HomeMy WebLinkAboutUSBORPermitAttachmentsSTANDARD FORM 299 (05/2009)
Prescribed by DOI/USDAIDOT APPLICATION FOR TRANSPORTATION AND
P.L. 96-487 and Federal UTILITY SYSTEMS AND FACILITIES
Register Notice 5-22-95 ON FEDERAL LANDS
NOTE: Before completing and filing the application, the applicant should completely review this package and schedule a
preapplication meeting with representatives of the agency responsible for processing the application. Each agency may have
specific and unique requirements to be met in preparing and processing the application. Many times, with the help of the agency
representative, the application can be completed at the preapplication meeting.
1. Name
(include zip code)
Kittitas County Public Works
411 North Ruby, Suite 1
Ellensburg, WA 98926
4. As applicant are you? (check one)
a. ❑
Individual
b. ❑
Corporation"
c. ❑
Partnership/Association`
d. ❑
State Government/State Agency
e. ❑x
Local Government
f. ❑
Federal Agency
5. Specify
2. Name, title, and address of authorized agent if
different from item 1 (include zip code)
Mark R. Cook, Director
411 North Ruby, Suite 1
Ellensburg, WA 98926
one)
FORM APPROVED
OMB Control Number: 0596-0082
Expiration Date: 12/31/2013
FOR AGENCY USE ONLY
Application Number
Date Filed
3. Telephone (area code)
509-962-7523
Applicant
Kittitas County Public Works
Authorized Agent
Mark R. Cook
a. ❑x
New authorization
b. ❑
Renewing existing authorization No.
C. ❑
Amend existing authorization No.
d. ❑
Assign existing authorization No.
e. ❑
Existing use for which no authorization has been received "
f. ❑
Other"
" If checked, provide details under item 7
6. If an individual, or partnership are you a citizen(s) of the United States? ❑x Yes ❑ No
7. Project description (describe in detail): (a) Type of system or facility, (e.g., canal, pipeline, road); (b) related structures and facilities; (c) physical
specifications (Length, width, grading, etc.); (d) term of years needed: (e) time of year of use or operation; (f) Volume or amount of product to be
transported; (g) duration and timing of construction; and (h) temporary work areas needed for construction (Attach additional sheets, if additional
space is needed.)
The proposed public bridge provides fire/life/safety access to approximately 100 single family residences in the next
several years (phase one will serve approximately 60 single family homes within the next two years). The bridge
provides the start of a transportation corridor serving Nelson Siding Road to Fowler Creek Road using a mixture of
federal and local roadways.
The bridge is expected to be steel construction, approximately 28 feet wide with an anticipated clear span of 70 feet.
The current single lane wooden structure is removed in the proposal. The current structure does not provide a crash
tested guardrail while the new structure will have the appropriate rail. The current bridge has three pile bents of five
pile each (total of 15 piles in the canal). The proposed bridge eliminates any piles within the canal.
Construction is scheduled for October of 2017. Three months of construction is anticipated supporting completion of
the bridge erection. Temporary staging an work areas are located outside of the canal right of way (ownership).
B. Attach a map covering area and show location of project proposal
9. State or Local government approval: ❑ Attached ❑x Applied for ❑ Not Required
10. Nonreturnable application fee: ❑x Attached ❑ Not required
11. Does project cross international boundary or affect international waterways? ❑ Yes ❑x No (if "Yes," indicate on map)
12. Give statement of your technical and financial capability to construct, operate, maintain, and terminate system for which authorization is being
requested.
Kittitas County maintains approximately 140 bridges of twenty (20) feet or longer. These bridges are inspected every
two (2) years as mandated by the federal government. In addition, the County inspects approximately 160 bridges
under 20 feet in length and voluntarily inspects them within the same reporting system as maintained by the
Washington State Department of Transportation. Many of the under 20 foot bridges cross numerous irrigation canals
owned by the Bureau of Reclamation. The proposed new bridge will be entered into the mandatory inspection program
and inspected consistent with federal bridge inspection requirements. The bridge is being funded by a local land
developer consistent with Public Bridge requirements stipulated in County Code Chapter 12.
