elevation or grade, remove any soil, construct or place any obstructions, buildings, improvements, fences, engineering works, utilities, roads, or structures, impound any water, affect the lateral or subjacent support of the Pipeline, or plant any trees, or shrubs (collectively, the 'Prohibited items°) on, through, under, or upon the (i) Easement Lands until termination of the temporary easements and (ii) the Permanent Easement Area thereafter, without the pnor written consent of Grantee in each case If any Prohibited Items are placed upon the Easement kends without Grantee's prior written consent, Grantee shall have the right, but not the obligation, to (a) enter and remove any such Prohibited Items upon notice to Grantor (such notice being reasonable under the circumstances), at Grantor's cost, or (b) notify and require Grantor, at Grantor's cost, to immediately remove any such Prohibited Items The Grantee shall have the right of ingress and egress over the Easement Lands and adjacent real property of Grantor at convenient points and the nght to install gates in fences and driveway culverts that cross the Permanent Easement Area, all in order that the Grantee may access the Permanent Easement Area and exercise the Easement Rights. 4 Ito Grantee's Easement Rights within the Permanent Easement Area shall be in perpetuity Grantee's Easement Rights within the Temporary Easement Area shall expire upon completion of the pipeline construction and restoration of the Easement Lands, provided, however Grantee may use such portion of the Grantor's property along and adjacent to the Permanent Easement Area as may be reasonably necessary in connection with construction, maintenance, repair, removal or replacement of the Pipeline 5 Abandonment This Agreement and all nghts and obligations of Grantee hereunder shall terminate. (1) in the event a release instrument is executed by Grantee and recorded In the county records, or (2) in the event of abandonment of the Pipeline by Grantee Grantee shall be deemed to have abandoned the Pipeline if at any time after construction, the Pipeline has ceased to be used for a continuous period of three (3) years and Grantee has received all required regulatory approvals for such abandonment 8 Depth of Cover Grantee agrees that the underground portions of the Pipeline will be constructed with at least forty-eight inches (48°) of soil cover 7 Restoration and Compensation Except as otherwise provided for herein (including, but not limited to, Grantee's restoration obligations), Grantee has compensated Grantor for damages associated with its use of the Easement Lands and initial installation of the Pipeline (and related activities) No successor, heir, or assign of Grantor or purchaser of all or any part of the Easement Lands shall be entitled to additional payment of such compensation already remitted to Grantor Grantor agrees to accept the aforementioned consideration on behalf of Grantor, Grantor's successors in interest, and any current or future tenant ("Tenant') of Grantor, and to take full responsibility for compensating Grantor's Tenant for any damage or loss that is owed to the Tenant as a result of this conveyance and the Grantee's exercise of the Easement Rights. By agreeing to accept Grantee's consideration, Grantor agrees to indemnify and hold harmless the Grantee, its parent companies, affiliates and subsidianes, and their officers, agents, and employees, from any claim asserted by the Grantor's Tenant, Tenant's successor in interest, or Tenant's heirs, for compensation, restitution, crop loss, consideration, or damage of any kind that the Tenant, if any, may be lawfully entitled to as a result of this conveyance and Grantee's use of the Easement Rights Grantee agrees to pay Grantor for any and all additional actual physical damages which were not already paid to Grantor, including but not limited to those to (i) fences, (ii) growing crops and timber which arise from the Grantee's use of the Easement Lands in connection with any such installation, and (iii) occasioned by any additional installations or construction and future reconstruction, maintenance, operation, alteration, protection, inspection, moving, replacement, testing, repair, change in size, upgrade or removal of the Pipeline in the Permanent Easement Area Notwithstanding anything to the contrary herein, Grantee shall not be obligated to make any payment related to the removal of any Prohibited Items or payment for any damages caused by the negligence, recklessness, or willful misconduct of third parties or the Grantor or anyone acting on the Grantor's behalf The term °timber° is defined as trees or wood grown for commercial sale Grantee shall have the right, without liability for damages, from time to time 2 of 5 /17-e 4437307 Prages i 3 of 6 01/02/2019 02.08 P11 R Fee:$38.00 Carly Koppoa, Clark and R000rdor, Hold County, Co III after the initial construction of the Pipeline, to re -clear the Permanent Easement Area by removing Prohibited items and any other obstructions that may endanger or interfere in any manner with Grantee's use of the Permanent Easement Area or the Pipeline Grantee shall restore the surface of the Easement Lands, as nearly as reasonably practicable and permissible, to its prior condition following any disturbance occasioned by construction or use of the Easement Lands by the Grantee, its contractors, or agents 8 Jndemnification Except to the extent of Grantor's, or its agents, contractors, employees, successors, and assigns, negligence or willful misconduct, Grantee shall hold harmless and indemnify Grantor and its successors, and assigns, against loss or damage incurred as a direct result of the installation, operation or maintenance of any pipeline, including any actual damage, loss or liability that results from the discharge, emission, flow or other release of any substance from the pipeline within the Permanent Easement Area 9 Covenants Running with the Land. Assignment This Agreement (as well as any Memorandum and Notice of Pipeline Location pursuant to Section 2) shall be recorded in the real property records where the Easement Lands are located, and the terms of this Agreement shall constitute covenants running with the land and shall be binding upon and inure to the benefit of the parties and their respective successors, assigns, personal representatives, and heirs This Agreement and the Easement Rights may be freely assigned in whole or in part by either party, provided that any assignment by Grantor shall be made only to a subsequent owner of the fee interest in the lands subject to the Easement Rights granted herein 10 Notices All notices required or permitted under this Agreement shall be given by overnight courier service, by registered or certified mail, postage prepaid, or by hand delivery, directed to the addresses at the beginning of this Agreement or at other address provided by such party 11 Document Execution and Interpretation. This Agreement may be signed in counterparts and all such counterparts shall be deemed as originals This Agreement shall be/interpreted and enforced under the laws of the state where the Easement Lands are located if any part, term or provision of this Agreement IS, by a court of competent jurisdiction or regulatory authority having jurisdiction over the Easement Lands, held to be illegal, void, or unenforceable, or to be in conflict with the law of that junsdiction, the validity of the remaining provisions, or portion hereof, shall not be affected, and the nghts and obligations of the parties shall be construed and enforced as if this Agreement did not contain the particular part, term or provision to be held invalid This Agreement together with exhibits incorporated herein by reference, if any, embodies the whole agreement of the parties There are no promises, terms, conditions, or obligations other than those contained herein, and this Agreement shall supersede all previous communications, representations, or agreements, either verbal or written, between the parties Whenever the context of this Agreement requires, words used in the singular shall be construed to include the plural and vice versa and pronouns designating a particular gender shall be deemed to include and designate the masculine, feminine and neuter gender This Agreement shall not be construed against either party in the event of an ambiguity or other dispute as to its interpretation Grantor and Grantee represent to one another that each has the power and authority to execute and deliver this Agreement and to perform its respective obligations under this Agreement and the person or persons signing for each party ha been duly authonzed by such party to do so Should Grantor consist of more than one person or entity, they shall be jointly and severally liable under this Agreement The paragraph headings that appear in this Agreement are for purposes of convenience of reference only and are not in any sense to be construed as modifying the substance of the paragraphs in which they appear. 12 Miscellaneous in the event of any litigation, controversy, claim or dispute between the parties hereto arising out of or relating to this Agreement, or the breach hereof, or the interpretation hereof, the substantially prevailing party, whether by judgment or out -of -court settlement, shall recover from the other party, reasonable expenses, attorneys' fees and costs incurred in connection therewith, or in the enforcement or collection of any judgment or award rendered therein Time is of the essence herein Failure of any party hereto to insist upon the strict performance of any provision of this Agreement shall not be construed as a waiver for the future of any such provision No breach of this Agreement shall entitle either party to cancel, rescind or otherwise terminate this Agreement or the Easement Rights, but such limitation shall not affect in any manner any other rights or remedies which such party may have hereunder 3 of 5 4 01/02/20191/ 02 Pages: H R of $38,00Carly Koppas, Clerk County, ®III Pro 'MI `JINNInd Recorder,Li h g Ake EMI I or pursuant to applicable law Non-use of the Easement Lands shall not constitute abandonment of the Easement Rights or the Easement Lands and other rights granted herein, and shall not be grounds for termination of this Agreement. Grantor shall not disclose to any other person or entity the amount of payments made or to be made by Grantee for this Agreement without Grantee's pnor consent TO HAVE AND TO HOLD the Easement Rights unto the Grantee, Grantee's successors, assigns, personal representatives, and heirs forever IN WITNESS WHEREOF, Grantor has hereunto set its hand this 21st day of December 2018 GRANTOR "‘A Michael Lance Palmer STATE OF COLORADO ) COUNTY OF WELD ) On this 21st day of December in the year 2018, before me, the undersigned notary public, personally appeared Michael Lance Palmer, known to me to be the person whose name is subscnbed to the within instrument, and acknowledged that he executed the same for the purposes therein contained In Witness Whereof, I hereunto set my hand and official seal The foregoing instrument was acknowledged before me this 21st day of December 2018 BRADLEY DlIDALLE'd NOTARY PUBLIC STATE OF COLORADO NOTARY ID 20154O11498 fit' 3 ISSIL`f9 sews MARCH 20, 2019 My commission expires ) ss 4 of 5 Notary Public BA MLP EXHIBIT "A" hid I 8 5 NORTH LINE NE1/4 CHEYENNE CONNECTOR PIPELINE, INC. PIPE9JNE EASEMENT PART OF NEI/4 SEC. 17, T. a N., R. 88 W., 8TH WELD COUNTY, COLS DO CO -WE -977 000 PRAIRIE GOLD, LLC P 0 C NE COR NE1/4 SEC 17 T 9N, R 66W N 09'42'18' W 1548' \\\ \ 15 Na1518328.85 \ ` Ea3195754 81 A \ \ \ \ \ N 27 02'26' W 790 82' SEE DETAIL 'A' CO -WE -976 0001 MICHAEL LANCE PALMER CD z \ y_ S 89'59'43' W 70 78 P O.B N=1517609 23 5=3196187 46 CO -WE -975 WO SE OCR NE1/4 SEC 17 T9N, R66W EASEMENT CENTERL N D55061EION BEING A FIFTY (50) FOOT WIDE EASENEIT, TWENTY—FIVE (25) FEET ON EACH SIDE OF THE FOLLOWING DESCRIBED CENIERUNE, WHOSE SIDELINES EXPEND OR TRW TO THE EDGES OF THE SUBJECT TRACT, CROSSING THE NORTHEAST QUARTER (NE1/4) OF SECTION SEVENTEEN (17), TOWNSHIP (9)NORTH. RANGE SIXTY -SCI UNTY, COLORADO, NGMORE ePA wEsr OF RTICULARLY DESCRIBED AS FOLLOWS COMUENCINC (P0 C ) AT THE NORTHEAST COMER (NE CDR) OF THE NORTHEAST QUARTER (NEI/4) OF SAID SECTION SEVENTEEN (17). THENCE SOUTH 00'45'38" EAST ALONG THE EAST UNE OF THE NORTHEAST QUARTER (NEI/4) OF SAID SECTION, A DISTANCE OF 724.35 FEET, MICE SOUTH 89'59'43' WEST, A DISTANCE Of 151 49 FEET TO me POINT OF BEGINNING (P.0.9), THENCE CONTINUING SOUTH 89'59 43' WEST, A DISTANCE OF 70,78 FEET. THENCE NORTH 2702 26' WEST, A DISTANCE OF 79062 FEET, THENCE NORTH Off42.18" WEST, A DISTANCE OF 15.48 FEET 10 171E NORTH UNE OF THE NORTHEAST QUARTER (NE1/4) OF SARD SECTION. BERTH THE POINT OF IMITATION (P 0 T). PIPELINE NAME. CHEYENNE CONNECTOR SECTION 17 TOWNSHIP' 9 NORTH RANGE. 66 WEST PARCEL NO; CO -WE -976.200 PROPERTY OWNER SEWS, LANCE PALMER RECEPTION NO. 4200325 A N !- EAST UNE NE1/4 VI ATWS 15,000 SO FT q, !—S 89'59 43' W 151 49' i 4 T 1v to 'co c0 PJ 04 0/1 N GRAPE= @CALK •IF 0 TOO 200 (IN FEET) 1 ,neh o 200 ft R 66 W EASEMENT —A LOCATION malt 104 LOCATION MAP NOT 10 SCALE a T 9 DETAIL !WT 1O ev LOSE 15' 25' 25' 60' 75 WM- THIS EXHIBIT IS A PIPELINE ROUTE AND DOES NOT REPRESENT A TRUE BOUNDARY SURVEY LOCATIONS OF UNDERGROUND PIPELINES AND UTILITIES SHOWN ARE: APPROXIMATE, ACCORDING TO ABOVE GROUND EViDENCE AND LOCATES PROVIDED BY OHMS UNIVERSAL SURVEYING & MAPPING. LLC IS NOT RESPONSIBLE FOR THE ACCURACY OF SND LOCATIONS. THIS &H ST WAS COMPLETED WITHOUT THE BENEYTT OF A T= ABSTRACT THERE NAY BE EASDASHTS OR MDT MATTERS OF RECORD THAT AFFECT MRS PROPERTY, WHICH ME NOT' SHOWN HEREON OWNERSHIP 5W0FI MIlON PROVTDEO BY OTHERS. BEARING MASTS. COLORADO STATE PLANE COORDINATE SYSTEM, NORTH 2ONE, HAD 83. ALL DISTANCES AND COORDINATES SHOWN ARE GRID VALUES, WAVED FROM CPS OBSERVXTIONS USING WOS RIK NETWORK. POC. P0.B. P.O T A.TWS LEGEND. P I, POINT OF COMMENCEMENT POUR OF BECINNING POINT OF' TERMINATION A DMONA. TEMPORARY WORKSPACE ADB NO 5815 CENTERLINE LENGTEI 877.06 FT CENTERUTTE LFJlCTFR 5316 RODS PERMANENT EASEMENT 1 01 AC TEMP CONST WORKSPACE 1.40 AC ADD TEMP. WORKSPACE 0.35 AC PACE 1 OF 1 REV ORAN BY CLUB BY IF DATE 0 lG 11/28/17 CHEYENNE CONNECTOR PIPELINE, INC. ]IOY4nIq"b46L14133.4 CO 0700 F01410 5w108.2850 attemocary14 , =as= EFaRALD MOUNTAIN SURVEYS, INC. 1mG.,,r.