HomeMy WebLinkAboutHUMAN BEAN AT SPRING CREEK - Filed GC-GENERAL CORRESPONDENCE - (4)s.
COLORADO DEPARTMENT OF TRANSPORTATION
CDOT Permit No.
407049
STATE HIGHWAY ACCESS CODE
SH/S/MP
287 C / 344.910 / R
NOTICE TO PROCEEDN
Local Jurisdiction
Fort Collins
Permittee(s): RECEIVED Applicant:
Piazza LLC Piazza LLC
Troy Jones MAY 2 4 2007 Troy Jones
204 Walnut Street, Suite D 204 Walnut Street, Suite D
Fort Collins, CO 80524 Fort Collins, CO 80524
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 2.301)(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.
PLEASE REVIEW TERMS AND CONDITIONS PRIOR TO BEGINNING WORK WITHIN CDOT RIGHT-OF-WAY.
1
a .
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
X) ,C pt ^ l
Title /
nACCGr7 S S !/ "
Date
5/21/2007
Copy i ribu on: Required:
1. Region (original)
2. Applicant
3. Staff Access Section
Make copies as necessary tor: U
Local Authority Inspector Linda McWilliams
MTCE Patrol Traffic Engineer
4-Fort Collins
corm 1261 at9ts, b/yy
COLORADO DEPARTMENT OF TRANSPORTATION CD
c..
Permit No.
4,07049
STATE HIGHWAY ACCESS PERMIT State Highway No/Mp!$ide
287 C / 344.910 / R
Permit fee Date of transmittal Region/Section/Patrol Local Jurisdiction
100.00 1 5/10/2007 4 / 01 /4-Fort Collins Fort Collins
The Permittee(s); Applicant: Ref No.:
Piazza LLC Piazza LLC
Troy Jones Troy Jones
204 Walnut Street, Suite D 204 Walnut Street, Suite D
Fort Collins, CO 80524 Fort Collins, CO 80524
970-416-7431 970-416-7431
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 State Highway 287, a distance of 4,805 feet north of Mile Post 344 on the east/right side.
Access to Provide Service to:
Land Use Code:) (Size or Count) (Units)
829 - Coffee Shop -Drive Thru - 62 Peak Hour 500 SQ FT
Other terms and conditions:
HUMAN BEAN'
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
By
Date Title
x)
Upon the signing of this permit the permittee agrees to the terms and conditions and referenced attachments contained
herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from
Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to
being used.
The permittee shall notify Linda McWilliams with the Colorado Department of Transportation, telephone
nbc. (970) 350-2147 at least 48 hours prior to commencing construction within the State Highway right-of-way.
The person signing s the perrnitt a must be the owner or legal representative of the property served by the permitted access and have full authority to
accept the;pertnit a d its to s a conditions.
Permittee Signat
WI
r J
Date
S .
Permittee Printed Irn
1__ M W • T.Vle,-S
This permit is not valid until signed by d duly authorized representative of the Department.
COLORADO DEPARTMENT OF TRANSPORTATION
B 0 c
Date (ofissue)
6 u d
Title
Accessc
Copy istributi n: Required:
1.Region
2.Applicant
3.Staff Access Section
Make ecessary for. Previous editions are obs6lete6oll may not be used
Local Authority Inspector Linda McWilliams CDOT Form #101 8198
MTCE Patrol Traffic Engineer
4-Fort Collins
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 fled 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 includ. ing 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 perrnit or a denial, if the
permittee or applicant wishes to appeal the Department's
decision to the Commission for 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.
right-of-way or any adopted municipal system and drainage
plan.
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 Depa..rtment and included in the permit.
The Department or issuing authority may order a
he
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
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 aria 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
u ut wuu uEPARTMENT 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 toperformworkrelatedtotheirownfacilities (such as Utility; Special Use or Access Permittees), about some of the more commonlyencounteredenvironmentalpermits/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 RegulatoryRequirementsMayResult -in Suspension or Revocation_of Your CDOT Permit, Or Enforcement.Actions B Other A encies
CLEARANCE CONTACTS - As indicated in the permit/clearance descriptions listed below, the following individuals or agenciesmaybecontactedforadditionalinformation:
Colorado .Department of Public Health and Environment (CDPHE) — General Information — (303) 692-2035
Water Quality Control Division (WQCD) (303) 692-3500
Environmental Permitting Website htto://www cdohe state co us/permits as[).
