W912ES20B0005-0004 Permit 89985.pdf

form 1721 (l>-26-2013) m DEPARTMENT OF Document Man.agcmcnl System 1/

TRANSPORTATION District Pennlt # £)-<.JS -c),Oa..Q- 3 'f/fS APPLICATION FOR MISCELLANEOUS WORK ON c.s. I ~,~ T,H. ~ Id\.

TRUNK HIGHWAY RIGHT OF WAY RP.~ qr: .3 S a_/, 'HtSSECTION 1--oR M11DOT OFPIC& USE ONLY)

ATTACH A SKETCH OF THE PROPOSED WORK AREA AND RELATION TO TRUNK HIGHWAY.

5u'l ~ lat fcR SUBMIT TO DISTRICT PERMIT OFFICE OF' /11 /NNESOTA DEPARTMENT OF TRANSPORTATION.

APPLICANT TELEPHONE ADDRESS (Street, City, State, Zip)

City of Montevideo 320-269-657 5 P.O. Box 517, Montevideo. MN 56265

PARTY PERFORML'\'G WORK TELEPHONE ADDRESS (Street, City, State, Zip)

United States Army Corps of Engineers Contractor

LOCATION OF PROPOSED WORK (C'uy/fown5h,p) (County) (Distance) (N-S-E-W) SPECIFIC ROAD lNTERSECflON OR LANDMARK

212 Montevideo Chippewa 0.36 West US Highway 212 & TH 29 Intersection

HiciJwav m Miles of

WILL THIS FACILITY BE WITHIN TRIBAL LANDS? D Yes • No IF YES, WHICH ONE?

NATURE OF WORK

Phase 38 of Flood Control Project with USACE. Work to include roadwa'z'./lurf grading in highwa'z'. right-of-wat where it c2nnects 10 highwa'z'..

SURFACE TO BE DISTURBED (Check Approprio.te Boxes) 0 Roadway D Shoulder D Concrete 0 Bituminous D Gravel • Turf Only 0 Other (explain) Tho ---1~ • 1.,n r.:--··-· On ,ri ··"' h0

·--•-·-"' ' "" hitumina"" ·•'--- •• --·· 1., ---~,-·- I\ ~ ,uill ho r,:,nf::iceri o~ nn!l"n

DEPTH 01'' EXCAVATION BELOW NUMBER & SIZE OF EXCAVATIONS '.\-lETHOD OF INSTALLATION/CONSTRUCTION

SURFACE

WORK TO START ON OR AFTER DATE WORK TO BE COMPLETED BY IS TRAFFIC DETOUR NECESSARY? 0Ycs • No

1 July 2019 1 December 2020

(IF YES, TRAFFIC CONTROL PLAN IS REQUIRED.)

APPLICANT'S ACCEPTANCE, WAIVER AND INDEMNIFICATION

The undersigned applicant her,by Hgrees to comply with applicable statutes, rules, and the standard conditions and special provisions of this permit. The applicant understands and agrees that no work in connection with this application will be started until the application has been approved and the permit issued, The applicant is aware of circumstances or hazards that may arise while performing the work associated with this application that could result in injury, loss, damage or death, and the applicant assumes the risk of such tircumstances, dangers and hazards, whether reasonably foreseeable or not.

The appliunt also understands that this permit may also be subject to the approval of local road authorities having joint supervision over said street or highway, and may be subject to applicant's compliance with the rules and regulations of the Minnesota Environmental Quality Board and/or any other affected govunmcntal agencies, The undersigned applicant expressly agrees that except for negligent acts of the State, its agents and employees, the applicant or his/her agents or contractor shall 11ssume all liabiUty for, and s11ve the State, its agents and employees, harmless from any and all daims for damn gos, artions or ca usu of action arising out of the work to be done in connection with this ~pplication and permit.