(a l ma,ia MAW; 0201'1 PlIevSIORie X100°/® S 4w..o4 '5=,,- '7r.,..11721117 toutOmetAtio tok /'�I z.".3 EXHIBIT "A" SIMPLE ACCESS DESIGN Define: SURFACING: R.O.W \:. Width of access exclusive of radii Radii Profile Angle if other than 900 Surfacing — material type (asphalt, grading, concrete class, total thickness, individual mat thickness for asphaltic materials) Curb and gutter type/dimensions/material Permanent signing or pavement markings necessary Drainage features — culvert type and size (no RCP in ROW), no increased runoff to ROW Special or unusual features Any landscaping in ROW ( EXHIBIT A" J r�P ouJ6cr S.H. No. g 5 Width P6 �e �, es • I a 114 Mk (3 ti i\J A White Line Center Line r, new - 4 • Legend Exhibit B Google Earth 2018 Google Access rig 2 2 Cr en x V= I. a t PE EA .W: ( is�:, . L' j 111 • ` 1 • w Oa a tarp • y. G f altfti r� s. . • sir =1 • • • 4 en. t t "Jr • • rei.A. • ;- -‘• -s� • r A , • 17 a 4 ` •Niatp gip s. • At • r a • .. r• t a *It;. , k, ter 1 • dirr te+ido -+ v It k • R . r. • gs�44 a . 5 kt r. *el* eret IC 42. f � • .1` • C r. 1000 ft t fit - 4.1 t 3f ._'y�. slier i r w Seed Mix 1 - Elevation: Mid Temperature: Warm Humidity: Average Grasses 1. Big Bluestem — 15% (3.6 lbs/acre) 2. Fringed Brome — 10% (1.5 tbs/acre) 3. Sand Lovegrass — 10% (0.2 lbs/acre) 4. Green Sprangleroot — 10% (0.6 lbs/acre) S. Little Bluestem — 10% (1.4 lbs/acre) 6. Sandberg Bluegrass — 10% (0.3 lbs/acre) 7. Prairie Junegrass — 10% (1.3 lbs/acre) 8. Sideoats Grama — 10% (2.2 lips/acre) Forbs/Shrubs/FlowerinR 1. Yellow Spiderflower — 6% (2.1 lbs/acre) 2. Desert Verbena — 3% (0.2 lbs/acre) 3. Palmer Pestemon — 3% (0.2 lbs/acre) 4. Sulpher-Flower Buckwheat — 3% (0.5 lbs/acre) Seeding Application: EXHIBIT "C" Drill seed 0.25" to 0.50" into the topsoil. In areas that are not accessible to drill, hand broadcast at triple the above rate and rake 0.25" to 0.50" into the topsoil. Mulching Application: 1.5 tons of certified weed free hay per acre to be mechanically crimped into the topsoil in combination with an organic mulch tackifier at 200 pounds per acre. Note: Hydroseeding and/or Hydromulching will not be allowed. COLORADO STATE NOTICE DEPARTMENT HIGHWAY OF ACCESS PROCEED CODE e CDOT Permit No. 419065 TRANSPORTATION State Highway/Mile 034A Post/Side / 118.469/Right - Local Jurisdiction Weld County TO , Permittee(s): Applicant Janet K. and Edward D. Schmidt Rebecca Lieders 24250 Greeley, County Colorado Road 58 80631 Cheyenne Connector Pipeline, Inc (970) 897-2652 370 Lakewood, Van Gordon Colorado St 80226 (303) 763-2981 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By Title Date (X) 1 This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By i Title Date (X) Assistant Access Manager 05/10/2019 opy distribution: Required: Region (original) Applicant Staff Access Section Make copies as necessary for: Local Authority Inspector MICE Patrol Traffic Engineer Form 1265 8/98, 6/99 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT Permit Fee $100.00 Date of Transmittal 04/24/2C19 Region / Section / Patrol / Name 4/01/25 COOT Permit No. 419065 State Highway No / Mp / Side 034A / 118.469 / Right Local Jurisdiction Weld County The Perrnittee(s): Janet K. and Edward D. Schmidt 24250 County Road 58 Greeley, Colorado 80631 (970) 897-2652 The Applicant(s): Rebecca Lieders Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 (303) 763-2981 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 access is to be located on US Highway 34, a distance of 2,481 feet east of Mile Post 118 on the south/right side. Access to Provide Service to (Land Use Code) 994 - Temporary Construction Access 997 - Agriculture (Size) 10.42 (Units) Acres 1 Each Additional Information: The use of the access by the Applicant is only until 03/01/2020. MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Date Title 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 Bruce Barnett with the Colorado Department of Transportation, 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 fu:I authority to accept the permit and its terms and conditions Permittee Signature: . ete./.L.O Print Name Date '(-e-/biGt-C1ti L e, acres Co-Permtttee Signature: (if applicable) Print Name (tei/e;"6O Date This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT OF TRANSPORTATION Sigrtajure , Print Name Title A951 - Copy Distribution: Required Make copies as necessary for. 1.Reg;on 3.Staff Access Section Local Authority Inspector 2App!icant 4 Central F►ies MTCE Petro' Traffic Engineer Date (of issue) lik,1044a1@_ Se/ /6/ZEI 16/ Previous editions are obedt eie and may not be used Page 1 of 3 COOT Form #101 5107 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code These are provided for your convenience but do not alleviate compliance with all sections of the Access Code A copy of the State Highway Access Code is available from your local Issuing authority (local government) or the Colorado Department of Transportation (Department) When this permit was issued, the issuing authority made its decision based in part on information submitted by the applicant, on the access category which Is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit APPEALS 1. Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a right to appeal the decision to the [Transportation] Commission [of Colorado] To appeal a decision, submit a request for administrative heanng to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400 The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant 2 Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority 3 in submitting the request for administrative hearing, the appellant has the option of including within the appeal a request for a review by the Department's internal administrative review committee pursuant to [Code] subsection 210 When such committee review is requested, processing of the appeal for formal administrative hearing, 2 9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative heanng, or the appellant submits a request to the Commission or the administrative law Judge to withdraw the appeal The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently 4 Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a heanng, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit PERMIT EXPIRATION 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 extension. When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authonty No more than two one-year extensions may be granted under any circumstances If the access is not under construction within three years from date of issue the permit will be considered expired. Any request for an extension must be in writing and submitted to the issuing authority before the permit expires. The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit Extension approvals shall be in writing The local issuing authonty shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days Any person wishing to reestablish an access permit that has expired may begin again with the application procedures An approved Notice to Proceed, automatically renews the access permit for the penod of the Notice to Proceed. CONSTRUCTION 1 Construction may not begin until a Notice to Proceed is approved (Code subsection 2 4] 2. The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 2.14 All matenals used in the construction of the access within the highway right-of-way or on permanent easements, become public property Any materials removed from the highway nght-of-way will be disposed of only as directed by the Department All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector 3. The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days pnor to any construction within state highway right-of-way Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit. 4 The issuing authonty and the Department may inspect the access during construction and upon completion of the access to ensure that all terms and conditions of the permit are met Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public 5 Prior to using the access, the permittee is required to complete the 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 the Department or Issuing authority to initiate action to suspend or revoke the permit and close the access if in the determination of the Department or issuing authority the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the summary suspension of the permit If the permittee wishes to use the access pnor to completion, arrangements must be approved by the issuing authority and Department and included in the permit The Department or issuing authority may order a halt to any unauthonzed use of the access pursuant to statutory and regulatory powers Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or materials if any construction element fails within two years due to improper construction or material specifications, the permittee shall be responsible for all repairs Failure to make such repairs may result in suspension of the permit and closure of the access 8 The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M U T C D as required by section 42- 4-104, C R S , as amended 7 A utility permit shall be obtained for any utility work within highway right-of-way Where necessary to remove, relocate, or repair a traffic control device or public or pnvate utilities for the construction of a permitted access, the relocation, removal or repair shall be accomplished by the permittee without cost to the Department or issuing authority, and at the direction of the Department or utility company Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair 8 In the event it becomes necessary to remove any right- , of -way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence All posts and wire removed are Department property and shall be turned over to a representative of the Department 9. The permittee shall ensure that a copy of the permit is available for review at the construction site at all times The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and materials specifications Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions 10 Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the nght-of-way or any adopted municipal system and drainage plan 11 By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suds, actions, claims of any type or character brought because of injunes or damage sustained by any person resulting from the permittee's use of the access permit dunng the construction of the access CHANGES iN ACCESS USE AND PERMIT VIOLATIONS 1 It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine If a new access permit and modifications to the access are required 2 When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C R S , of the Act applies The Department or issuing authority may summarily suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety Summary suspension shall comply with article 4 of title 24, C R S MAINTENANCE 1 The permittee, his or her heirs, successors -in -Interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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 Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system However, the permittee Is responsible for the repair and replacement of any access -related culverts within the right-of-way Within incorporated areas, drainage responsibilities for municipalities are determined by statute and local ordinance The Department will maintain the roadway including auxiliary lanes and shoulders, except in those cases where the access installation has failed due to improper access construction and/or failure to follow permit requirements and specifications in which case the perrnittee shall be responsible for such repair Any significant repairs such as culvert replacement, resurfacing, or changes in design or specifications, requires authorization from the Department Form 101, Page 3 COLORADO DEPARTMENT OF TRANSPORTATION nvironmental Clearances Information SummaQ PURPOSE - This summary is intended to inform entitles external -to COAT that may be entering the state highway right-of-way to perform work related to their own facilities (such as Utility, Special Use or Access Perrnittees), about some of the more commonly encountered environmental permits/clearances that may apply to their activities. This listing is not ail -inclusive • additional environmental or cultural resource permits/clearances may be required in certain instances. Appropriate local, state and federal agencies should be contacted for additional information if there is any uncertainty about what permits/clearances are required for a specific activity. IMPORTANT Please Review The Following Information Carefully— Failure to Comply With Regulatory .Regubaernents Max Result In • . on or Revocation of Your COOT Penrtnfl, or Enforcemont Actions By.Other tip CLEARANCE CE CONTACTS - As Indicated in the permliklearance descriptions listed below, the following individuals or agencies may be contacted for additional information: • • Colorado Department of Public Health and Environment (CDPHE): General information — (303) 692-2035 Water Quality Control Division (WC!CD): (303) 692-3500 Environmental Permitting Website J i;:f,:ficissipthtfisperi • CDOT Water Quality Program Manager". (303)157-9343 itittesplAssvver.Opdac yierogram e t r, Ts,; f • CDOT Asbestos Project Manager. Phil Kangas, (303) 512-5519 • • Colorado Office of Archaeology and Historic Preservation: (303) 866-5216 • U.S. Army Corps of Engineers. District Regulatory Offices: Omaha District (NE CO), Denver Office (303) 979-4120 h So://wwwm.wo.msg. .m ' € ; 3� estc-yyPro9nsnrtg: araatasox Sacramento Dist. (Western CO), Grand Junction Office (970) 243-1199 `Ito: Mww.sok:.usaea.