CDOT Water Quality Program Manager; Rick Willard (303) 757-9343
CDOT / CDPHE Liaison; Pat Martinek (303) 757-9787
CDOT Asbestos Project Manager; Julia Horn (303) 512-5519
Colorado Office of Archaeology and Historic Preservation: (303) 866-3395
U.S. Army Corps of Engineers, District Regulatory Offices
Omaha District (NE Colorado), Denver Office (303) 979-4120 hftr)://www.nwo.usace.army.mil/htrhl/odTti/"tri-lakes.htmlSacramentoDist. (Western CO), Grand Junction Office (970) 243-1199, hftp://www.sok.usare.army.niii/c-esj)k-co/regulatory/
Albuquerque District (SE Colorado), Pueblo Reg. Office (719)-543-6915 httb://www.spa.usace.armv.mil/rea/
CDOT Utilities, Special Use and Access Permitting: 303) 757-9654 hfD://www.dot.stIate.- - - Permits/
Ecological Resources — Disturbance of wildlife shalt be avoided to the maximum extent practicable. Entry into areas of known or
suspected threatened or endangered species habitat will require special authorization from the CDOT permitting office. If any _ threatened or endangered species.are encountered during the progress of the permitted work, work in the subject area shall be halted
and the CDOT Regional Permitting Office and Regional Planning and Environmental Manager shall be contacted immediately. Authorization must be provided by CDOT prior to the continuation of work. Information about threatened or endangered species maybeobtainedfromtheCDOTwebsitehttb://www.dot.state.co.us/environmental/W'ildlife/Guidelines asp, or the Colorado Division of
Wildlife website htto://wildlife.state.co.us/WildlifeSr)eci6s/SDeciesOfOoncern/. Additional guidance may be provided by the RegionalPermittingOfficeinthePermitSpecialProvisions.
Cultural Resources —The applicant must request a file search of the permit area through the Colorado Office of Archaeology and
Historic Preservation (OAHP), Denver, to ascertain if historic or archaeological resources have previously been identified. Inventory ofthepermitareabyaqualifiedculturalresourcesspecialistmaybenecessary., per the recommendation of OAHP and/or CDOT. If
archaeological or historical artifacts are encountered during the progress of the permitted work, work in the subject area shall be
halted and the CDOT Regional Permitting Office and Regional Planning and Environmental Manager shall be contacted immediately:. Authorization must be provided by CDOT prior to the continuation of work. Additional guidance may be provided by the RegionalPermittingOfficeinthePermitSpecialProvisions. Contact Information Contact the OAHP at 303 866-3395.
General Prohibition — Discharges - All discharges are subject to the provisions of the Colorado Water Quality Control Act and the
Colorado Discharge Permit Regulations. Prohibited discharges include substances such as wash water, paint; automotive fluids,
solvents, oils or soaps. Contact Information: Contact the. CDOT Water Quality Program Manager at (303) 757-9343, or the
Colorado.Qe artment of Public Health and Environment; Water QualityControl Division WQCD at 303 692-3500.
General Authorization - Allowable Non-Stormwater Discharges Unless otherwise identified by CDOT or the WQCD as significant
sources of pollutants to the waters of the State, the following discharges to stormwater systems are allowed without a. Colorado
Discharge Permit System permit: landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to separate
storm sewers, discharges from potable water sources, foundation drains, air conditioning condensation, irrigation water, springs, footing drains; water line flushing, flows from riparian habitats and wetlands, and flow from fire fighting activities. Contact
Information: The CDOT Water QualityProgram Manager or the CDPHE Water QualityControl Division (telephone Vs listed above).