NAME AND TITLE EMAIL ADDRESS

Michael Amborn, City Engineer mam born@rbengr.com

DATE c:z--11-;?026 SIGNATllRE /~~;;?'~

DO NOT IV/UTE BELOW THIS LINE

PERMIT NOT VALID UNLESS DEARING AUTHORIZED M11DOT SIGNATURE AND PERMIT NUMBER

AUTHORJZATION OF PERMIT

It is expressly understood that this permit is conditioned upon restoration of the trunk higliway right-of-way to its original condi1ion or to a satisfactory condition. [n consideration orthc applicant's agreement lo comply in all rtspects with the applicable Jaws and the conditions oflh• Commissioner of Transportation pertaining lo this permit, permission is hereby gr~nted for the work to be performed ss described in the above application, s~id work to be performed in accorda11ce with the following standard conditions and specfal provisions:

SEE ATTACHED STANDARD CONDITIONS AND SPECIAL PROVISIONS

n I

J o ,. I - "J.-o -;)._O K.., A ' v~ 2-~+-~oc:;10 ,~ - DarcAII Work To Be Comnleled By Authorized MnDOT Si~11at111e Date of Authorized Signature

DISTRIBUTION DEPOSIT REQUIREMENTS DEPOSIT TYPE

Original to Arca Mainienance Engineer • No Deposit Required Cashie~s Ch1,ck #

Applicant • D~posil Required in ihe Amount of$ Certified Check#

Subarca Supervisor Date Deposit Received d--J /-;;20 d--0 Money Order Ii

Roadwav Re11.ulations Supervisor Depol·it to he rch1r11etf upm, !utliifaetury completi<m of all K'Ork Bond II t1_~0 >I 7 5 q?, HA.TE WORK COMPUTED (The tf(lfe when the worl. is comp/,:ted 11111st be ro111med tu flit! M11DOT Di.rfrict Pumils 0/fiu)

Page I of2

Vick1Ger Cross-Out

Vick1Ger Typewritten Text 11-1-2023

Vick1Ger Approved

STANDARD CONDITIONS OF MISCELLANEOUS WORK PERMIT

1. The permit holder must comply with all applicable laws and regulations, including Worker's Compensation laws.

2. If work to be done lies within a city or platted town, permission must also be obtained from such city or town.

3. Any permanent signs or permanent traffic barriers (including crash cushions) installed on the State Highway system must be deemed crashworthy under the American Association of State Highway and Transportation Officials (AASHTO) "Manual for Assessing Safety Hardware, 2016 (MASH-16)". Where work on or near the traveled roadway is necessary, proper traffic signs, channelizing devices, warning lights, and barricades shall be erected to protect traffic, employees, and pedestrians. All temporary traffic control devices and methods shall conform to the Minnesota Field Manual on Temporary Traffic Control Zone Layouts, Minnesota Manual on Uniform Traffic Control Devices (MMUTCD), Minnesota Standard Signs and Markings Manual, and the appropriate provisions of Standard Specification 1710. All temporary traffic control devices shall be deemed crashworthy under the American Association of State Highway and Transportation Officials (AASHTO) "Manual for Assessing Safety Hardware, 2016 (MASH-16)" with exceptions as noted under Mn DOT Technical Memorandum No. 19-03-T-01 Crashworthy Requirements for Temporary Traffic Control Devices. (See memo at:

http://dotapp 7 .dot.state .m n. us/edms/ download?docld=2434220)

4. Unless adequately protected by a traffic barrier, there shall be no work within the clear zone, nor shall pipe materials, equipment or other objects be stored within the clear zone. If temporary traffic barrier is used, it will be placed according to the "Mn DOT Temporary Barrier Guidance Manual" (December 2018). (See website at:

www.dot.state.mn.us/trafficeng/workzone/doc/Temporary%20Barrier%20Guidance%20Manual%20181129.pdf) Any temporary traffic barrier (including crash cushions) must be deemed crashworthy under MASH-16.

5. Any person acting as a Flagger for permitted work shall have attended a training session taught by a Mn DOT Qualified Flagger Trainer within the twelve months immediately preceding the start date of all flagging activity. A Flagger shall receive a Flagger Qualification Card, signed by a Mn DOT Qualified Flagger Trainer, upon successful completion of this training. During all flagging activity, a Flagger must carry a signed Flagger Qualification Card on that Flagger's person and be in possession of a current Minnesota Flagging Handbook. The Minnesota Flagging Handbook is available from Mn DOT Qualified Flagger Trainers or from a Mn DOT District Office.

6. Excavations must be cribbed when necessary, depending upon type of soil, in order to prevent cave-ins. All excavations, trenching and/or jacking and boring pits shall be shored or sloped in accordance with OSHA requirements.