&nry.mfl/Misslcrisr - guiaierv.asp Albuquerque District (SE Cd), Pueblo Office (719}543-9459 rarip:fAWfit nj'i. u �ra m yerni sit i. u n( �rnr y T d �eli'ttity asax • COO Special Use and Aooess Pennittin!: 303 7557-9664 tl! s".41/eivAmcocioti. vifou `i;�� . its Mel REOSOUrCel • Disturbance of wildlife shall be avoided to the rrieudmum extent practicable. Entry into areas of known or suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. If any threatened or endangered species are encountered during the progress of the permitted work, work in the subject area shall be hated and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shell be contacted. immediately. Authorization Must be provided by CDOT priorto the continuation of work. information about threatened or endangered specs may be obtained from the CDOT website, /i2,a4traMrtie i nlitilwicl'aiggidtitte or the Colorado Parks and WUdllfe CPW website, ?et :f� �t ' .�. -_ :t ,. , ( ) �,. - �. � t , � � � ..., � �" �� , :�� ' n .rah � ..�,p:. Additlonal guidance may be videci theepropria�gion PIanrilr and Environmental Mane er RP culturalftesourcis- The applicant must request a file search of the permit area through the Colorado office of Archaeology and Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously been identified ( ra-./1 tvc� er ee et i.• -;. ,arcqualified ;;J. inventory of the permit area by a cultural resources specialist may be necessary, per the recommendation of COOT. if archaeological sites/artifacts or historic resources are known to exist prior to the initiation of the permitted work or are encountered as the project progresses, all work in the subject area shall be halted and the COOT Regional Permitting Office and Region Planning and Environmental Manager shell be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office and RPEM. Contact Information: Contact the OAHP for file searches at (303) 8684216. paleontolg$1eaiNpOu e - The applicant ntst request a fossil loo alley file search through the lntversity of Colorado Museum, Boulder ( tt.. s;1/oumuasun ..cc do du/resasn paleontc v/v nit t id 9 ), and the Denver Museum of Nature and Science (;':n:/l:tir .,a c1sc: �� ,�,;zf) to ascertain if paleontological resources have been s:�.dmr>� P celz�,.o3�a�.laaxi"��nt.��oy.a previously identified in or near the permit area. Inventory of the permit area by a qualified paleontologist may be names .eery, per the recommendation of ODOM if fossils are encountered during the permitted work, all work in the subject area shall be halted and the CDOT Regional Permitting Office and Region Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by COOT prior to the continuation of work. Additional guidance may be provided by the Regional Permitting Office in the Permit Special Provisions. Contact information: See the museum websites listed above for Paleontological Collections Manager contact information. Contact the CDOT Paleontologist for further infennatfon at n'cip aaav_e @, te.cco.ya or (303) 757- 2. The COOT Paleontoio Ist will not conduct a -cote rehensivee file search independently of the museums. liner tous Matarfalt SeligWaste - The Solid Wastes Disposal "Sites and Facilities Act C.R.S. 30-20-100; et al, and Regulations Pertaining to Solid Waste Disposal Sites and Facilities (6 OCR 10072), prohibit solid waste disposal without an approved Certificate of Designation (a landfill Permit). The Colorado Hazardous Waste Act C.R.S..25-15-301 et at, and the Colorado Hazardous Waste Regulations (6 CCR 1007-3) prohibit the transfer, storage or disposal (TED) of hazardous waste except at permitted TSD sites. There are no permitted landfills or TSD sites within the State Highway Right of Way. Therefore, all solid or hazardous wastes that might be generated by the activities of entitles entering the State Highway Right of Way must be removed from the ROW and disposed of at a permitted facility or designated collection point (e.g., for solid waste, a utility or construction company's own dumpster). if pre existing solid waste or hazardous materials contamination (Including oil or petroleum contaminated soil, asbestos, chemicals, mine tailings, etc.) is encountered during the performance of work, the pennittee shall.halt work in the affected area and immediately contact the COOT Regional Permitting Office for direction as to how to proceed. Contact Inloarmaton: Theresa Santangelo-D'rofiing, CDOT :Hazardous Materials Management Supervisor: (303)512-.6624. Aso besContaining Materials. Asbelito. Cont1minated Soll - All work on asbestos containing materials (ACM) must comply with the applicable requirements of the CDPHE Air Pollution Control Divisions (APCD) Regulation 8. Disposal Of ACM, and work done in asbestos -contaminated soil, must oomph, with the CDPHE Hazardous Materials and Waste Management Division's kHMWMD) Solid Environmental Clearances Information Summary Page 1 of 3 Colorado Department of Transportation August 2017 Waste Regulations. The application for any CDOT' peirnit must specifiSily identity any ACM. involved in the work for Which authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact Info: COPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additional information ccorturningslekame on CDpTrprotects. is available. from the COOT Asbestos Project Manager (303) 512- .5519, or Theresa Santar eto-Dreilinkit Hezerdous Materials wement perviaot: (303j 512-5524. g ..rtstlo alerts -.No person may offer or accept a hazardoUs material for transportation in oorimerce utdess. that person is registered in conformance with the United States Department of Transportation regulatons at 49 CFR, Part 171. The hazardous material must be properly classed, described, packaged, marked, labeled, and In condition for shipment as required or authorized by applicable requirements, or an exemption, approval or registration has been Issued. Vehicles requiring a placards must obtain authorization and a State HAZMAT Permit from the Colorado Public Utilities Commission. Contact tnfonnetfop: For authorization and more.info call the Federal Motor Safety Carrier Administration, US DOT for inter- and intra-state HAZMAT Reais�tlon �303J 969.6748. Colorado Public Utilities Commission: (303) 894-2968. - . - -'.mac••-� _ - p+�ai.s. J I� P Q t Y r J 4. • r �laa::. '� �. l Ll t : Ad it . f• l:�' .' • Water Quality Certifications Issued by the COPNE WQCD - Corps of Engineers 404 permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 permits, including nationwide perms, which are issued for activities with relatively minor impacts. For example, there is a nationwide permit for utility line activities (nwp #12). Depending upon the specific circumstances, it Is possible that either a agerterar or Individual" 404 permit would be required. if an individual 404 penult is required, section 401 water quality certification from the CDPHE WQCD is also required. Contact the appropriate Corps District Regulatory Office for information about what type of 404 permit may be required contact information above . Canted the COPHE Water Quail .Control Division at (303) 692-3500. worktnP on pr In any stream or Its .- In order b.protect and preserve the state's fit* and wildlife resources Irani actions that may obstruct, diminish, destroy, change, modify, or vet/ a natural exist$r.g stream or its banks or tributaries, it may be necessary to obtain a Senate 8111 40 certification from the Colorado Department of Natural Resources. A stream is defined as 1) represented by:a solid blue line on USGS 7.5' quadrangle maps; and/or 2) Intermittent streams providing live water beneficial to fish and wildlife; and/or 3) segments of streams supporting 25% or more cover within 1o0 yards upstream or downstream of t`te project and/or 4) segments of streams having wetlands presentwlthln 200 yards upstream or downstream of the project measured by valley length. The CPW application,. as per guidelines agreed upon by COOT and CPW, can be accessed at :Y±pn• h ►.r '►oc.alovlartiit vnvir t ll Stormwater Construction Permit ISCP) a9d_fito nwateTplacha From t ndu Facilities • Discharges of stitinitwatertunpff from Construction sites ding one acre or more - or certain types of industrial facilities, such as concrete batch plants - require a CDPS Stormwater Permit, Contact Infonnailon: Contact the CDPHE Water Quality Control Divlslon at (303) 6924500. Website: i J/ r. radmnovluadncl�aoh / nstrnc on-oer iu:-r,3 :1: and sell a.oa ;; on Industry -pen /its. cons jinn Dewvatertna ' hpr' a or_f4, at n�,and ,�ed�iatlon sat *des - Discharges of watet encountered during excavation or work in wet areas may require a Construction Dewatering or Rernediation Activities Discharge Permit. Contact Information: For Construction Dewatering and Remediation Activities Discharge Permits. -contact the CDPHE WQCD at (303) 692- 3500. For Applications and instructions (CDPHE webs s jktn H--nforado,._.014D6c-INcicophat wtiemoraiiixbiTniis. jillunfoloafSenerste Stain k!mr Sveitettl fM841 Also Pern* - Discharged from the storm sewer systems of larger rger municipalities, and from the COOT highway drainage system that lies within those municipalities, ere subject b MS4 Permits issued by the CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to an MS4 permit, the cxwner of such facility should contact the municipality regarding stormwater related clearances that may have been established under that. municipality's MS4 permit. All discharges to the CDOT highway' drainage system or within the Right of Way, (ROW) must comply with the applicable provisions of the Colorado Water Quality Control Act, the Water Quality Control Commission (WQCC) Regulations ovlo^.ttfci1:aj'. ! car .;:.;; 4-oogci -: )ckva er 'tit ) and the COOT MS4 Permit # COS‘ 000005 (h tc nisi` .vrid c L ::-qcv/prcgr ' vJa:v r : �rs.ir w: . tcYrr-ar �itvIdz c2me :a). Discharges are subject to Inspection by COOT and CDPHE. Contact the CDPHE Water. Quality Control DiAslon at (303) 6924600 for a listing of municipalities required to obtain MS4 Permits, or go to restti.• ��t_E:JI .; . . •• : -test 'rk. For CDOT-related MS4 regulations, go to: c j ues tr orw.codot s ovf - r - grar9gletriironnierkte a Tatar- cu.l'rhr/stermi -,p roconerric . gimEasit2mhirsth - Ail discharges are subject to the provisions of the Colorado Water Quality Control Act and the Colorado Discharge Permit Regulations. Prohibited discharges include, but:are not limited to, substances such as wash water, paint, automotive fluids, solvents, oils or soaps and sediment. .Contact Information: Contact the CDPHE Water Quality Control Division at (3031 89Gt5D0. General Authorisation Allowable - Non4torinwater Discha►rDes - Unless otherwise identified by COOT or the WQCD as significant sources of pollutants to the waters of the States the following discharges to stormwater systems are allowed without a Colorado - Discha►rge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, Irrigation water, uncontaminated springs, footing drains, water line flushing, flows from riparian habitats and wetlands, and flow from firefighting activities. Allowable non-stormwater discharges can be found under Illicit Discharge POD at ' .cock mov/ra nviro a� c = slotrrir 3%.r:• r rns tr i. Contact Information: The CDPHE Water Quality Control Division {telephone #'s listedaboweie a dimOi% t •Process - For activities redulring a Storrnwater ConatruCtion Pernik.. erosion &intro, requirements *will be specified in that permit. Inesltuatlons where a stormwater permit Is not required, all reasonable measures should be taken to minimize erosion and sedimentation according to CDOT Standard Specifications 107.25, 208, 213 and .216 hush des rasa - . rt 11 coris t ours 9c1r 11ens/201 -'S acts/2011 eat; _ : ). Ail cftsturbances require a stabilization -plan, native seeding or landscape design plan acddrding to applicable COOT Standard Specifications 212-217 and 623. The COOT Erosion Control and Stormvitater Quality Guide (available from the Bid Plans Office at (303) 757-9313) should be used to design erosion controls and restore disturbed vetation. Environmental Clearances Information Summary Page 2 of 3 Colorado Department of Transportation August 2017 Disposal of Drittlnct Flu1a - Drilling fluids used in operations such as Horizontal Directional Drillingng may be classified as "discharges' or "solid wastes," and In general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of Way, and disposed of at permitted facilities that specifically accept such wastes. Disposal of drilling fluids into storm drains, storm sewers, roadside ditches or any other type of man-made or natural waterway Is prohibited by Water Quality Control and/or Solid Waste regulations. Small quantifies of drilling fluid solids (less than 1 cubic yard of solids) may be left on -Site after either being separated from fluids or air Infiltration of the water, provided: 1) the drilling fluid consists of only water and bentonite day, or, if required for proper drilling properties, smith quantities of polymer additives that are approved for use in drinking water well drilling; 2) the solids are fully contained in a pit, and are not likely to pose a nuisance to future work in the area, 3) the solids are covered and the - area restored as required by CDOT pit requirements (Utility, Special Use, or Access Permits, etc.). Contact Information: Corded CDPHE 'telephone Ws listed shovel. _ tfolous Weeds end Invasive 4pecles MantmemeM Plan - Noxious Weeds .and Invasive Species gtldsnce can be'found by .contacting the Colorado Department of Agriculture . zaw • Al ,'e w . ,arc . and the Colorado Division of Parks and Wildlife ! .. J- :Lpsi '�•�'g cetS In either case, management tans invotvinc the control of noxious weeds associated. th the peRr edhr%t ' actand deaninp of egulpment will be reyu(r�ed. Concrete Was$t4 soWaste generated froth concrete adt[vlttes shall NOT be allowed to flow into the drainage ways, ,inlets, receiving waters, or In the COOT ROW. Concrete waste shall be placed in a temporary concrete washout facility and must be located a minimum of 50 feet from state waters, dralnageways, ard Inlets. Concrete washout shall only be performed as specified by the COOT Environmental Program and shat be in accordance to CDOT specifications and guidetihea. Contact Information: Contact CDPHE or find additional information on the CDOT website: a .f3t.oVfhtrtt1dtra .iliZe,;-TPLE1V2011.Ararea ietsoloo1 .. lecs and refer to the spedflcationa and their for sections 101. 