Hazardous Materials, Solid Waste - The Solid Wastes Disposal Sites and Facilities Act C.R.S. 30-20-100, et al, and Regulations
Pertaining to Solid Waste Disposal Sites and Facilities (6 CCR 1007-2), prohibit solid waste disposal without an approved CertificateofDesignation (a landfill permit). The Colorado Hazardous Waste Act C.R.S. 25-15-301 at 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 apermittedfacilityordesignatedcollectionpoint (e.g., for solid waste, a utility or construction company's own dumpster). If pre-existingsolidwasteorhazardousmaterialscontamination (including oil or gasoline 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
Re Tonal PermittingOffice for direction as to how to proceed. Contact Info. Contact the CDOT/CDPHE_Liaison at 303 75769787.
Asbestos -Containing Materials, Asbestos Contaminated Soil — All work on asbestos containing materials (ACM) must comply withtheapplicablerequirementsoftheCDPHEAirPollutionControlDivision's (APCD) Regulation 8. Disposal of ACM, and work done in
asbestos -contaminated soil, must comply with the CDHPE Hazardous Materials and Waste Management Division's (HMWMD) Solid
Waste Regulations. The application for any CDOT permit must specifically identify any ACM involved in the work for which
authorization is being requested. Additional guidance or requirements may be specified in the permit special provisions. Contact
Info: CDPHE APCD and HMWMD Regulations can be accessed via the CDPHE Environmental Permitting Website listed above. Additionalinformation is available from Julia Horn, CDOT Asbestos Project Manager (303) 512.5519. Environmental
Clearances Information Summary Page 1 of Colorado Department of Transportation Jan '06
Construction Stormwater Permit• Stormwater Discharge From -Industrial Facilities - Discharges of stormwater runoff fromconstructionsitesdisturbingoneacreormore - or certain types of industrial facilities - requires a CDPS Stormwater Permit. Contact
Information; For Utility/Special Use activities being performed in conjunction and coordination with a CDOT highway constructioncontract, please contact the CDOT Water Quality Program Managerat.(303) 757-9343. Otherwise, contact the CDPHE Water Quality
Control.Division at 303 692-3500. Website: h :Hwww.cd he;tate.co.us/w /Pe.rmitsUnit/w cd mt.html --
ConstructionDewatering (Discharge or Infiltration) = Discharges of`water encountered during excavation or work in wet areas may
require a Construction Dewatering Discharge Permit. Contact Information: For Construction Dewatering Discharge Permits, contact
the,CDPHE WQCD at 303 692-3500. Website:htt ://w.ww.cd he.state.co.us/w /PermitsUnit/w cd mt.html Minimal
Industrial Discharge. Permit — Discharges of small quantities of wastewater or wastewater requiring minimal treatment; suchasthatresultingfromhydrostatictestingorcertainwashwaters, may require a Minimal Industrial Discharge Permit ("MINDI"). ContactInfo: Contact the CDPHE-WQCD at 303 692-3500. Website: hftg7//www.cdghe.state.co.ustwq/ParrnitsUnittwqtdpmt.htmI Municipal
Separate Storm SewerSystem-(MS4)Discharge Permit— Discharges from the storm sewer systems of larger municipalities, andfromtheCDOThighwaydrainagesystemthatlieswithinthosemunicipalities, are subject to MS4 Permits 'issued by the
CDPHE WQCD. For facilities that lie within the boundaries of a municipality that is subject to a MS4 permit, the owner of such facility shouldcontactthemunicipalityregardingstormwaterrelatedclearancesthatmayhavebeenestablishedunderthatmunicipality'sMS4permit. All discharges to the CDOT highway drainage system must comply with the applicable provisions of the Colorado WaterQualityControlActandtheColoradoDischargePermitRegulations, and are subject to inspection by the CDOT and the CDHPE. Contact Information: Contact the CDPHE Water Quality Control Division at (303) 692-3500 for listing of municipalities re wired
to -obtain MS-4 Permits, or goto htt ://www.cd he.state.co.us/w /PermitsUnit/w cd mt.html#Munici alFormsGuidance. Discharge of
Dredged -or -Fill Material 404 Permits Administered By the U.S. Army Corps of Engineers. and Section 401 Water Quality
Certifications Issued by the CDPHE WQCD.- Corps of Engineers 404 Permits are required for the discharge of dredged or
fill materials into waters of the United States, including wetlands. There are various types of 404 Permits, including Nationwide Permits, which are issued for activities with relatively minor impacts. For example, there is a Nationwide Permit for Utility Line Activities (