7. No guys, stays, or any structures are to be attached to trees on trunk highway right of way.

8. No poles, anchors, anchor braces, or other construction shall be placed on the roadway shoulder or within the prescribed clear zone.

9. Installation of pipe under concrete or bituminous pavements shall be done by jacking or boring or other approved methods.

10. When open trenching or excavating in existing roadways, all subgrade, base, and surfacing materials shall be replaced with the same type, depth, and density of materials which were removed, unless approved by the Area Maintenance Engineer.

11. All work that involves trenching, backfill, or compaction must be done to MnDOT's Standard Specifications for

Construction. Depending on the constru.ction work to be performed, use of one or more of the following specifications may be needed: Excavation and Embankment 2105, Aggregate Base 2211, Aggregate Shouldering 2221, or Structural Excavation and Backfills 2451, Subgrade Preparation 2112.

12. Compaction methods must be approved in advance by the District Permit Office

13. If pavement or roadway is damaged, same shall be restored to a condition as good as or better than the original condition.

14. All pavements shall be replaced in accordance with State specifications.

15. If settlement occurs or excavation caves in so that replaced materials settle (bituminous mat or concrete base), same shall be restored to a condition as good as or better than the original condition.

16. No lugs shall be used on equipment traversing the road which will damage the road surface.

17. No driving onto highway from ditch or driving on shoulders will be permitted where damage will occur.

18. No foreign material such as dirt, gravel, or bituminous material shall be deposited or left on the road during any construction activities.

19. Roadside shall be cleaned to original status upon completion of work.

20. Underground construction must be so constructed as not to harm or unnecessarily destroy the root growth of specimen trees.

21. Cutting and trimming of trees within the right of way and removal of resulting stumps require prior approval of the Area

Maintenance Engineer or his authorized representative.

22 . If Mn DOT shall make any improvements or changes upon, over, under, or along the trunk highway, then and in every case the applicant herein named shall after notice from MnDOT proceed to alter, change, vacate, or remove from trunk highway right of way said works necessary to conform with said changes without cost whatsoever to the State of Minnesota.

23 . After work on a project is completed, the permit holder must notify the Area Maintenance Engineer or his authorized representative that such work has been completed and is ready for final inspection and acceptance by Mn DOT.

Mn DOT Form 1723 Standard Conditions of Miscellaneous Work Permit (11-19-2019)

SPECIAL PROVISIONS

The 2018 edition of the Minnesota Department of Transportation "Standard Specifications for Construction" shall govern. All applicable MnDOT design standards shall apply. MnDOT design standards shall govern if there is a discrepancy between the plan and MnDOT design standards.

The city of Montevideo has no authority to work on the State Right of Way until Cooperative Construction Agreement No. 103 5202 has been approved and signed by the city of Montevideo.

This permit is granted solely for the purpose of allowing the city of Montevideo to construct an earthen flood control structure Phase 3B (USACE Flood Control Project) and tie into an existing storm sewer on State Right of Way at designated areas. The construction, maintenance, supervision and operation of the earthen flood control structure and storm sewer system shall be at no expense or cost to the Minnesota Department of Transportation. This permit shall not allow the construction of any permanent buildings, structures, other obstructions, or any use not specifically listed and shown in the plans. The Permittee will hold harmless and indemnify the State of Minnesota, its Commission of Transportation and employees from claim resulting from temporary or permanent changes in drainage patterns resulting in flood damage. The city will obtain all necessary permits from MnDOT prior to performing maintenance and repair on MnDOT right of way.

By this permit MnDOT has granted permission to the city to occupy space within MnDOT's Highway easement or highway right of way.

All design will be done by the Permittee/Corp of Engineers. Approval from MnDOT will be required for any changes from the approved plan. Approval of the design will not relieve the Permittee of the responsibility for the proper execution of the work or the consequence of any act, neglect, omission, or misconduct in execution or non-execution of the work of the Permittee or its contractor.

Applicant and/or contractor shall replace all sidewalk and/or pedestrian ramps that are disturbed.

Removal and construction shall be performed according to MnDOT Standards, Specifications and Regulations.