107 end 208. Spill Reporting - Spa shal'ba contained and cleaned up as soon n possfbte. strait NOT be Washed down into the storm drain or buried. All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-+4446.(4H20), as well as the Regional Permitting Office and Regional Maintenance Supervisor. Spills on highways, into waterways, any spill in the highway right-of-way exceeding 25 gallons, or that may otherwise present an immediate danger to the public shall be reported by calling 911, and shall also be reported to the CDPHE at 1477-618-5608. More information can be found at ' , t •ass ,,r ., , -_l r S IX 7- , ail+ t4 -gate" -.-- - --- _-- - - About This _Roan - Questions or comments about this Information Summary may be directed to Alex Karami, Program Administrator, CDOT Access Management Unit, at (3031 757-9841, alex.karami@state.co.us. Environmental Clearances Information Summary Page 3 o€ 3 Colorado Department of Transportation August 2017 COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowrnelt flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking Into the ground Why is stormwater runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow into CDOT's storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters CDOTs storm drain system is discharged untreated Into the waterways we use for fishing, swimming, and providing drinking water. Tips for Reporting an illicit Discharge Call the illicit discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae, etc.). Obtain information on the vehicle dumping the waste (if applicable). Do not approach! Call ''CSP for illicit dumping. If possible, take a photo, record a license plate. iei4v a-ipi.iee. Never get too dose to the Illicit discharge, it may be dangerouslll For more information on CDOT Utility Permits: httn://www.codot.itovibusinsipermitsjutilitie burin sipermitsjutilitie sspeciatuse For more information on CDOT Access Permits: httos:fiwww.c,udot.gov/businesslpermitslaccess permits For more information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222 303-757-9343 COLORADO Department of Transportation Water tkitualll v I vi gram Industrial facilities I tivram CDOT has a Munidpal Separate Storm Sewer System permit, otherwise known as (MS4) from the Colorado Department of Public Health and Environment. The permit states that only stormwater can be discharged from CDOTs storm drain system 1 ._ --my- -a- *tsar p% 3 e.. Mora drain 1001, • TO THE WASTEWA1t i rnEATIMNr PUNT c. TOM LOCAL WAnesouv As part of the permit, COOT has several different programs to prevent pollutants from entering into the storm drain system: Construction Site Program New Development Redevelopment Program Illicit Discharge Program industrial Facilities Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program IcoLoRADo Department of Transportation Control Measures for Industrial rlcitities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices WWMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering into CUOT's storm drain system. Control Measures also include treatment, operating procedures, and practices to control site run off which can include structural and non-structural controls. • • aa., C. -_•• tire NW WERT ',l MERE A OAP PR MKT? Mlle pa -11a nErouvram In compliancetl CDOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: 1 Communications ✓ Cable television ✓ Power ✓ Electricity ✓ light • Heat Gas if Oil ✓ Crude Products ✓ Water ✓ Stream ✓ Waste ✓ Stormwater not connected with highway drainage ✓ Similar Commodity COLORADO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. CDOT has put together an Environmental Clearances Information Summary for those applying for a CDOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: http: / /www.coloradodot.info/;.iro rams/ environmental / resources/guidance- standards / Envi ron rnentat%2QClea rances% zOlrtfo%z,QSummary.pdf State Highway Access Permit Attachment to Permit No 419065 - Additional Terms and Conditions 1 1 If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350- 2148. 2 The Permittee or the contractor shall notify Bruce Bamett 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 3 The Permittee shall request final Inspection by Bruce Barnett at (970) 350-2147 within 10 days following the completion of access construction, and prior to authorized use. The Permittee or their representative shall be present 4 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 5 The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments. 6. Incorporated as part of this permit are the following Application for Access Permit (COOT Form No 137) Permit (COOT Form No 101) and its attachments Exhibits. "A" — Access Plan "Be — Vicinity Map 7. 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 be applied for based upon the existing and anticipated future conditions 8. 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. 9. 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 10 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 State Highway Access Permit Attachment to Permit No 419065 - Additional Terms and Conditions 2 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 permit and be available on the site during construction. 11 All costs associated with any reconstruction of this access are the responsibility of the Permittee. This includes design, construction, signing and striping, utility relocation, testing of materials, and inspections. In the event a signal is warranted in the future, CDOT will not participate in any fashion with that signal installation, including financially. 12. The 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. 13. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from the CDOT Permitting Offices or may be accessed via the CDOT Planning/Construction- Environmental Guidance webpage at htto.//www.dot.state.co us/environmental/Forms/asp FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations Prohibited discharges include substances such as. wash water, paint, automotive fluids, solvents, oils or soaps Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CHPHE website at: State Highway Access Permit Attachment to Permit No. 419065 - Additional Terms and Conditions 3 http://cdphe.state.co.us/wq/PermitsUnit/wau. 14. 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 15. 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 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 16. Landscaping and site construction shall not obstruct sight distance at any State Highway access point Landscaping within the State Highway right-of-way requires the Permittee to obtain a CDOT Landscaping Permit from the Traffic/Access Section. The access permit does not authorize that activity. Irrigation of features within the right-of-way may require the Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other approved system. The Permittee shall contact Allyson Mattson at the Greeley Traffic Office, (970) 350-2148 to obtain the Landscaping Permit 17 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. 18 The Department inspector may suspend 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. 19 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. 20 Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs 21 The Department retains the right to perform any necessary maintenance work in this area State Highway Access Permit Attachment to Permit No. 419065 - Additional Terms and Conditions 4 22. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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 23. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 24. All materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable. A State Highway Access Code, 2 CCR601-1 B Roadway Design Manual C. Materials Manual D. Construction Manual E Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G Manual on Uniform Traffic Control Devices (M.U.T.C.D ) for Streets and Highways and the Colorado Supplement thereto H. A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHTO), latest edition I AASHTO Roadside Design Guide J Institute of Transportation Engineer's Trip Generation Manual, 6a' Edition Some of the reference materials listed above (A through E) may be purchased from Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from: The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is: www cdot gov 25 All workers within the State Highway nght-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 State Highway Access Permit Attachment to Permit No 419065 - Additional Terms and Conditions 5 CFR Part 1910 — Occupational Safety and Health Standards and 29 CRF Part 1926 — Safety and Health Regulations for Construction At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment. m Head protection that complies with the ANSI Z89.1-1997 standard, © At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn e High visibility apparel as specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2) Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply, 26 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. 27 No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight 28 Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority. 29. Traffic detours or lane closures will not be allowed, unless pre -approved by the Department 30 Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department. 31 Construction traffic control devices, when not in use, shall be removed or turned away from traffic. Devices must be stored outside of the roadway clear zone per the latest AASHTO guidelines 32 Cattle guards are not permitted in State Highway right-of-way 33 If State Highway right-of-way fence exists or is proposed, the Permittee must contact Bruce Barnett at the Greeley Traffic Office, (970) 350-2147 prior to removal or installation The Permittee will be required to obtain a highway right-of-way fence agreement for a special fence if the Permittee desires to remove the existing standard highway fencing in this area When it Is necessary to remove any highway right-of-way fence, the posts on either side of the access entrance shall be securely braced with approved end posts and in conformance with the State Highway Access Permit Attachment to Permit No 419065 - Additional Terms and Conditions 6 Department's M-607-1 standard, before the fence is cut to prevent slacking of the remaining fence. All posts and wire removed shall be returned to the Department. 34. Any access construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highway right-of-way 35. All required access improvements shall be installed prior to the herein authorized use of this access Failure to do so will result in the appropriate legal action from the Department, up to Permit Revocation. 36. The access shall be constructed as a minimum as per Exhibit "A" Upon completion of the construction the access shall be returned to as good or better condition. 37. If necessary, the access shall be reconstructed 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. 38. No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw cut to assure a straight edge for patching Full panel concrete replacement is required for any concrete work 39 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 40. The access shall be reconstructed and maintained In such a manner that will not cause water to enter onto the roadway, and will not interfere with the existing drainage system within the State Highway right-of-way Drainage to the State Highway right-of-way shall not exceed historical rate of flow 41 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. 42. The use of this access by the Applicant is only until 03/01/2020. COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT APPLICATION Instructions: - Contact the Colorado Department of Transportation (COOT) or your focal government to determ ne your issuing authoriity. Please print or type lssu,ng authority application acceptance date: 4/7)4/ Contact the issuing authority to determine what plans and other documents are required to be submitted with your appkcation. - Complete this form (some questions may not apply to you) and attach all necessary documents and Submit it to the issuing authority. - Submit an application for each access affected. - if you have any questions contact the issuing authority. - For additional information see C0OT's Access Management wehsite at http://wwwtdot.statelc9,ustA ssPe x,hlrh 1) Property owner (Permittee) Janet K. and Edward D. Schmidt Street address 24250 County Road 58 City, state & zip Greeley, CO 80631 E-mail address Phone • 970-897-2652 2) Applicant or Agent for permlttee (ii different from property owner) Cheyenne Connector Pipeline, Inc. Mailing address 870 Van Gordon Street City, state & zip Phone ft (required) Lakewood, CO 80226 3) Address of property to be served by permit (required) US Highway 34 E-mail address if available rebecca1iedereQ alzmrni treeoures,'and . corn 479n306-8807 4) Legal description of property: If within jurisdictional limits of Municipality, city and/or County, which one? county subdivision block tot section Weld 5) What State Highway are you requesting access from? State Highway 34 ❑ E 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? 