N.WP #12). However, depending upon the specific circumstances, it is possible that either a "General" or "Individual" 404 permit
would be required. If an Individual 404 Permit is required, Section 401 water quality certfication from the CDPHE WQCD is also
required. Contact Information: Coniact.the appropriate Corps District Regulatory Office for information about what type of 404 ermit May
be -required information provided atlop of ECIS . Contact the CDPHE Water Qua - lity Control Division at 303 692-3500. Erosion and
Sediment Control -Practices - Foractivities requiring a Construction Stormwater Permit, erosion control requirements will bespecifiedthroughthatpermit. In those situations where a stormwater permit is not required, all reasonable measures should be taken inordertominimizeerosionandsedimentation. In either case, the CDOT Stormwater Quality and Erosion Control Guide (2002) should beusedtodesignerosioncontrols. Contact Information: The CDOT Stormwater Quality and Erosion Control Guide may be obtained from
the Bid Plans Office at_ 303 757-9313 or from: h=.-I/www.dot.state.co.us/environrhental/envWaterQual/Mms4.a§g- Disposal of'
Drilling Fluids - Drilling fluids used in operations such as Horizontal Directional Drilling maybe 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, roadsideditchesoranyothertypeofman-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 fromfluidsorafterinfiltrationofthewater, provided: 1) the drilling fluid consists of only water and bentonite clay, or, if required forproperdrillingproperties, small quantities of polymer additives that are approved for use in drinking water well drilling, 2) the solidsarefullycontainedinapit, and are not likely to pose a nuisance to future work in the area; 3) the solids are covered and the area restored
as required by CDOT permit requirements (Utility; Special Use, or Access Permits, etc.). Contact Information: Contact the
CDOT / CDPHE Liaison or CDOT Water Quality Pro ram Manager. Concrete Washout -
Waste generated from concrete activities shall NOT be allowed to flow into the drainage ways, inlets, receiving waters, orintheCDOTROW. Concrete waste shall be placed in a temporary concrete washout facility. Concrete washout shall only be performed
as specified by the CDOT Environmental Program and shall be in accordance to CDOT specifications and guidelines. Contact Information:, Contact the CDOT Water Quali -Pko ram Manager at 303 757-9343. -- - Spill Reporting -
Spills shall be contained and cleaned up as soon as possible. Spills shall NOT be washed down into the storm drain orburied:
All spills shall be reported to the CDOT Illicit Discharge Hotline at (303) 512-4446 (4H2O), as well as the Regional lls on highways, into waterways, or that may otherwise present an Permitting Office andRegionalMaintenanceSupervisor. Spi immediate- danger to
the public shall be repo . by calling 9111 and shall also be re orted to the CDPHE at 1- 877 518-5608. Transportation of Hazardous_
Materials - No person may offer or accept a hazardous material for transportation in commerce unless that person is
registered in conformance with the United States Department of Transportation regulations at 49 CFR, Part 171. The hazardous material mustbepropertyclassed, described, packaged, marked, labeled, and in condition for shipment as required or authorized by applicable
requirements, or an exemption, approval or registration has been issued. Vehicles requiring a placard, must obtain authorization andaStateHAZMATPermitfromtheColoradoPublicUtilitiesCommission. Contact Information: For authorization and more
info call the Federal Motor Safety Carrier Administration., US DOT for inter- and intra-state HAZMAT Re istration 303
969-6748. Colorado Public Utilities Commission: (303)894-2868. About This Form -
Questions or comments about this Information Summary may be directed to Dahir Egal, CDOT Safety& Traffic Engineering, Utilities_ Unit,
at 303 757-9344, dahir.e al dotstate.co.us Environmental Clearances Information
Summary Page 2 of 2 Colorado Department of Transportation Jan '06
State_Hishway Access Permit 1
Attachment to Permit No. 407049 - Additional Terms and Conditions
1 If there are any questions regarding this permit, please contact Gloria Hice-Idler at (970)
350-2148.
2 . The Permittee shall refer to all additional standard requirements included with this permit
and any enclosed additional terms, conditions, exhibits, and noted attachments.