STANDARD FORM 299 (REV. 5/2009)
13a. Describe other reasonable alternative routes and modes considered.
The current single lane wooden bridge is not capable of supporting additional traffic. Using existing federal access
roads to service new development is problematic as the roads do not meet current fire/life/safety requirements. Only
motorized vehicles are capable of providing the required fire/life/safety support.
b. Why were these alternatives not selected?
While the cost of improving the alternate routes is prohibitive, the added time in Fre/life/safety response is untenable.
c. Give explanation as 10 why it is necessary to cross Federal Lands.
The physical location of the canal bisects the private property associated with the proposal.
14. List authorizations and pending applications filed for similar projects which may provide information to the authorizing agency. (Specify number,
date, code, orname)
The developer has secured preliminary Planned Unit Development approval supporting 58 single family residences on
the far side of the canal. Public Works will apply for all necessary environmental permits prior to construction.
15. Provide statement of need for project, including the economic feasibility and items such as: (a) cost of proposal (construction, operation, and
maintenance); (b) estimated cost of next best alternative; and (c) expected public benefits.
See attached supplemental sheet.
16. Describe probable effects on the population in the area, including the social and economic aspects, and the rural lifestyles.
See attached supplemental sheet.
17. Describe likely environmental effects that the proposed project will have on: (a) air quality; (b) visual impact; (c) surface and ground water quality
and quantity; (d) the control or structural change on any stream or other body of water; (e) existing noise levels; and (f) the surface of the land,
including vegetation, permafrost, soil, and soil stability.
The proposal eliminates flow restrictions associated with the existing three pile bents of the existing bridge.
Construction will occur during inactive flow in the canal - eliminating water quality concerns.
18. Describe the probable effects that the proposed project will have on (a) populations of fish, plantlife, wildlife, and marine life, including threatened
and endangered species; and (b) marine mammals, including hunting, capturing, collecting, or killing these animals.
Constructing during canal shut down eliminates adverse impacts of fish and aquatic species. Some associated
plantlife may be impacted during construction. Re-establishment of ground cover will be completed at the close of
construction or during the immediate growing period following construction.
19. State whether any hazardous material, as defined in this paragraph, will be used, produced, transported or stored on or within the right-of-way or
any of the right-of-way facilities, or used in the construction, operation, maintenance or termination of the right-of-way or any of its facilities.
"Hazardous material" means any substance, pollutant or contaminant that is listed as hazardous under the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980, as amended, 42 U.S.C. 9601 at seq., and its regulations. The definition of hazardous
substances under CERCLA includes any "hazardous waste" as defined in the Resource Conservation and Recovery Act of 1976 (RCRA), as
amended, 42 U.S.C. 6901 et seq., and its regulations. The term hazardous materials also includes any nuclear or byproduct material as defined
by the Atomic Energy Act of 1954, as amended, 42 U.S.C. 2011 et seq. The term does not include petroleum, including crude oil or any fraction
thereof that is not otherwise specifically listed or designated as a hazardous substance under CERCIA Section 101(14), 42 U.S.C. 9601(14), nor
does the term include natural gas.
Construction equipment is expected to contain oils and carbon fuels (diesel). A spill prevention and response plan will
minimize adverse impacts associated with minimal leakage from construction equipment.
20. Name all the Department(s)/Agency(ies) where this application is being filed.
Bureau of Reclamation. Unknown at this point if United States Army Corps of Engineers will be involved with the
project or if State Department of Fish and Wildlife will be involved in environmental permitting.
I HEREBY CERTIFY, That I am of legal age and authorized to do business in the State and that I have personally examined the information contained
in the application and believe that the information submitted is correct to the best of my knowledge.
of Applicant
Date
I itle 18, U.S.C. Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any
false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.