3107 feet IN flS fl E Wwi tree 119 1160 feet ON OS IIE ) from: Weld County Road 51 of mnat is ine approximate date you intend to begin construction? 4/1/2019 9) Check here if you are requesting a: at 1 20 8) What side of the hi • hway? N S N range 64W new access )temporary access (duration anticipated: 4/1/19-12/31/19 ) change in access use is removal of access 10) Provide existing property use Agricultural improvement to existing access relocation of an existing access (provide detail) 11) Do you have knowledge of any State Highway access permits serving this property, or adjacent properties in which you have a property interest? Ono O 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? C no 1 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 • 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? 10.42 AC 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 i 16) if you are requesting residential developemen; access, what is the type (single family, apartment, townhouse) and number of units? type number of units type L _ _ 17) Provide the following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. ris or multi unit truoke at peak now volumes 25 number of units indicate if your counts are It Passenger cars and Cent trucks at peals hour volumes peak hour volumes or El average daily volumes. i 50 I of single trait vehicles in excess of 30 it. # i farm f rm vehicles (field equipment) 8 Total count of ail vehicles 91 Previous editions are obsolete and may not be used Page 1 of 2 COOT Form #137 01110 18) Check with the issuing authority to determine which of the following documents a) Property map indicating other access, bordering roads and streets. b) Highway and driveway plan profile. c) Drainage plan showing impact to the highway right-of-way. d) Map and letters detailing utility locations before and after development in and along the right-of-way. are recruited to complete the review of your application. e) Subcjv.sion. zoning, or development plan. f) Proposed access design. g) Parcel and ownership maps including easements, h) Traffic studies. 0 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 PermitSystem . The CDOT Environmental permits, or ecological, archeological, historical or cultural resource clearancescnmental Clearances Information Summary presents contact information for agencies administering certain clearances, information about prohibited discharges, and may be obtained from Regional COOT Utility/Special Use Permit CDOT Planning/Construction-Environmental-Guidance offices or accessed via the once webpage htti_ :l/www,dot,state.co.us/environment (/Forms as 3, 2- All workers within the State Highway right of way shall comply with their employer's safety and health policies/ procedures, and alt applicable U.S. Occupational Safety and Health Administration OSHA regulations P n limited to the applicable sections of 29 CFR Part 1910 - (OSHA) e9 aeons - including, but not 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 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 (lowing 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, ANSIISEA 107-1999, class 2); head protection that complies with the ANSI Z89.1-1997 standard; and at all construction sites or whenever P ct on feet, workers shall comply with OSHA's PPE requirements for footprotection there is danger of injury to q 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 under the American Disabilities Act (ADA). These guidelines define traversable slope requirements th Board use of a defined pattern of truncated domes as detectable warnings at street crossings.g ants and prescribe the g The new Standards Plans and can be found on the Design and Construction Project Support web page at: chttp://www.dot.state.co.us/Deslgnsupport/>, 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 u permitted access not consistent with the terms and conditions listed on the permit may be considered a violation o of the permit. on of the 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 l attachments are to the best of their knowledge true and complete,I ledge understand receipt of an access permit does not constitute permission to start access construction work, Applicant or Agent for Permittee ai • .) camdtztAk nature LtehAjc-) Print name Rebecca Lieders If the applicant is not the owner of the property, we require their legally authorized representative (or other acceptable with this application by all owners -of -interest unless n ss stated cases, will be listed as the permittee. Date 1/14/2019 this application also to be signed by the property owner or written evidence). This signature shall constitute in writing. If a agreement g permit Is issued, the property owner, in most Property owner signature Print name Previous editions are obsolete and may not be used Date Page 2 of 2 COOT Forth #137 01/10 50 FT. MINIMUM NATURAL GRADE NOTES: UNIMPROVED GROUND 1O' PAIN. 20' MAX. s a ro. .♦ I 2 in 1•., .•,� O. • • .4 ••a .• :�; • �•••. • s• tip' • CLEAN ROCK FILL 1 .. • � •••••• t: • . •• • : •,..• :l_ GEOTEXTILE FABRIC AND GEOTEXTILE GRID, AS REQUIRED BERM 3' WIDE x 2" HIGH • RADIUS = 20' MAX. PLAN VIEW 50 FT. MINIMUM 2'-4" MIN. 'IN •,1(17,:;•17. y PROFILE SP - —Sam •4.•. °a ;•• • • • . EXISTING ROAD PAVEMENT EXISTING ROAD PA • •_ M ENT CONTRACTOR TO PROVIDE AND INSTALL CULVERT (1r MIN. FOR CDOT) (15" MIN. FOR WELD COUNTY) 1. ACCESS PADS, AS ILLUSTRA(ED ABOVE, ARE TO BE INSTALLED ADJACENT TO ALL ROAD CROSSINGS. 2. IF USED IN AGRICULTURAL LAND, ROCK SHALL BE PLACED ON A GEOTEXTILE FABRIC TO FACILITATE ROCK REMOVAL. 3. SHOULD THE ROCK PAD BECOME INEt•FtCTIVE FOR REDUCING THE BUILDUP OF MUD AND DIRT AND MINIMIZING TRACKING ONTO THE PAVED ROAD, THE CONTRACTOR SHALL WASH THE EXISTING ROCK FILL SURFACE OR ADD A ROCK FILL LAYER TO THE ACCESS PAD. 4. CONTRACTOR SHALL KEEP ROAD SURFACES CLEAR OF MUD AND DEBRIS. 5. CONTRACTOR SHALL REMOVE ALL IMPORTED ROCK FILL MATERIAL, GEOTEXTILE FABRIC AND CULVERT (IF INSTALLED) AND RESTORE THE GROUND TO NATURAL CONTOURS UNLESS OTHERWISE DIRECTED BY COMPANY'S INSPECTOR. 6. CONTRACTOR SHALL MAINTAIN A MINIMUM 2% GRADE AWAY FROM ROADWAY FOR A MINIMUM 20 FEET FROM EDGE OF ROAD. 021113/0* REVISIONS DESCRIPTICIN mum go MIDI 0111 REVSED PER ant COMM a, a Die MDR RUES OS SIVIWIS MIMED POaOM.mut a DS 1112COS MIND PC CODY RID. IP a 11/nhs REVSED ND COOT aoa COS TALLGRASS & EYWBri "A" parnell+ #lo}19Dto5 (aanG DEPICTED ES SUPERSEDED &( WRITTEN STANDARD, SCOPE OF *'ORX OR UNE UST. TYPICAL ROAD ACCESS PAD DATE: 11/20/1s SOLE N.T. S . APPROVED W CST -P--1000 -Pt45 S K. 1 OF 1 COLORADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS CODE NOTICE TO PROCEED Permittee(s): Terry and Christi Johnson 6037 W. 24th Street Greeley, Colorado 80634 (970) 631-6978 Applicant CDOT Permit No. 419013 State Highway/Mile Post/Side 014C / 158.658/Right Local Jurisdiction Weld County Shawn Bates Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 The permittee is hereby authorized to proceed with access construction within state highway right-of-way in accordance with the above referenced State Highway Access Permit and this Notice to Proceed. This Notice to Proceed is valid only if the referenced Access Permit has not expired. Access Permits expire one year from date of issue if not under construction, or completed. Access Permits may be extended in accordance with Section 2.3(11)(d), of the Access Code. Adequate advance warning is required at all times during access construction, in conformance with the Manual on Uniform Traffic Control Devices for Streets and Highways. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation. The permittee or applicant shall notify the Department prior to commencing construction as indicated on the Access Permit. Both the Access Permit and this Notice To Proceed shall be available for review at the construction site. This Notice to Proceed is conditional. The following items shall be addressed prior to or during construction as appropriate. Municipality or County Approval (When the appropriate local authority retains issuing authority) By (X) Title This Notice is not valid until signed by a duly authorized representative of the Department Colorado Department of Transportation By (X) Date Title Assistant Access Manager Copy distribution: Required: Make copies as necessary for: Region (original) Local Authority Inspector Applicant MTCE Pa:rol Traffic Engineer Staff Access Section Date 02/15/2019 Form 1265 8/98, 6/99 OL RADO DEPARTMENT OF TRANSPORTATION STATE HIGHWAY ACCESS PERMIT Permit Fee $100.00 Date of Transmittal 02/04/2019 Region / Section / Patrol / Name 4/01/20 COOT Permit No. 419013 State Highway No / P4 /Side 014C/158.658/Right Local Jurisdiction Weld County 0 The Perm ittee(s ) Terry and Christi Johnson 6037 W. 24th Street Greeley. Colorado 80634 (970) 631-6978 The Applicant(s): Shawn Bates Cheyenne Connector Pipeline, Inc 370 Van Gordon St Lakewood, Colorado 80226 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 sistained by reason of the exercise of theperrn it_ Location: The access is located on State Highway 14, a distance of 3,476 feet east of Mile Post 158 on the right/south side. Access to Provide Service to: (Land use Code) 994 - Temporary Construction Access Pipeline 210 - Single -Family Detached Housing Additional information: (Size) 2.53 16 (Units) Acres AOT This permit is for a permanent, residential access. The use of the this access by the Applicant is temporary. Expiration date for the temporary use is 02/01/2020. 4 MUNICIPALITY OR COUNTY APPROVAL Required only when the appropriate local authority retains issuing authority. Signature Print Name Date ' Title Omo Upon the signing of this permit the permitiee 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 Bruce Barnett with the Colorado Department of Transportation, 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 conditions. -COI; Signature: applicable) Print s lay 1/41 04)90 ;NI/ Date Date etsfrisn L_Nbi4,N5eit\i La lo This permit is not valid until signed by a duly authorized representative of the Department. COLORADO DEPARTMENT _ OF TRANSPORTATION Signature' nt Name Copy Di Required: 1.Region 2.Appllcan t a )9 T ie - fete (oaissue) Make copies as necessary for. 3.Staff Access Section Local Authority inspector 4.Cerrai Flies MICE Patrol Traffic Engineer tied . are obs and may not be used Page 1 of S COOT Form #jO1 5/07 State Highway Access Permit Form 101, Page 2 The following paragraphs are excerpts of the State Highway Access Code These are provided for your convenience but do not alleviate compliance with all sections of the Access Code A copy of the State Highway Access Code is available from your local issuing authonty (local government) or the Colorado Department of Transportation (Department) When this permit was issued, the issuing authonty made its decision based in part on information submitted by the applicant, on the access category which is assigned to the highway, what alternative access to other public roads and streets is available, and safety and design standards Changes in use or design not approved by the permit or the issuing authority may cause the revocation or suspension of the permit APPEALS 1 Should the permittee or applicant object to the denial of a permit application by the Department or object to any of the terms or conditions of a permit placed there by the Department, the applicant and permittee (appellant) have a nght to appeal the decision to the [Transportation] Commission [of Colorado] To appeal a decision, submit a request for administrative heanng to the Transportation Commission of Colorado within 60 days of transmittal of notice of denial or transmittal of the permit for signature Submit the request to the Transportation Commission of Colorado, 4201 East Arkansas Avenue, Denver, Colorado 80222-3400 The request shall include reasons for the appeal and may include changes, revisions, or conditions that would be acceptable to the permittee or applicant 2 Any appeal by the applicant or permittee of action by a local issuing authority shall be filed with the local authority and be consistent with the appeal procedures of the local authority 3 In submitting the request for administrative hearing, the appellant has the 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 When such committee review is requested, processing of the appeal for formal administrative heanng, 2 9(5) and (6), shall be suspended until the appellant notifies the Commission to proceed with the administrative hearing, or the appellant submits a request to the Commission or the administrative law judge to withdraw the appeal The two administrative processes, the internal administrative review committee, and the administrative hearing, may not run concurrently 4 Regardless of any communications, meetings, administrative reviews or negotiations with the Department or the internal administrative review Committee regarding revisions or objections to the permit or a denial, if the permittee or applicant wishes to appeal the Department's decision to the Commission for a hearing, the appeal must be brought to the Commission within 60 days of transmittal of notice of denial or transmittal of the permit PERMIT EXPIRATION 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 extension When the permittee is unable to commence construction within one year after the permit issue date, the permittee may request a one year extension from the issuing authority No more than two one-year extensions may be