Sidewalk Removal

Remove sidewalk as necessary. Sidewalk, unless the removal is made to an existing joint, shall be sawed along the removal lines(s) with a concrete saw to such depth that will assure a clean break (minimum depth shall be 1/3 thickness of slab). The use of wedges driven into the saw cut to break off the portion to be removed will not be permitted. Elsewhere, the structure shall be cut and chipped to true lines and vertical faces. The removed concrete shall be disposed outside of the right-of-way according to Spec. 2104 at no cost to the State.

Construction

1. Concrete Material Requirements: sidewalk shall be constructed according to

Specification 2531. Concrete Mix No. 3F52 (3A32 - old design mix) shall be required for Manual Placement. Blanket Curing Method and/or extreme service membrane method (Specification 2531.30) shall be required for cold temperature curing of the concrete.

2. The applicant will satisfactorily restore all curb and/or sidewalk it disturbs during its operations. Pedestrian curb ramps and sidewalk shall be constructed to the new ADA (American Disability Act) standards based on guidance found in the MnDOT Curb and Ramp Guidelines Document at http://www.dot.state.mn.us/ada/design.html and attached sheets.

1. A maximum cross slope ofless than 2.0%

3. Minimum depth of aggregate base shall be 3 inches and minimum depth of sidewalk shall be 4 inches.

The side slopes of the clay embankment within TH 212 clear zone shall be 6:1 or flatter.

The applicant will use material removed from the trench and/or inspection hole for backfilling, if suitable. The applicant will remove all rocks from the trench and/or inspection hole. No rock shall be replaced in the trench or inspection hole, but shall be removed from the site by the applicant. To secure satisfactory compaction, backfilling will consist of approved material tamped mechanically (maximum 12 inch layers). The applicant must immediately repair the shoulders and roadways disturbed by these operations with suitable and approved material to conform to existing grades. The applicant must restore drainage and slopes. The applicant must restore any settlement.

If the Minnesota Department of Transportation shall make any improvements or change on all or any part of its right of way upon, over, under or along the trunk highway, then and in every case the applicant herein named shall, after notice from the Commissioner of Transportation or his authorized agents, proceed to alter, change, vacate or remove from trunk highway right of way said works necessary to conform with said changes without cost to the State of Minnesota.

If the City desires to abandon flood control structure in the future, the City will remove the material at its sole cost and restore Right of Way to MnDOT's satisfaction at no cost to the State.

This permit is non-exclusive and is granted subject to the right of others, including, but not limited to public utilities which may occupy the right of way or intend to occupy the right of way.

The installation authorized in this permit will be inspected by Jeff Illies, Engineering Specialist, D8 - Willmar, 320-214-631 7 J eff.Illies@state.mn. us. The applicant or its contractor will notify him at least five days prior to starting work on State Right of Way. MnDOT's inspector will approve all highway materials prior to placement, and the total installation must meet with his satisfaction.

You must notify the Permit Office, (320-214-6364) or Jeff.illies@state.mn.us once the work is completed. The security deposit will be held a minimum of one freeze/thaw cycle season. If sidewalk settles it shall be removed and placed by the applicant. If the construction of the sidewalk and restoration of TH 12 roadway is satisfactory the security deposit will be released.

The applicant shall provide in-house inspection at all times while on trunk highway right of way.

Applicant shall provide the permit or copy to his/her contractor to assure that the construction will be made in accordance with MN/DOT Rules and Regulations, Special Provisions, and approved plans.

The contractor performing the work must carry a copy of the issued utility permit while working on state highway right of way.

According to OSHA requirements, the applicant must sheet and shore all excavations, trenching and/or jacking and boring pits. The applicant will not leave any trench unsheeted overnight.

This permit is issued subject to the applicant's compliance with the Minnesota Pollution Control Agency's General National Pollution Discharge Elimination System (NPDES) Permit for Construction Activities and any other affected Governmental Agencies.

The applicant must comply with all local ordinances and required local permits.

The applicant must comply with measures to protect the environment, including but not limited to: protection measures for specimen trees and environmentally sensitive areas; steps required to preserve the scenic quality of the highway; erosion control measures; turf establishment; use and disposal of treated wood/trash/waste and asbestos; and the disposal of waste material outside of the right of way. More information can be found in the Environmental Requirements document at:

hhttp://dotapp7.dot.state.mn.us/cyberdocs_guest/quickstart.asp?show=view:1397164&noframes= yes

The applicant will preserve and protect all MnDOT facilities. IfMnDOT determines that the applicant or its contractor has damaged any MnDOT facilities during its construction activities, the applicant will repair or replace these facilities to the satisfaction of the Assistant District Maintenance Engineer.