STANDARD FORM 299 (REV. 5/2009) PAGE 2
GENERAL INFORMATION
ALASKA NATIONAL INTEREST LANDS
This application will be used when applying for a right-of-way, permit,
license, lease, or certificate for the use of Federal lands which lie within
conservation system units and National Recreation or Conservation Areas
as defined in the Alaska National Interest lands Conservation Act.
Conservation system units include the National Park System, National
Wildlife Refuge System, National Wild and Scenic Rivers System,
National Trails System, National Wilderness Preservation System, and
National Forest Monuments.
Transportation and utility systems and facility uses for which the
application may be used are:
1. Canals, ditches, flumes, laterals, pipes, pipelines, tunnels, and other
systems for the transportation of water.
2. Pipelines and other systems for the transportation of liquids other than
water, including oil, natural gas, synthetic liquid and gaseous fuels, and
any refined product produced therefrom.
3. Pipelines, slurry and emulsion systems, and conveyor belts for
transportation of solid materials.
4. Systems for the transmission and distribution of electric energy.
5. Systems for transmission or reception of radio, television, telephone,
telegraph, and other electronic signals, and other means of
communications.
6. Improved right-of-way for snow machines, air cushion vehicles, and all -
terrain vehicles.
7. Roads, highways, railroads, tunnels, tramways, airports, landing strips
docks, and other systems of general transportation.
This application must be fled simultaneously with each Federal
department or agency requiring authorization to establish and operate
your proposal.
In Alaska, the following agencies will help the applicant file an application
and identify the other agencies the applicant should contact and possibly
file with:
Department of Agriculture
Regional Forester, Forest Service (USFS)
Federal Office Building,
P.O. Box 21628
Juneau, Alaska 99802-1628
Telephone: (907) 586-7847 (or a local Forest Service Office)
Department of the Interior
Bureau of Indian Affairs (BIA)
Juneau Area Office
Federal Building Annex
9109 Mendenhall Mall Road, Suite 5
Juneau, Alaska 99802
Telephone: (907) 586-7177
Department of the Interior
Bureau of Land Management
222 West 7th Avenue
P.O. Box 13
Anchorage, Alaska 99513-7599
Telephone: (907) 271-5477 (or a local BLM Office)
U.S. Fish & Wildlife Service (FWS)
Office of the Regional Director
1011 East Tudor Road
Anchorage, Alaska 99503
Telephone: (907) 786-3440
National Park Service (NPA)
Alaska Regional Office, 2225
Gambell St., Rm. 107
Anchorage, Alaska 99502-2892
Telephone: (907) 786-3440
Note - Filings with any Interior agency may be filed with any office noted
above or with the Office of the Secretary of the Interior, Regional
Environmental Office, P.O. Box 120, 1675 C Street, Anchorage, Alaska
9513.
Department of Transportation
Federal Aviation Administration
Alaska Region AAL -4, 222 West 7th Ave., Box 14
Anchorage, Alaska 99513-7587
Telephone: (907) 271-5285
NOTE - The Department of Transportation has established the above
central filing point for agencies within that Department. Affected agencies
are: Federal Aviation Administration (FAA), Coast Guard (USCG), Federal
Highway Administration (FHWA), Federal Railroad Administration (FRA).
OTHER THAN ALASKA NATIONAL INTEREST LANDS
Use of this form is not limited to National Interest Conservation Lands of
Alaska.
Individual departmentlagencies may authorize the use of this form by
applicants for transportation and utility systems and facilities on other
Federal lands outside those areas described above.
For proposals located outside of Alaska, applications will be filed at the
local agency office or at a location specified by the responsible Federal
agency.
SPECIFIC INSTRUCTIONS
(Items not listed are self-explanatory)
7 Attach preliminary site and facility construction plans. The responsible
agency will provide instructions whenever specific plans are required.
