Tamarack Ranch SWA - Recharge Pond and Pipelines Phase II - Bid Package (4 of 5).pdf

Tamarack Ranch SWA Recharge Pond and Pipelines - Phase II

DIVISION III – PERMITS

PROJECT I.D. NO. C16NE6C

RQS: 2017*763

APPR. CODE PC002INFP

MANDATORY PRE-BID CONFERENCE: March 30, 2017 at 11:30 am

BID OPENING: April 13, 2017 at 1:30 pm

TABLE OF CONTENTS

Tamarack Ranch SWA Recharge Pond and Pipelines - Phase II

C16NE6C

• CDOT UTILITY/SPECIAL USE PERMIT

https://www.codot.gov/business/permits/utilitiesspecialuse

• GENERAL PERMIT FOR STORMWATER DISCHARGES ASSOCIATED WITH

CONSTRUCTION ACTIVITIES

https://www.colorado.gov/pacific/cdphe/wq-construction-general-permits https://www.codot.gov/business/permits/utilitiesspecialuse https://www.colorado.gov/pacific/cdphe/wq-construction-general-permits

STORMWATER DISCHARGE ASSOCIATED WITH CONSTRUCTION ACTIVITIES APPLICATION

COLORADO DISCHARGE PERMIT SYSTEM (CDPS)

PHOTO COPIES, FAXED COPIES, PDF COPIES OR EMAILS WILL NOT BE ACCEPTED.

For Applications submitted on paper - Please print or type. Original signatures are required.

All items must be completed accurately and in their entirety for the application to be deemed complete. Incomplete applications will not be processed until all information is received which will ultimately delay the issuance of a permit. If more space is required to answer any question, please attach additional sheets to the application form. Applications or signature pages for the application may be submitted by mail or hand delivered to:

Colorado Department of Public Health and Environment, 4300 Cherry Creek Drive South, WQCD-P-B2, Denver, CO 80246-1530

For Applications submitted electronically Please note that you can ONLY complete the feedback form by downloading it to a PC or Mac/Apple computer and opening the Application with Adobe Reader or a similar PDF reader. The form will NOT work with web browsers, Google preview, Mac preview software or on mobile devices using iOS or Android operating systems.

If application is submitted electronically, processing of the application will begin at that time and not be delayed for receipt of the signed document.

Any additional information that you would like the Division to consider in developing the permit should be provided with the application. Examples include effluent data and/or modeling and planned pollutant removal strategies.

Beginning July 1, 2016, invoices will be based on acres disturbed.

DO NOT PAY THE FEES NOW – Invoices will be sent after the receipt of the application.

Disturbed Acreage for this application (see page 4)

Less than 1 acre ($83 initial fee, $165 annual fee) 1-30 acres ($175 initial fee, $350 annual fee) Greater than 30 acres ($270 initial fee, $540 annual fee)

Responsible Person (Title):

PERMIT INFORMATION

Reason for Application: NEW CERT RENEW CERT EXISTING CERT#

Applicant is: Property Owner Contractor/Operator

A. CONTACT INFORMATION - *indicates required

* PERMITTED ORGANIZATION FORMAL NAME:

1) * PERMIT OPERATOR - the party that has operational control over day to day activities - may be the same as owner.

Currently Held By (Person): FirstName: LastName:

Telephone: Email Address:

Organization:

Mailing Address:

City: State: Zip Code:

Per Regulation 61 : All reports required by permits, and other information requested by the Division shall be signed by the permittee or by a duly authorized representative of that person. A person is a duly authorized representative only if:

(i) The authorization is made in writing by the permittee

(ii) The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity such as the position of plant manager, operator of a well or a well field, superintendent, position of equivalent responsibility, or an individual or position having overall responsibility for environmental matters for the company. (A duly authorized representative may thus be either a named individual or any individual occupying a named position); and

(iii) The written authorization is submitted to the Division

SW Construction Application for: page 1 of 5

ASSIGNED PERMIT NUMBER

Date Received _____/_____/_____

MM DD YYYY

Revised: 3-2016

Responsible Person (Title):

2) OWNER - party has ownership or long term lease of property - may be the same as the operator.