granted under any circumstances If the access is not under construction within three years from date of issue the permit will be considered expired Any request for an extension must be in writing and submitted to the issuing authority before the permit expires The request should state the reasons why the extension is necessary, when construction is anticipated, and include a copy of page 1 (face of permit) of the access permit Extension approvals shall be in writing The local issuing authority shall obtain the concurrence of the Department prior to the approval of an extension, and shall notify the Department of all denied extensions within ten days Any person wishing to reestablish an access permit that has expired may begin again with the application procedures An approved Notice to Proceed, automatically renews the access permit for the period of the Notice to Proceed CONSTRUCTION 1 Construction may not begin until a Notice to Proceed is approved (Code subsection 2 4] 2 The construction of the access and its appurtenances as required by the terms and conditions of the permit shall be completed at the expense of the permittee except as provided in subsection 214 All materials used in the construction of the access within the highway right-of-way or on permanent easements, become public property Any materials removed from the highway nght-of-way will be disposed of only as directed by the Department All fencing, guard rail, traffic control devices and other equipment and materials removed in the course of access construction shall be given to the Department unless otherwise instructed by the permit or the Department inspector 3 The permittee shall notify the individual or the office specified on the permit or Notice to Proceed at least two working days prior to any construction within state highway right-of-way Construction of the access shall not proceed until both the access permit and the Notice to Proceed are issued The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within the highway right-of-way A construction time extension not to exceed 30 working days may be requested from the individual or office specified on the permit 4 The issuing authority and the Department may inspect the access dunng construction and upon completion of the access to ensure that all terms and conditions of the permit are met Inspectors are authorized to enforce the conditions of the permit during construction and to halt any activities within state right-of-way that do not comply with the provisions of the permit, that conflict with concurrent highway construction or maintenance work, that endanger highway property, natural or cultural resources protected by law, or the health and safety of workers or the public 5 Pnor to using the access, the permittee is required to complete the 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 the Department or issuing authority to initiate action to suspend or revoke the permit and close the access If in the determination of the Department or issuing authonty the failure to comply with or complete the construction requirements of the permit create a highway safety hazard, such shall be sufficient cause for the 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 Department and included in the permit The Department or issuing authority may order a halt to any unauthorized use of the access pursuant to statutory and regulatory powers Reconstruction or improvement of the access may be required when the permittee has failed to meet required specifications of design or matenals If any construction element fails within two years due to improper construction or material specifications, the permittee shall be responsible for all repairs Failure to make such repairs may result in suspension of the permit and closure of the access 6 The permittee shall provide construction traffic control devices at all times during access construction, in conformance with the M U T C D as required by section 42- 4-104, C R S , as amended 7 A utility permit shall be obtained for any utility work within highway right-of-way Where necessary to remove, relocate, or repair a traffic control device or 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 Department or issuing authonty, and at the direction of the Department or utility company Any damage to the state highway or other public right-of-way beyond that which is allowed in the permit shall be repaired immediately The permittee is responsible for the repair of any utility damaged in the course of access construction, reconstruction or repair 8 In the event it becomes necessary to remove any nght- of-way fence, the posts on either side of the access shall be securely braced with an approved end post before the fence is cut to prevent any slacking of the remaining fence All posts and wire removed are Department property and shall be turned over to a representative of the Department 9 The permittee shall ensure that a copy of the permit is available for review at the construction site at all times The permit may require the contractor to notify the individual or office specified on the permit at any specified phases in construction to allow the field inspector to inspect various aspects of construction such as concrete forms, subbase, base course compaction, and matenals specifications Minor changes and additions may be ordered by the Department or local authority field inspector to meet unanticipated site conditions 10 Each access shall be constructed in a manner that shall not cause water to enter onto the roadway or shoulder, and shall not interfere with the existing drainage system on the nght-of-way or any adopted municipal system and drainage plan 11 By accepting the permit, permittee agrees to save, indemnify, and hold harmless to the extent allowed by law, the issuing authority, the Department, its officers, and employees from suits, actions, claims of any type or character brought because of injuries or damage sustained by any person resulting from the permittee's use of the access permit during the construction of the access CHANGES IN ACCESS USE AND PERMIT VIOLATIONS 1 It is the responsibility of the property owner and permittee to ensure that the use of the access to the property is not in violation of the Code, permit terms and conditions or the Act The terms and conditions of any permit are binding upon all assigns, successors -in -interest, heirs and occupants If any significant changes are made or will be made in the use of the property which will affect access operation, traffic volume and or vehicle type, the permittee or property owner shall contact the local issuing authority or the Department to determine if a new access permit and modifications to the access are required 2 When an access is constructed or used in violation of the Code, section 43-2-147(5)(c), C R S , of the Act applies The Department or issuing authority may summanly suspend an access permit and immediately order closure of the access when its continued use presents an immediate threat to public health, welfare or safety Summary suspension shall comply wrth article 4 of title 24, C R S MAINTENANCE 1 The permittee, his or her heirs, successors -in -interest, assigns, and occupants of the property serviced by the access shall be responsible for meeting the terms and conditions of the permit, the repair and maintenance of the access beyond the edge of the roadway including any cattle guard and gate, 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 Within unincorporated areas the Department will keep access culverts clean as part of maintenance of the highway drainage system However, the permittee is responsible for the repair and replacement of any access -related culverts within the nght-of-way Within incorporated areas, 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Wad Regulates. authorization Info: CDPHE is being APCD The requested. and application HMWMD Additional Regulations for any COOT guidance can permit or be accessed must requirements specifically may via the CDPHE Identify be any specified Environmental ACM in the involved permit Permitting in the special Website work provisions. for listed which Contact above. Additional infornetion concerning) clearance on COOT prole* Is available from the CDOT Asbestos Project Manager (303) 512- 5519, or Theresa Santan jeto-OruJin; Hazardous Materials Mane mant Su or: 512-5524. Transootthtlon of H?wdoua iilc a No person may offer or accept a hazardous ma for transportation in commerce un ss that hazardous authorized obtain person authorization is material by registered applicable must and in conformance be requirements, a State properly HAZMAT classed, or with an Permit the described, exemption, from United the States packaged, approval Colorado Department marked, or registration Public of Utilities labeled, Transportation has Commission. and been in issued. condition regulations Vehicles Contact for at shipment Information: 49 requiring CFR, Part as required a placard, 171. For The or must authorization Registration (303) and more info 969-8748. call Colorado the Federal Public Motor Utilities Safety Commission: Carrier Administration, 1303) 894-2868. US DOT for inter- _ and lntrasstate HAZMAT Discharge of Dredged or Fill Material —404 Permits Administered Dv the US., v Cams of En�eors1 and _ _ Section 401 Water Quality Certifications Issued by the CDPHE WQCD - Corps of Engineers 404 permits are required for the discharge of dredged or fill materials into waters of the United States, including wetlands. There are various types of 404 permits, including line nationwide would required. contact activities be information required. permits, Contact (nwp #12), if the which above. an appropriate Depending individual are Issued Contact Corps 404 for upon the permit activities the District CDPHE specific is required, Regulatory with Water relatively circumstances, section Quaal Office minor 401 Control for Information impacts. it water is Division possible quality For at about that certification 303 example, either what 692-3500. type there a "general" from of is the 404 a nationwide or CDPHE permit individual' WQCD may permit 404 Is be required for permit also utility Working on or in any stream or its bank - in order to protect and preserve the state's fish and wildlife resources from actions that may obstruct, diminish, destroy, change, modify, or vary a natural existing stream or its banks or tributaries, it may be necessary to solid obtain 3) streams segments a blue Senate having tins of on Bill streams wetlands USGS 40 certification supporting 7.6' present quadrangle within from 25% 200 the maps; or more Colorado yards and/or cover upstream Department 2) within intermittent 100 or downstream of yards Natural streams upstream of Resources. providing the or project downstream live A measured stream water is beneficial of the by defined project valley as to length. fish and/or 1) represented and The wildlife; 4) segments CPW by and/or a of -' • application, as per guidelines agreed upon by COOT and CPW, can be accessed at .'_ _ Y. .... ._ • ...- et,: OtiVnIvister Construction Permit 1SCP 8 ter Discha F Fact!, • Discharges of storrmater nmoif from cx3nsttuc Lion sites disturbing one acre or more - or certain types of industrial facilities, such as concrete batch plants - require a CDPS :.. .ti. Stormwater wydruuli I` Permit 4 Cl n. Contact .. . ".. - information: a . . cr Contact a the -. . CDPHE _2 . 'Ptak' Water and Quality ...:p.; st cip: Control :,1 Division )) -- -... at (303) -. ' p 892-3500. . Webslte: inri.tiperrn,fre as,= Construction Dewatterfno (Discharge or Inffltradflni and Remediation Activities - Discharges of water encountered during excavation Information: or work For In Construction wet areas Instructions may Dewatering require.a and Construction Remediation Dewetering Activities or Discharge Remediation Perri Activities 7flti- contact Discharge the CDPHE Permit WQCD Contact at (303) 692- 3500. For Applications and (CDPHE website): . . 4. iv . :iuiadch.a .air - _' i �v.a-c�cu r 4an-•. �;a:• v' AlunkipALSepanate Morin Sewer System IMS4) Ageism* Prmit - Discharges from the storm sewer systems of larger municipalities, by facility municipalities the the applicable CDPHE should and contact MS4 provisions WQCD. from permit. the the For municipality of All the COOT facilities discharges Colorado highway that regarding lie to Water drainage within the stormwater CDOT Quality the system boundaries highway Control that related Iles drainage Act of dearanoes the within a municipality Water system those that Quality or municipalities, that may within is subject have the been Right Commission are to an established of subject MS4 Way (ROW) Iti1QCC) to permit, MS4 under Permits the must Rey�gp�ulla�t{�i�{ons that owner comply issued of such with -fi • +Control (NttPN/,_ . -Ili LJ no7. ......J.�... •-+ /� . . . tiid-poi .. . - .41. . .,tW ) and � the COOT l� Permit # COS - 000005 '/fie{u, nt c_._' g<rr-or -."