3. Incorporated as part of this permit are the following:
Application for Access Permit (CDOT Form No. 137)
Permit (CDOT Form No. 101) and its two page attachment:
Exhibits:.
A" - Access Plans (8 sheets)
4.
1 This permit is issued in accordance with the State Highway Access Code (2 CCR 601-1),
and is based upon the information submitted by the Permittee. This permit is only for the
use and purpose stated in the Application and Permit. Any changes in traffic volumes or
type, drainage, or other operation aspects may render this permit void, requiring a new
permit to the be applied for based upon existing and anticipated future conditions.
5. Access construction methods and materials shall conform to the Colorado Department of
Transportation Standard Specifications for Road and Bridge Construction (current edition).
6 If necessary, minor changes, corrections and/or additions to this permit may be ordered by
the Department inspector, other Department representative or local authority to meet
unanticipated site conditions. Changes may not be in violation of the State Highway Access
Code. All major changes to the plans must be approved in writing by the Department prior to
commencement of any work on or within the State Highway right-of-way.
All workers within the State Highway right of way shall comply with their employer's safety
and health policies/procedures, and all applicable U.S. Occupational Safety and Health
Administration (OSHA) regulations — including, but not limited to the applicable sections of
29 CFR Part 1910 - Occupational Safety and Health Standards and 29 CFR Part 1926 -
Safety and Health Regulations for Construction.
At a minimum, all workers in the State Highway right of way, except when in their vehicles,
shall wear the following 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 provisions of this permit (at 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.
7 . This permit is subject to revocation due to: 1) Noncompliance with the provisions of this
permit; 2) Abandonment; 3) Supersedure by new permit covering the same installation; or 4)
Conflict with necessary planned highway construction and/or improvements. The Permittee
shall promptly terminate occupancy upon notice of cancellation of the permit from the
Department, unless a new permit is applied for and granted.
State Highway Access Permit 2
Attachment to Permit No. 407049 - Additional Terms and Conditions
8 . This access is limited to RIGHT TURNS ONLY. Left turns are not allowed.
9 . 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,
10 . The Department retains the right to perform any necessary maintenance work in this area.
11 Backing maneuvers within and into the State Highway right-of-way are strictly prohibited. All
vehicles shall enter and exit the highway right-of-way in forward movement. Backing into the
right-of-way shall be considered a violation of the terms and conditions of this access permit
and may result in revocation of the permit by the Department and/or the issuing authority.
12 . 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.
13. 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.
14 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.
15 . Traffic detours or lane closures will not be allowed, unless pre -approved by the Department.
16 . Two-way traffic shall be maintained throughout the work area at all times unless specific
written authorization is obtained from the Department
17 . No construction vehicles shall be parked, or construction materials/equipment stored, on the
State Highway right-of-way overnight.
18 No work shall be performed near a Department electronic traffic control device without.
coordination with Cobie Garbiso at (970) 350-2137.
19. The Department will not participate in any costs related to the design and installation of a
traffic signal, should one be approved at this access in the future.
20. 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, although a proposed landscaping plan shall be included in
the access permitting document. Irrigation of features within the right-of=way may require the
Permittee to install a subsurface drain in accordance with CDOT Standard M-605-1 or other
approved system. The Permittee shall contact Linda McWilliams at the Greeley Traffic Office,
970) 350-2147, to obtain the Landscaping Permit.
State Highway Access .Permit. 3
Attachment to Permit No. 407049 - Additional Terms and Conditions
21 . Routine, periodic maintenance and emergency repairs may be performed within the State
Highway right-of-way, under the general terms and conditions of the permit. Any significant
repairs such as culvert replacement, resurfacing, or changes in design or specifications, will
require written authorization from the Department. The Department shall be given proper .
advance notice whenever maintenance work will affect the movement or safety of traffic on
the State Highway. In an emergency, the Department Region Office and the State Patrol
shall immediately be notified of possible hazards.
22. 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.
23. 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 $1,000,000 combined single limit bodily
injury and property damage, each occurrence and $2,000,000 annual aggregate..
C. Automobile liability in the amount of $1,000,000 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.
24. Survey markers or monuments must be preserved in their original positions. Notify the
Department at (970) 350-2173 immediately upon damage to or discovery of any such
markers or monuments at the work site. Any survey markers or monuments disturbed
during the permitted work shall be repaired and/or replaced immediately at the expense of
the Permittee.