City: State: Zip Code:

Same as 1) Permit Operator

Per Regulation 61 : All reports required by permits, and other information requested by the Division shall be signed by the permittee or by a duly authorized representative of that person. A person is a duly authorized representative only if:

i. The authorization is made in writing by the permittee.

ii. The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity such as the position of plant manager, operator of a well or a well field, superintendent, position of equivalent responsibility, or an individual or position having overall responsibility for environmental matters for the company. (A duly authorized representative may thus be either a named individual or any individual occupying a named position); and

iii. The written authorization is submitted to the Division.

Responsible Person (Title):

City: State: Zip Code:

Same as 1) Permit Operator

4) *BILLING CONTACT if different than the permittee.

3) *SITE CONTACT local contact for questions relating to the facility & discharge authorized by this permit for the facility

Responsible Person (Title):

City: State: Zip Code:

Same as 1) Permit Operator

SW Construction Application for: page 2 of 5

Responsible Person (Title):

5) OTHER CONTACT TYPES (check below) Add pages if necessary:

City: State: Zip Code:

Environmental Contact

Inspection Facility Contact

Consultant

Compliance Contact

Stormwater MS4 Responsible Person

Stormwater Authorized Representative

B) PERMITTED PROJECT/FACILITY INFORMATION

Latitude

Project/Facility Name

Street Address or Cross Streets (e.g., Park St and 5 Ave; CR 21 and Hwy 10; 44 Ave and Clear Creek) ; A street name without an address, intersection, mile marker, or other identifying information describing the location of the project is not adequate. For linear projects, the route of the project should be described as best as possible using the starting point for the address and latitude and longitude – more clearly defined in the required map )

Facility Latitude/Longitude - List the latitude and longitude of the excavation(s) resulting in the discharge(s). If the exact soil disturbing location(s) are not known, list the latitude and longitude of the center point of the construction project. If using the center point, be sure to specify that it is the center point of construction activity. The preferred method is GPS and Decimal Degrees.

Longitude .

Decimal Degrees (to 5 decimal places)

Decimal Degrees (to 5 decimal places)

(e.g., 39.70312°, 104.93348°)

This information may be obtained from a variety of sources, including:

Surveyors or engineers for the project should have, or be able to calculate, this information.

U.S. Geological Survey topographical map(s), available at area map stores.

Using a Global Positioning System (GPS) unit to obtain a direct reading.

Google - enter address in search engine, select the map, right click on location, and select “what’s here”.

Note: the latitude/longitude required above is not the directional degrees, minutes, and seconds provided on a site legal description to define property boundaries.

C) MAP (Attachment) If no map is submitted, the application cannot be submitted.

Map: Attach a map that indicates the site location and that CLEARLY shows the boundaries of the area that will be disturbed. A vicinity map is not adequate for this purpose.

Legal description: If subdivided, provide the legal description below, or indicate that it is not applicable (do not supply Township/Range/Section or metes and bounds description of site)

Subdivision(s): Lot(s): Block(s)

OR Not applicable (site has not been subdivided)

SW Construction Application for: page 3 of 5

City: County: Zip Code:

D) LEGAL DESCRIPTION - only for Subdivisions

Total area of project disturbance site (acres):

E) AREA OF CONSTRUCTION SITE - SEE PAGE 1 - WILL DETERMINE FEE

Note: aside from clearing, grading and excavation activities, disturbed areas also include areas receiving overburden (e.g., stockpiles), demolition areas, and areas with heavy equipment/vehicle traffic and storage that disturb existing vegetative cover.

Part of Larger Common Plan of Development or Sale, (i.e., total, including all phases, filings, lots, and infrastructure not covered by this application)

Provide both the total area of the construction site, and the area that will undergo disturbance, in acres.

Commercial Development

Non-structural and other development (i.e. parks, trails, stream realignment, bank stabilization, demolition, etc.)

F) NATURE OF CONSTRUCTION ACTIVITY

Check the appropriate box(es) or provide a brief description that indicates the general nature of the construction activities. (The full description of activities must be included in the Stormwater Management Plan.)