The applicant must preserve all existing survey monuments. If MnDOT determines that the applicant has disturbed or destroyed monuments during its construction activities, the applicant will accept full responsibility for all costs incurred in reestablishing the monuments.

Within 30 days of completing the installation, the applicant must furnish to the District Permit Supervisor the Certificate of Completion Form and a set of "AS BUILT" plans.

It is the applicant's responsibility to utilize the "Gopher State One Call" excavation notice system required under Minnesota Statute Chapter 216D, 48 hours before performing any excavation (phone 811 or 651-454-002 Twin Cities Metro Area or Toll Free 1-800-252-1166 or on the web at: www .gopherstateonecall.org/ ).

The applicant shall coordinate the proposed installation with the existing facilities of others in the area. The applicant and/or contractor shall protect all utilities located on the lands covered by this permit at no expense to the Minnesota Department of Transportation. Relocation costs shall be the responsibility of the applicant.

It is the Applicants/Operators responsibility to register its facilities with the GSOC system, per 216D statutes.

The contractor will mark proposed excavation with paint and flags, or in lieu of flags, with stakes. All flags and stakes must display the name and phone number of the contractor. All areas of proposed excavation will be considered "practical" under Minnesota State Statute 216D.05 (2).

The contractor must acquire a Positive Response confirmation from MnDOT for all proposed excavations when the Gopher State One Call indicates MnDOT utilities may be affected. The Contractor may call MnDOT Electrical Services Section (ESS) Dispatch Locating to confirm the status ofMnDOT's Utility infrastructure. The contractor can contact MnDOT Electrical Services Section (ESS) Dispatch Locating at the following phone numbers: 651-366-5750 or 651-366-5751.

The use of the term "abandoned" in this permit document and the submitted sketches shall mean that the facility is "left in place, out of service", and the facility remains the responsibility of the utility owner.

There will be no work within the clear zone and no pipe materials, equipment or other objects stored within the clear zone without the prior approval of the Assistant District Maintenance Engineer. Any work approved with in the clear zone or objects stored within the clear zone must be protected by a traffic barrier. If the pit or excavation is open overnight the applicant must use appropriately applied traffic barrier to protect it. The clear zone is defined in the "Temporary Traffic Control Zone Layouts Field Manual" (January 2018). (See website at:

www.dot.state.mn.us/trafficeng/publ/index.htrnl). If traffic barrier is used, it will be placed according to the "MnDOT Temporary Barrier Guidance Manual" (December 2018). (See website at:

http: //www.dot.state.rnn.us/trafficeng/workzone/doc/Temporary%20Barrier%20Guidance%20M anua1%20181129.pdf). Any traffic barrier placed prior to December 31, 2019 must be deemed crashworthy under the National Cooperative Highway Research Program (NCHRP) Report 350 or the American Association of State Highway and Transportation Officials (AASHTO) "Manual for Assessing Safety Hardware, 2016" (MASH-16). Any traffic barrier placed after December 31, 2019 must be deemed crash worthy under MASH-16.

The applicant will furnish, install, and maintain all required traffic control devices according to Minnesota's "Temporary Traffic Control Zone Layouts Field Manual" (January 2018) (see website at: www.dot.state.rnn.us/trafficeng/publ/index.html), while performing the construction authorized by this permit.

If the temporary traffic control zone is to remain in place for more than 3 days or involves a detour, road closure or a situation where the typical layouts do not apply, the applicant will prepare a specific Traffic Control Plan for MnDOT approval prior to the start of any construction

All persons while performing authorized work on MnDOT Right of Way shall be required to wear a High Visibility Safety Garment that meets or exceeds ANSI/ISEA 107 2004 Standards for a Class 2 garment for daytime hours and a Class 3 garment with pants for night time hours or low light conditions. In addition, all persons shall be required to wear a high visibility soft cap or ANSI X 89 approved hard hat while working on the MnDOT Right of Way.