25 . 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.
26 . The Permittee or the contractor shall notify Linda McWilliams at (970) 350-2147 or (970) 301-
1127 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.
State Highway Access Permit 4
Attachment to Permit No. 407049 - Additional Terms and Conditions
27 . The Department inspector may suspend any work due to: 1) Noncompliance with the
provisions of this permit, 2) Adverse weather or traffic conditions; 3) Concurrent highway
construction or maintenance in conflict with permit work; 4) Any condition deemed unsafe for
workers or the general public. The work may be resumed upon notice from the Department
inspector.
28. The access shall be constructed as per Exhibit "A".
29 . 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.
30 . All required access improvements shall be installed prior to the herein authorized use of this
access.
31 The access shall be surfaced immediately upon completion of earthwork construction and
prior to use.
32 . Surfacing of the access shall be completed as per Exhibit "A".
33 . No paved surface shall be cut unless specified in this permit. Asphalt removal shall be saw
cut to assure a straight edge for patching.
34. 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.
35 . The access shall be constructed and maintained in a manner that will not cause water to
enter onto the roadway, and will not interfere with the existing drainage system within the
State Highway right-of-way. Drainage to the State Highway right-of-way shall not exceed
historical rate of flow.
36 . 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.
37 . The Permittee shall request final inspection by Linda McWilliams at (970) 350-2147, within
10 days following completion of access construction, and prior to authorized use. The
Permittee or their representative shall be present.
38 . 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.
39 . The design and construction of access and/or development of this property shall not
negatively impact adjacent nearby properties. Correction of the problem and cost resulting
from damages shall be borne by the Permittee.
State Highway Access Permit 5
Attachment to Permit No. 407049 - Additional Terms and Conditions
40 . It is the responsibility of the Permittee to determine which environmental clearances
and/or regulations apply to the project, and to obtain any clearances that are required
directly for the appropriate agency prior to commencing work. Please refer to or
request a copy of the "CDOT Environmental Clearance Information Summary" (ECIS)
for details. The ECIS may be obtained CDOT Permitting Offices or may be accessed
via the CDOT Planning/Constructio.n-Environmental Guidance webpage at
http://www.dot.state.co.us/environmental/Forms/asp. FAILURE TO COMPLY WITH
REGULATORY REQUIREMENTS MAY RESULT IN SUSPENSION OR REVOCATION
OF YOUR CDOT PERMIT, OR ENFORCEMENT ACTIONS BY OTHER AGENCIES.
ALL discharges are subject to the provisions of the Colorado Water Quality Act and the
Colorado Discharge Permit. Regulations. Prohibited discharges include substance
such as: wash water, paint, automotive fluids, solvents; oils or soaps.
Unless otherwise identified by CDOT or the Colorado Department of Public Health and
Environmental (CDPHE) Water Quality Control Division (WQCD) as significant
sources of pollutants to the waters of the State, the following discharges to storm
water systems are allowed without a Colorado Discharge Permit System Permit:
landscape irrigation, diverted stream flows, uncontaminated ground water infiltration to
separate storm sewers, discharges from potable water sources, foundation drains, air
condition condensation, irrigation water, springs, footing drains, waterline flushing,
flows from riparian habitats and wetlands, and flow from fire fighting activities.
ANY OTHER DISCHARGES, including storm water discharges from industrial facility or
construction sites, may require Colorado Discharge Permit System permits from
CDPHE before work begins. For additional information and forms, go to the CDPHE
website at: http //cdphe.state.co.us/wq/Perm its Unit/wpu.
41 . The Permittee shall provide contractor's certificate(s) of insurance to the Access Inspector,
Linda McWilliams, at (970) 350=2147, prior to beginning work within CDOT right-of-way.
I
c
COLQRADO DEPARTMENT OF TRANSPORTATION Issuing authority application
STATE HIGHWAY ACCESS PERMIT APPLICATION
acceptance date:
5 fo 0
instructions:. Contact the Colorado Department of Transportation (CDOT) or your local government to determine your issuing authority.