Residential Development

Highway and Transportation Development

Pipeline and Utilities (including natural gas, electricity, water, and communications)

Oil and Gas Exploration and Well Pad Development

SW Construction Application for: page 4 of 5

G) ANTICIPATED CONSTRUCTION SCHEDULE

Final Stabilization Date: Construction Start Date:

Construction Start Date - This is the day you expect to begin ground disturbing activities, including grubbing, stockpiling, excavating, demolition, and grading activities.

Final Stabilization Date - in terms of permit coverage, this is when the site is finally stabilized. This means that all ground surface disturbing activities at the site have been completed, and all disturbed areas have been either built on, paved, or a uniform vegetative cover has been established with an individual plant density of at least 70 percent of pre-disturbance levels. Permit coverage must be maintained until the site is finally stabilized. Even if you are only doing one part of the project, the estimated final stabilization date must be for the overall project.

If permit coverage is still required once your part is completed, the permit certification may be transferred or reassigned to a new responsible entity(s).

H) RECEIVING WATERS (If discharge is to a ditch or storm sewer, include the name of the ultimate receiving waters)

Immediate Receiving Water(s):

Ultimate Receiving Water(s):

Identify the receiving water of the stormwater from your site. Receiving waters are any waters of the State of Colorado. This includes all water courses, even if they are usually dry. If stormwater from the construction site enters a ditch or storm sewer system, identify that system and indicate the ultimate receiving water for the ditch or storm sewer. Note: a stormwater discharge permit does not allow a discharge into a ditch or storm sewer system without the approval of the owner/ operator of that system.

I) SIGNATURE PAGE

STORMWATER MANAGEMENT PLAN CERTIFICATION

Ink Signature For Docusign Electronic Signature

1. You may print and sign this document and mail the hard copy to the State along with required documents (address on page one).

2. Electronic Submission Signature You may choose to submit your application electronically, along with required attachments. To do so, click the SUBMIT button below which will direct you, via e-mail , to sign the document electronically using the DocuSign Electronic Signature process. Once complete, you will receive via e-mail, an electronically stamped Adobe pdf of this application. Print the signature page from the electronically stamped pdf, sign it and mail it to the WQCD Permits Section to complete the application process (address is on page one of the application).

The Division encourages use of the electronic submission of the application and electronic signature. This method meets signature requirements as required by the State of Colorado.

The ink signed copy of the electronically stamped pdf signature page is also required to meet Federal EPA Requirements.

Processing of the application will begin with the receipt of the valid electronic signature.

By checking this box “I certify under penalty of law that a complete Stormwater Management Plan, as described in Appendix B of this application, has been pre-pared for my activity. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the Stormwater Management Plan is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for falsely certifying the completion of said SWMP, including the possibility of fine and imprisonment for knowing violations.”

Date:

Signature of Legally Responsible Person or Authorized Agent (submission must include original signature)

Name (printed) Title

"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is to the best of my knowledge and belief, true, accurate and complete.

I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations."

“I understand that submittal of this application is for coverage under the State of Colorado General Permit for Stormwater Discharges Associated with Construction Activity for the entirety of the construction site/project described and applied for, until such time as the application is amended or the certification is transferred, inactivated, or expired.” [Reg 61.4(1)(h)]

DO NOT INCLUDE A COPY OF THE STORMWATER MANAGEMENT PLAN

DO NOT INCLUDE PAYMENT—AN INVOICE WILL BE SENT AFTER THE CERTIFICATION IS ISSUED.

Signature: The applicant must be either the owner and operator of the construction site. Refer to Part B of the instructions for additional information.

The application must be signed by the applicant to be considered complete. In all cases, it shall be signed as follows:

(Regulation 61.4 (1ei)

a) In the case of corporations, by the responsible corporate officer is responsible for the overall operation of the facility from which the discharge described in the form originates

b) In the case of a partnership, by a general partner.

c) In the case of a sole proprietorship, by the proprietor.

d) In the case of a municipal, state, or other public facility, by either a principal executive officer, ranking elected official, (a principal executive officer has responsibility for the overall operation of the facility from which the discharge originates).

SW Construction Application for: page 5 of 5

3rd Party Preparer: If this form was prepared by an authorized agent on behalf of the Permittee, please complete the field below.

Preparer Name (printed) Email Address

(Page Intentionally Left Blank)