...Sc;; en�rjro et' ' -.:' 1' • �)• Discharges are subject to inspection by COOT and CDPHE. Contact the CDPHE Water Quaff Control Div�lon at (303) 692-3500 for a listing For COOT of municipalities required to obtain MS4 Permits, or go to it p$Swei4..tcnlo dtigo papi 4tAtteA '. #r upk(pin �.,"C :. -related MS4 regulations, go to: � . ;p r aeon l tar a% -1. , Fsi#or - carcr ' = General -ikon .. Vtion — Mechanises - All discharges are subject to the provisions of the Colorado Water Quality Control Mt and the Colorado automotive (303) 692-3500. Discharge fluids, solvents, Permit Regulations, oils or soaps Prohibited and sediment discharges Contact include, Information: but are not Contact limited the to, CDPHE substances Water such Quality as wash Control water, Division paint at General Authorization - Allowable Discharges - Unless otherwise identified by COOT or theWQCD as significant sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a Colorado Discharge storm uncontaminated activities. sewers, Permit Allowable discharges springs, System non-stormwater permit from footing potable drains, landscape discharges water water irrigation, sources, line can foundation flushing, be diverted found flows under stream from drains, elicit riparian flows, air Discharge uncontaminated conditioning habitats PDD and condensation, at ground wetlands, ..:':.:;: ' water irrigation and - ' flow :,,_ infiltration . from -.:. water, -:. firefighting to separate . -3 '-1 marrh'Avater-q: ,tllston�et' prograi aSmI, Contact Information: The CDPHE Water Quality Control Division (telephone Vs listed vels Erosion and sediment Corti?! Practices - For activities requiring a Storrmvater Construction Permit, erosion contra requirements MI minimize be specified erosion in that and permit. sedimentation In -situations according where a to COOT stormwater Standard permit Specifications is not required, 107.25, all reasonable 208, 213 and measures 216 (. :-- should �.:.::: - .. - be .... , taken to -. .1, rj 'At.,. 1..Z..:. , ..:,..:-rin!!,r:n if iiartr* �P:: ;'...rttirsr . 111'1-~`;r. l S2k -1:. - 2. • All disturbances require a stabilization plan, native Erosion erosion seeding Control controls or and and landscape Stormwater restore design disturbed plan Quality according Guide vegetation. to (available applicable from the CDOT Bid Plans Standard Specifications Office at (303) _ 212-217 757-9313) should and 623. be used The to CDOT design Environmental Clearances information Summary Page 2 of 3 Colorado Department of Transportation August 2017 posal of Ding Flub - Drilling fluids used in operations such as Horizontal Directional Drilling may be classified as 'discharges' or `solid wastes,' and in general, should be pumped or vacuumed from the construction area, removed from the State Highway Right of sewers, Waste Way, and roadside regulations. disposed ditches Small of at or perrnitted any quantities other facilities type of drilling of that man-made fluid specifically solids or (less natural accept than waterway 1 such cubic wastes. is yard prohibited of solids) Disposal by may of Water drilling be left fluids Quality on -site hto Control after storm either drains, and/or being Solid storm separated required the solids from for proper are fully fluids drilling contained or after properties, infiltration in a pit, of small and the are quantities water, not likely provided; of to polymer pose 1) a the additives nuisance drilling to fluid that future are consists approved work in of the only for area, water use in 3) and drinking the solids bentonite water are clay, well covered drilling; or, if and 2) the area restored Contact CDPHE as required I tele ?hone by CDOT ifs listed permit above requirements . (Utility, Special Use, or Access _ Permits, etc.). Contact Information: oxtoua Weeds and Invasive $pecles f anaaement Plan - Noxious Weeds and Invasive Species guidance ound b_y ' contacting the Colorado Department of Agriculture L G..:_. iawv octal+ _tioagovioac elagoonsers alai maxlo . ••. 3:10) and the Colorado Division of Perks and Wildlife (.. oia _y 14 . - ,t.us out{.2•sw ,. =s1RS-10 -- ---: fear Ism). We either ape, management fans tnvotvin the control of noxious weeds associated the psfmrtteed witheativlt en d cieanin of mi di:a nent will be required. c hout - Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, riving waters, minimum Environmental or of in 50 the feet Program CDOT from ROW. state end shall Concrete waters, be in dralnageways, accordance waste shall to be and CDOT • . placed inlets. specifications in a Concrete temporary concrete washout and guidelines. shall washout only be Contact facility performed and information: must as specified be located Contact by the CDPHE a CDOT or find addttionaJ information on the CDOT website: , ,......,4,.„4;.,., . . _ _ _ n ' , c,nal u •i ' - ii, and refer to the srecificatians and their revisions for sections 101, 107 and 208. SRN! ReegrtlQq • Spills shall be contained and cleaned up as soon as possible. Splits shall NOT be washed down into the storm drain Permitting be wing reported or buried. Office 25 gallons, to the Ail and spills CDPHE Regional or shall that at may 1-877-518-5608. be reported Maintenance otherwise to present the Supervisor. More EST an information ilt immediate Spills Discharge on can highways, danger Hotline be to found into the at at (303) waterways, public 6124446 shall any split be reported - (4H20), • . in as the by calling :' : well highway -`'- as 911, . ' the right-of-way _ Regional and • ... shall - also , _ . About This Form - Questions or comments about this information Summary may be directed b Alex Karam', Program Administrator, CDOT Access Management Unit, atJ303) 757-980, alszkarami.:i,tate.co.us. Environmental Clearances Information Summary Page 3 of 3 Colorado Department of Transportation August 2017 COLORADO Department of Transportation What is stormwater runoff? Stormwater runoff occurs when precipitation from rain or snowmett flows over the ground. Impervious surfaces like roads and sidewalks prevent stormwater from naturally soaking into the ground Why is stnr'rn\Pnter runoff a problem? Stormwater can pick up debris, chemicals, dirt and other pollutants and flow Into COOT'S storm drain system or directly into a stream, river, lake, wetland or reservoir. Anything that enters MOT's storm drain system is discharged untreated Into the waterways we use for fishing, swimming, and providing drinking water. ..t�,.� ..►n. tr-''"nr 1ttt Dredged p'$t t r'tt. sh. rv, L• �f • • -..•e• ,. - • . „,rw i •.. 7.1 -11..._.. �..•.•f,•.. .. `. I• • '_, _�1 ..-.�•• ♦'r• -4,-•f ►i 't-' •-.•7•- .. •4 • , (.., -• • a. • j � • 1 •, cs �,v t 1 fen Orr: ^t, rt 'L tar'd iteLr vi •`,l r' 1 Tips for Reporting an illicit Discharge Call the illicit discharge hotline at (303) 512-4426 From a safe distance try to estimate the amount of the discharge. Identify characteristics of the discharge (color, odor, algae, etc). Obtain information on the vehicle dumping the waste (if applicable). Do not approach! Call '(SP for illicit dumping_ if possible, take a photo, record a license plate. Never ger too close to the Illicit discharge, it may be dangerous!!! For more Information on COOT Utility Permits: http.:l/www.coaot.aov/busines..e permiLs/ utilitie 5Wpec aluse For more information on COOT Access Permits: https:n www.codot.gow business,/ p ermit access permits For more information on CDOT Water Quality Program: Water Quality Program Manager 4201 E. Arkansas Ave. Shumate Building Denver, Colorado 80222 303-757-9343 COLOR A DO Department of Transportation Mater 4)ti aiitf 1•; rterarn industrial facilities ( Oaf (HAM COOT has a Municipal Separate Storm Sewer System permit, otherwise known as (M54) from the Colorado Department of Public Health and Environment. The permit states that only stormwater can be discharged from 0)0T% storm drain system air pipe ---► ` TOME WASTEWATER TREATITPWfT belie t.gt ale am.. storm drain p T0THEL0CAL WATERS00Y As part of the permit, CDOT has several different programs to prevent pollutants from entering Into the storm drain system: Construction Site Program New Development Redevelopment Program Illicit Discharge Program industrial Facilities Program Public Education and Outreach Program Pollution Prevention and Good Housekeeping Program Wet Weather Monitoring Program COLORADO Department of Transportation Control Measures for Industrial racilities Industrial facilities can use control measures (CM) otherwise known as Best Management Practices (BMP) during the construction of a facility and when operating the facility. Control measures are schedules of activities, maintenance procedures, and other management practices to prevent and reduce pollution entering Into CDOrs storm drain system. Control Measures also Include treatment, operating procedures, and practices to control site run off which can indude structural and non-structural controls. wan el MLR POILLITAMit S muttAOS p ESxn 11.0.041 �' f aetat IWO -- ►va ,AKI7 1 Y' Si 'iSfSWr MICIPERLWan* `Y In c mpdanal l COOT defines a utility, or utility facility as any privately, publicly, or cooperatively owned line, facility, or system producing, transmitting or distributing the following: ✓ Communications ✓ Cable television ✓ Power ✓ Electricity ✓ tight ✓ Heat Gas ✓ Oil ✓ Crude Products ✓ Water - ✓ Stream ✓ Waste ✓ Stormwater nat connected with highway drainage ✓ Similar Commodity COLORADO Department of Transportation Industrial Facilities Program Elements: 1. Educate and outreach to owners or operators that have potential to contribute substantial pollutant to water. 2. Report and include information on discharge and water quality concerns. Provide written notification within 15 days of discovery to CDPHE. 3. Submit an annual report to CDPHE containing the number of informational brochures distributed; name and title of each individual trained. Education There are instances when a utility company or other entity doing work in the state highway right-of-way will require some type of environmental permit or clearance for that work. CDOT has put together an Environmental Clearances information Summary for those applying for a COOT Utility and Special Use Permit or Access Permit to obtain all required clearances. This fact sheet is given to each permittee and is available at: http: / /www.coloradodot.infoiTroctrams/ environmental/ resources/ guidance- standards/Environmentat%20Clearances% 2olnfo%20Summary .pdf State Highway Access Permit Attachment to Permit No 419013 - Additional Terms and Conditions 1 1. If there are any questions regarding this permit, please contact Allyson Mattson at (970) 350-2148 2 The Permlttee or the contractor shall notify Bruce Barnett 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. 3 The Permittee shall request final inspection by Bruce Barnett at (970) 350-2'.147 within 10 days following the completion of access construction, and prior to authorized use The Permittee or their representative shall be present 4 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 orthe issuing authority. 5. The Permittee shall refer to all additional standard requirements included with this permit and any enclosed additional terms, conditions, exhibits, and noted attachments 6 incorporated as part of this permit are the following. Application for Access Permit (COOT Form No 137) Permit (CDOT Form No. 101) and its attachments Exhibits. "A" — Access Plan "B" — Vicinity Map "C" —Temporary Easement 7. 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 Permlttee. 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 be applied for based upon the existing and anticipated future conditions. 8. 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 9. 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 Permlttee State Highway Access Permit Attachment to Permit No. 419013 - Additional Terms and Conditions 2 10. 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 permit and be available on the site during construction. 11. 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. In the event a signal is warranted in the future, CDOT will not participate in any fashion with that signal installation, including financially. 12. The 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. 13. It is the responsibility of the Permittee to determine which environmental clearances and/or regulations apply to the project, and to obtain any clearances that are required directly for the appropriate agency prior to commencing work. Please refer to or request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS) for details. The ECIS may be obtained from the CDOT Permitting Offices or may be accessed via the COOT Planning/Construction-Environmental Guidance webpage at ittj:J Jwww.uut. rate.co.us, eIIvtronmentai, e-orms1asu. FAILURE TO COMPLY WITH REGULATORY REQUIREMENTS MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES. ALL discharges are subject to the provisions of the Colorado Water Quality Act and the Colorado Discharge Permit Regulations. Prohibited discharges include substances such as: wash water, paint, automotive fluids, solvents, oils or soaps. Unless otherwise identified by CDOT or the Colorado Department of Public Health and Environmental (CDPHE) Water Quality Control Division (WQCD) as significant sources of pollutants to the waters of the State, the following discharges to storm water systems are allowed without a Colorado Discharge Permit System Permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate storm sewers, discharges from potable water sources, foundation drains, air condition condensation, irrigation water, springs, footing drains, waterline flushing, flows from riparian habitats and wetlands, and flow from fire -fighting activities. ANY OTHER DISCHARGES, including storm water discharges from industrial facility or construction sites, may require Colorado Discharge Permit System permits from CDPHE before work begins. For additional information and forms, go to the CHPHE website at: State Highway Access Permit Attachment to Permit No. 419013 - Additional Terms and Conditions 3 http://cdphe.state.co.us/wq/PermitsUnit/wqu. 14. 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. 15. 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 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. 16. 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. 17. The Department Inspector may suspend 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. 18. 