Contact the issuing authority to determine what plans and other documents are required to be submitted with your application.
Complete this form (some questions may not apply to you) and attach all necessary documents and Submit it to the issuing authority.
Please print Submit an application for each access affected..
or type If you have any questions contact the issuing authority.
For additional information see CDOT's Access Management website at hip://www.dot.state.co.us/AccessPermits/index:htm
1) Property owner (Permittee) 2) Agent for permittee (if different from property owner)
fa 2z F_o, L L - Savvv-,'
Street address Petwdil sir;
Mailing address
City, state & zip
ri fi G.II ,ems CO 8oS
Phone #
17 q1& Fq 31
City, state & zip Phone # (required)
E-mail address
@ a -max, firs
E-mail address if available
3) Address of property tobe served by permit (required) j1
Is lamro. SOL
1[ \ V e J 4) Legal
description of property: If within jurisdi ional limits of Municipality, city and/ r (] 'u1111nty, which one? A1..y.
county subdivision ( block lot section r township range&/ 1 1
L 'ill 5) What
State Highway are you requestingaccessfrom? 6) What side of the hi hway? N MS ® E
W 7) Now many
feet is the proposed access from the nearest mile post? How many feet is the proposed access -from the nearest cross st-t-reet?/ feet N_ S
E L rr11 W)from:
M
31 3( feet N[IS EIEQW)from: sIR FAR)f &\%E- 8) What is
the approximate date you intend to begin construction? O'00 9
Check here
if you are requ _ ting a: 0 new access
temporary access (duration anticipated: ) improvement to existing access 10 change in
access use Elremoval of access relocation of an existing access (provide detail) 10) Provide existing
property use 11) Do you
have knowledge of any State Highway access permits serving this property, oradjacent properties in which you have a property interest? Ono ® yes,, if
yes - what are the permit number(s) and provide copies: and/or, permit date: 12) Does the
rope owner own or have any interests in any adjacent property? o L] yes,
if yes - please describe: 13) Are there
other existing or dedicated public streets, roads, highways or access easements bordering or within the property? JMno 0 yes,
if yes -list them on your plans and indicate the proposed and existing access points. 14) If you
are requesting agricultural field access - how many acres will the access serve? 15) If you
are requesting commercial or industrial access please indicate the types and number of businesses and provide the floor area square footage of each. business/land use
square footage business square footage J(wt 40-
4 co skop 00 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 N ( 17) Provide
the
following vehicle count estimates for vehicles that will use the access. Leaving the property then returning is two counts. Indicate if your
counts are of passenger cars and light trucks at peak hour volumes 2_ of multi
trucks
at peak hour volumes eak hour volumes
or ®average daily volumes. of single unit
vehid in excess of 30 ft. of fans vehicles (field e;ipm nt) Total Cct pnYof all vellicles. Previous editions are
obsolete and may not be used I Page 1
of
2 CDOT Form #137 12104
18) Check with the issuing authority to determine which of the following documentsare required to complete the review of your application. a)
Property map indicating other access, bordering roads and streets. e) Subdivision, zoning, or development plan. b)
Highway and driveway plan profile. f) Proposed access design. c)
Drainage plan showing impact to the highway right -of --way. g) Parcel and ownership maps including easements. d)
Map and letters detailing utility locations before and after h) Traffic studies. development
in and along theright-cf--way. ) 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://vvww.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 rRinimum, 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/DesignSupporU>, 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 information provided on this form and submitted attachments are to the best of their knowledge true
and c mplete. I
unders d receipt of I i access permit does not constitute permission to start access construction work. Applicant'
s sig at re Print name 1—(
by UJ I -S 5 Date
7-
1 K71z0o :T If the
app ca t is of the o r of the property, we require this application also to be signed by the property owner or their legall
ut _ rized rep entative (or other acceptable written evidence). This signature shall constitute agreement with this
a p , cation by all ners-of-interest unless stated in writing. If a permit is issued, the property owner, in most gases, wil
be listed as th 'ermittee. Property owne "
signature Print name ^ "h Date 1a 1
a t i z ri LC— Z 7 007 Previous editions
are obsolete and may not be used Page 2 of 2 COOT Form #137 12104