The applicant shall not perform any work or have any equipment on the roadway system (mainline, shoulder area, ditch bottoms) when weather or road conditions are hazardous due to snow, ice, rain or dust; when visibility is less than 1 ¼ mile; or when winds or wind gusts prevent the safe operation of equipment. It is the applicant's responsibility to monitor local weather reports or MN 511 to determine satisfactory working weather conditions. Minnesota road condition information is available at the web site 222.511 mn.org. Work may be shut down for weather and safety reasons at any time at the discretion of the Assistant District Maintenance Engineer.

Any person acting as a Flagger for permitted work shall have attended a training session taught by a MnDOT Qualified Flagger Trainer within the twelve months immediately preceding the start date of all flagging activity. A Flagger shall receive a Flagger Qualification Card, signed by a MnDOT Qualified Flagger Trainer, upon successful completion of this training. During all flagging activity, a Flagger must carry a signed Flagger Qualification Card on that Flagger's person and be in possession of a current Minnesota Flagging Handbook. The Minnesota Flagging Handbook is available from MnDOT Qualified Flagger Trainers or from a MnDOT District Office. The requirements for flaggers and anybody working on State Right-of-Way are located in the Standard Conditions of Miscellaneous Work Permit and the Minnesota Flagging Handbook

No material shall be deposited on the traveled roadway or shoulder. Two-way traffic shall be maintained at all times.

Materials shall not be placed on highway right of way more than one week in advance of their use. All materials/equipment shall be stored at the back edge of right of way or off right of way.

In no case shall pipe materials, equipment and other objects be stored within the clear zone as determined by the Department.

All plants or trees removed or damaged shall be replaced in kind by the applicant if there has not been prior approval to remove.

Permittee must follow the MnDOT / USFWS tree clearing guidelines found at:

http://dotapp7.dot.state.mn.us/edms/download?docld= 1812444

*If a "tree" has a diameter of 3" or greater at 4.5' aboveground no tree clearing allowed June 1 to August 15, inclusive on MnDOT right-of-way.

*Clearing greater than or equal to one (1) acre, or 20 + individual trees, on MnDOT right-of-way must occur during the winter months (Nov. 1 to March 31, inclusive).

*Clearing less than one (1) acre, or less than 20 individual trees, on MnDOT right-of-way may occur August 16 to May 31, inclusive, if within 100' from the roadway surface. Clearing trees beyond 100' of the roadway surface must occur during the winter months (Nov. 1 to March 31, inclusive).

No driving onto highway from ditch or driving on shoulders where damage will occur. If shoulders and roadways are damaged or disturbed by these operations they shall be repaired immediately by the applicant with suitable and approved material, such repairs shall match existing slopes and grades. The applicant must restore any settlement.

The applicant and/or its contractor shall satisfactorily restore all areas it disturbs to original or better conditions.

All drainage structures removed or damaged shall be restored by the applicant to as good or better condition than before operations began.

Conditions may require temporary measures to control erosion and sedimentation. The applicant will install any temporary erosion measures concurrently with the operation or as soon as practicable. Temporary erosion controls are short lived devices such as straw bale structures, silt curtains, sediment traps or other means to temporarily protect the overall work prior to restoration of the worksite. The Assistant District Maintenance Engineer will decide when these measures are required according to the 2018 MnDOT Standard Specification for Construction 2573.

All areas disturbed by the applicant shall be restored with a minimum of 6" of topsoil ( according to MnDOT Standard Specification 3877 Table 1 Common Topsoil Borrow), then sodded or seeded. Seed or sod should be the same as/or compatible with the existing turf cover. If the areas are to be seeded, a MnDOT seed mixture comparable to the existing turf along with Category 20 (medium-duty 2-sided natural net straw blanket) or Category 25 (medium-duty 2-sided natural net wood fiber blanket) shall be used according to MnDOT Specification 2575.

When frozen conditions prevent the applicant from completing turf restoration the applicant must temporarily stabilize the disturbed area. Use seed mix 22-111 following the winter seeding method and type 1 mulch following the winter mulching method in the 2014 MnDOT Standard Specification for Construction section 2575. The applicant is responsible for competing final turf restoration prior to May 15 of the following spring.

Applicant has a continuing bond with the State of Minnesota, Commissioner of Transportation.