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 plan must be approved in writing by the Department prior to commencement of any work on or within the State Highway right-of-way. 19. Reconstruction and improvements to the access may be required when the Permittee has failed to meet the required design and/or material specifications. If any construction element fails within two years due to improper construction or material specifications, the Permittee is responsible for all such repairs. 20. The Department retains the right to perform any necessary maintenance work in this area. 21. Routine, periodic maintenance and emergency repairs may be performed within the State Highway right-of-way, under 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. State Highway Access Permit Attachment to Permit No. 419013 - Additional Terms and Conditions 4 22. Access construction methods and materials shall conform to the Colorado Department of Transportation Standard Specifications for Road and Bridge Construction (current edition). 23. Ali materials, equipment, installation, construction, and design, including the auxiliary lane(s) and intersection Improvement(s) within the State Highway shall be in accordance with the following Department standard references as applicable. A. State Highway Access Code, 2 CCR6O1-1 B. Roadway Design Manual C. Materials Manual D. Construction Manual E. Standard Specifications for Road and Bridge Construction, latest edition F. Standard Plans (M&S Standards) G. Manual on Uniform Traffic Control Devices (M.U.T.C.D.) for Streets and Highways and the Colorado Supplement thereto H. A Policy on Geometric Design of Highways and Streets, American Association of State Highway and Transportation Officials (AASHT0), latest edition I. AASHTO Roadside Design Guide J. Institute of Transportation Engineer's Trip Generation Manual, 6th Edition Some of the reference materials listed above (A through Ej may be purchased from: Colorado Department of Transportation Bid Plans Room 4201 East Arkansas Avenue Denver, CO 80222-3400 (303) 757-9313 The State Highway Access Code may be purchased from: The Public Records Corporation 1666 Lafayette Street PO Box 18186 Denver, CO 80218 (303) 832-8262 The website address is: www.cdot.gov 24, 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 CRF Part 1926 — Safety and Health Regulations for Construction. At a minimum, all workers in the State Highway right-of-way, except when in their vehicles, shall wear the following personal protective equipment: • Head protection that complies with the ANSI Z89.1-1997 standard; • At all construction sites or whenever there is danger of injury to feet, protective footwear that complies with the ANSI Z41-1999 standard will be worn State Highway Access Permit Attachment to Permit No. 419013 - Additional Terms and Conditions 5 • High visibility apparel as specified in the Traffic Control provision of this permit (at such a minimum ANSI/ISEA 107-1999, Class 2). Where any of the above referenced ANSI standards have been revised, the most recent version of the standard shall apply. 25. 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. 26. No construction vehicles shall be parked, or construction materials/equipment stored, on the State Highway right-of-way overnight. 27 Backing maneuvers within and into the State Highway right-of-way are stnctly prohibited All vehicles shall enter and exit the highway right-of-way in forward movement Backing into the right-of-way shall be considered a violation of the terms and conditions of the access permit and may result in revocation of the permit by the Department and/or the issuing authority. 28 Traffic detours or lane closures will not be allowed, unless pre -approved by the Department. 29. Two-way traffic shall be maintained throughout the work area at all times unless specific written authorization is obtained from the Department 30. Construction traffic control devices, when not in use, shall be removed or turned away from traffic, Devices must be stored outside of the roadway clear zone per the latest AASHTO guidelines. 31. Cattle guards are not permitted in State Highway right-of-way 32 if State Highway right-of-way fence exists or is proposed, the Permittee must contact Bruce Barnett at the Greeley Traffic Office, (970) 350-2147 prior to removal or Installation. The Permittee will be required to obtain a highway right-of-way fence agreement for a special fence if the Permittee desires to remove the existing standard highway fencing €n this area When it is necessary to remove any highway right-of-way fence, the posts on either side of the access entrance shall be securely braced with approved end posts and in conformance with the Department's M-607-1 standard, before the fence Is cut to prevent slacking of the remaining fence All posts and wire removed shall be returned to the Department. 33. The access shall be completed in an expeditious and safe manner and shall be finished within 45 days from initiation of construction within State Highway right-of-way. 34. All required access improvements shall be installed prior to the herein authorized use of this access Failure to do so will result in the appropriate legal action from the Department, up to Permit Revocation. State Highway Access Permit Attachment to Permit No 419013 - Additional Terms and Conditions 6 35 The access shall be constructed and maintained as per Exhibit "A" 36 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 37. The Permittee is required to install a tracking pad on private property to mitigate the effects of mud and other debris being tracked onto the State Highway system Should debris tracking onto the highway be a problem, CD0T will contact the Permittee who shall clean the highway within 24 hours of CDOT contact. Appropriate traffic control shall be used per the M.0 T.C D. 38. The access shall be surfaced immediately upon completion of earthwork construction and prior to use. 39 Surfacing of the access shall be completed as per Exhibit "A" 40 No paved surface shall be cut unless specified In this permit Asphalt removal shall be saw cut to assure a straight edge for patching Full panel concrete replacement is required for any concrete work 41 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 42 The access shall be constructed and maintained In such a manner that will not cause water to enter onto the roadway, and will not Interfere with the existing drainage system within the State Highway right-of-way Drainage to the State Highway right-of-way shall not exceed historical rate of flow 43 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 44 The use of this access by the Applicant Is only until 02/1/2020 TPg—f4tat e @IQ ' Ere QO cute Lssd taeod aoaj a w t and pat es UN AMINOfitglOgg. ea SUMPS sno4Ratd i gNn fa iagtunu DJt;AJtPIOW= Dw aob solnleA ault4P1 "pun% g ed Im IIIPM PIS PIPM P astimpA sag gest le IA put t ho 1) 02 )4 lona 1•8 =Wan Van tars Pi esauannut kip e8uJoA9m .10 SOWNOis Ino44 we gtunoo lnoA g eissmui 'SUl1OO 1 Sj &1$WQat uatW ittiedosd 941SWAM" ';stone eta asn got' xilit sad{ 'dA40) gall ier's lunoo epefeA Bulnrtajlo3 eyti opfiOld (L L - _._ .r.. ed13 syun p tagwnu 064 &allurep legwnu pue (asnotiuMol luauisreds 'Alfas,' .034 5) edl e41 et saym'sseto8 wewadu}eaap,eguaplseu 8ultsenbel DIe nurt jj (9 t i e5moot emnbs snuffing tool earths posysteutsnq - — t e jo tooe; etsnbe ewe ,oag a eppnaid pus se'sseulsn4 40 tegwnu pus sedA1041 04191mM/4 eseeld sseooe fe anput iolilaieww00 Bupssnbai ere noA II (8! of ES't Lewes ;neon aA M* SeaO'9 Au8W M04 - sseoeg pp" Fainnsrtoubn 8uasenbes t#w nO N (4L •saucod steam autism pus pesodoid sip a 1psu pug sugjd mod uo wow isa - seA j; `sa,CI au t4ledo+d 6141 u[449A to dupejzroq swains a steam ao sAeMi jy'epeoi's aa,gs ajgnd pelsagpsp JO flupspis law° emu fry (gi :equosep eseeld - sere fl 'seA ouD L + lueoef ps dim u s nietu1 Aug may 10 u1Ko iew Sold eyt flop (a :MVP ijtwed'w,pra sepdoo sptAold pug (Ofegwrtu Hausa mu are $syM - salt jj'aatrj ou[J t lseteWj Atiadord a any noA own u sepedoid wuealtj:e ao 'Ajadoid 81116u puss swuued stews Asratitip ems Aua to Seimotn sny nad(00 (t 1 Twain Trio-Laby esn Alsadotd 6upstxa mad (01 DROP 0311,104 ;wool etlftelk0ui jo uogebtx SS8 &Jpave 03 tuaweAoxLul il etak,ari Pinni —Llano-3 p7 Gm :D04 kAAS 3 MIS= o p+oute.0 esn S183Gll tit e8uetp ( 61/It/Et-CC/TM :Pollieflogue uoewnp) csecoe damadwaiall swoon met! :z$ Bup .anbai we Wait J! 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Such clearances may include Corps of Engineers 404 Permits or Colorado Discharge Permit System permits, or ecological, archeological, historical or cultural resource clearances. The COOT Environmental Clearances Information Summary presents contact information for agencies administering certain clearances, Information about prohibited discharges, and may be obtained from Regional COOT Utility/Special Use Permit offices or accessed via the COOT Planning/Construction-Environmental--Guidance webpege http://www.dotestate.cosusfenvironmental/Formseas... 2- Ali workers within the State Highway right of way shall comply with their employers 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 tt►eir 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, ANSIIISEA 107-1999, dass 2); head protection that complies with the ANSI Z89.1-1997 standard; and at ail 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: cJtlt nilwww.,state.0o.us/DosIqnSuppory?, then dick on Design Bulletins. r If an access permit is Issued to you, it will state the terms and conditions for its use. Any changes in the case of the permitted access not consistent with the terms and conditions listed on the permit may be considered a 'vn of the permit violation 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 foirtn 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. Anxiicaril Cif Apent for F'ennittee signalize Print name _. 'ctittiatuttibiCfA -... If the a c icant is not the owner of the , we require this application also to be signed the property r their loyally authorized representative or other acceptable written evidence), This signature shalt R Y owner � ) Q ahalf constitute with this application by all owners -of -interest unless stated In writing. If a permit Is Issued, the property owner, in agreement cases, will be listed as the permittee. most Property owner afgrmtuie p*d an Prevtauts edttlans are obsolete and may not be used _ Page 2 of 2 COOT Form 1187 dirt° re' UNIMPRO�D GROUND NATURAL c --\1/4 NOTES: Rai GEOTEXTILE GRID, AS REQUIRED F" R E -..•-.+as, ,ire. r 3EDEMA HIGH% "N 10 1. ACCESS PADS, AS ILLUSTRATED ABOVE, ARE TO BE INSTALLED ADJACENT TO Oa STING PAVED ROADS AT LOCATIONS IDENTIFIED ON THE CONSTRUCTION DRAWINGS OR AS DIRECTED BY THE COMPANY'S ',SPECTOR. 2. F USED IN AGRICULTURAL UWD, ROCK SW L BE PLACED ON A CECTEXTILE FABRIC 10 FACILITATE ROCK REMOVAL. 3. SHOULD THE ROCK PAD BECOME INEFTECTIVE FOR REDUCING THE BUILDUP OF MUD AND DIRT AND MOWING TRACKLMC ONTO TIE PAVED ROAD, THE COH1R#ICTOR SWALl WASH THE DOMING ROCK FILL SURFACE OR ADD A ROCK FILL LAYER TO THE ASS PAD. 4, CONTRACTOR SHALL KEEP PAVED ROAD SUiFACES CLEAR OF MUD AND DEBRIS. 5. PRIOR TO PERMANENT SEEDING, CONTRACTOR SHAH. ROAM ALL IMPORTED ROCK FILL MATERIAL, GEOTEX11LE FABRIC AND CULVERT (w INSTALLED) AND RESTORE THE GROUND TO NATURAL CONTOURS UNLESS OTHERWISE DIRECTED BY COMPANY'S INSPECTOR. REVISIONS ' wit aria pea aMS riiiiteatiliribT • • )(f -t t OTT 11 Nt TALLGRASS ti ardallapc: TYPICAL. TEMPORARY PAVED ROAD ACCESS PAD (warner rase at Rix SH. I OF , ?e,(0.1 44iecisoi3 a TEMPORARY ACCESS ROAD EXHIBIT PROJECT CENTERLINE TEMPORARY ACCTS ROAD PARCEL BOUNDARY 62.75 FT 14.35 AC BcHt SIT "g" Page- oaring tan n .....a FitO-PEWlY OF: F. TERRY a CHRISTI A. JOHNSON CHEYENNE CONNECTOR PIPELINE WELD COUNTY. COLORADO >'r' -1 WALE: . e DATE 1D/29/2osa Atria*COS E429400 amain / Tnl.or! 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W 04110 IA 1se/!!1 04110 e 6u}eq 'UMW 'aN uolideaeN le O002 '61UeAON PePoosi '9cgZ-IPt-60L0 'oW uaqdwa 3 Pe el FraPau00 10 b vi 6v eq Puel p itle4 V :pt. J1osioas Wd w.9 ISM 99 30 l NINON l d I NSNMOl =pogo; se pecunsap sl c}O?ym Apedaid feat vowels atco moss Joy pus! ;o dips aP (log) mod 411fd B tazlinn 01 IueWGsee sse3ae A wodutel pue IgOp emenloxe-uou ay# aajualp al Rusk Agaioy Joluni -RUN opeioloO Ipoommiel loans ueA OLE S4 sseJppe esoum ',eeitaus, se al pauapt Jo119wara4 'suBtsse pue wopa uoagns sll 'uopwothoo opwroio3 e `-au' %%add .lo3euuo0 euuaitaga pun `eWow 10 euo leq aiM tiaweion se o3 Pewa;w ta}jeuiauay) PIGS opesoIo0 `AaIeaJ9 1804S 4OZ LS09 sl sseippe esoyhn 'swim Mot 'uoseyor 'V 9j4O pue uoswyur Auel j uee*geq putt Aq apew sit (.n oye) Iuawaa3 ssetoy Mwodura j slu.l.. IN3V 3Sd3 SS333Y AUVeladW31 Z1.0 I NA OOQ'6Z8-3MO:oN 1 IN WITNESS WHEREOF, Grantor has hereunto set its hand this :.. day of 2018. GRANTOR: F. Terry Jofiriiion STATE OF COUNTY OF . .) ss. SUSAN MITCHELL NOTARY PUBLIC STATE OF coo NOTARY ID :. ,6086 ' NAY COMMISSION EXPIR �; APRIL 12, 2022 On this day of •e in the year 2018, before me, the undersigned notary public, personally appeared F. Terry Johnson, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained_ In Witness Whereof, I hereunto set my hand and official seal. The foregoing instrument was acknowledged before me !Ws - • _ day of -':' ; , 2018. My commission expos: Pope, Z of 3 2 of 3 • Nolary Public Extitsri •,C° perms Ike419D1 I!� WITNESS WHEREOF, Grantor has hereunto set its hand this r day of _..._ . 2018. GRANTOR: . I - Christi A.Johnson STATE OF COUNTY OF _ r --_ SUSAN MITCHELL NOTARY PUBLIC STATE OF COL9RAbO NOTARY 10 20t31016086 MY COMMON EXPj •, - • APRIL 151, On this ,1 -. day of .:� : c,�. in the ,� year 2018, before me, the undersigned notary public, personally appeared Chriaii A. Johnson, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. In Witness Whereof, I hereunto set ►ray hand and official seal. The foregoing instrument was acknovviedged ba€ore me this f- -day of - C , 2018. My commission eires: 303 Notary Public EYI-{ LetT''C" PeArrY0 It9n9oi3 Hello