8 Generally, the map must show the section(s), township(s), and
range(s) within which the project is to be located. Show the proposed
location of the project on the map as accurately as possible. Some
agencies require detailed survey maps. The responsible agency will
provide additional instructions.
9 , 10, and 12 The responsible agency will provide additional instructions.
13 Providing information on alternate routes and modes in as much detail
as possible, discussing why certain routes or modes were rejected
and why it is necessary to cross Federal lands will assist the
agency(les) in processing your application and reaching a final
decision. Include only reasonable alternate routes and modes as
related to current technology and economics.
14 The responsible agency will provide instructions.
15 Generally, a simple statement of the purpose of the proposal will be
sufficient. However, major proposals located in critical or sensitive
areas may require a full analysis with additional specific information.
The responsible agency will provide additional instructions.
16 through 19 Providing this information is as much detail as possible will
assist the Federal agency(ies) in processing the application and
reaching a decision. When completing these items, you should use a
sound judgment in furnishing relevant information. For example, if the
project is not near a stream or other body of water, do not address this
subject. The responsible agency will provide additional instructions.
Application must be signed by the applicant or applicant's authorized
representative.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the
information is voluntary. If all the information is not provided, the
application may be rejected.
DATA COLLECTION STATEMENT
The Federal agencies collect this information from applicants requesting
right-of-way, permit, license, lease, or certification for the use of Federal
lands. The Federal agencies use this information to evaluate the
applicant's proposal. The public is obligated to submit this form if they wish
to obtain permission to use Federal lands.
STANDARD FORM 299 (REV. 512009) PAGE 3
SUPPLEMENTAL
NOTE: The responsible agency(ies) will provide instructions
CHECK APPROPRIATE
BLOCK
I- PRIVATE CORPORATIONS
ATTACHED
FILED*
a. Articles of Incorporation
❑
❑
b. Corporation Bylaws
❑
❑
c. A certification from the State showing the corporation is in good standing and is entitled to operate within the State
❑
❑
d Copy of resolution authorizing fling
❑
❑
e. The name and address of each shareholder owning 3 percent or more of the shares, together with the number and
percentage of any class of voting shares of the entity which such shareholder is authorized to vote and the name and
address of each affiliate of the entity together with, in the case of an affiliate controlled by the entity, the number of
shares and the percentage of any class of voting stock of that affiliate owned, directly or indirectly, by that entity, and
in the case of an affiliate which controls that entity, the number of shares and the percentage of any class of voting
stock of that entity owned, directly or indirectly, by the affiliate.
❑
❑
f. If application is for an oil or gas pipeline, describe any related right- of -way or temporary use permit applications,
and identify previous applications.
❑
❑
g. If application is for an oil and gas pipeline, identify all Federal lands by agency impacted by proposal.
❑
❑
II - PUBLIC CORPORATIONS
a. Copy of law forming corporation
❑
❑
b. Proof of organization
❑
❑
c. Copy of Bylaws
❑
❑
d. Copy of resolution authorizing filing
❑
❑
e. If application is for an oil or gas pipeline, provide information required by item "I - f' and "I - g" above.
❑
❑
III - PARTNERSHIP OR OTHER UNINCORPORATED ENTITY
a. Articles of association, if any
❑
❑
b. If one partner is authorized to sign, resolution authorizing action is
❑
❑
c. Name and address of each participant, partner, association, or other
❑
❑
d. If application is for an oil or gas pipeline, provide information required by item "I - f' and "I - g" above.
❑
❑
if the required Information is already filed with the agency processing this application and is current, check block entitled "Filed." Provide the file
identification information (e.g., number, date, code, name). If not on file or current, attach the requested information.
STANDARD FORM 299 (REV. 512009) PAGE 4
NOTICES
Note: This applies to the Department of Agriculture/Forest Service (FS)
This information is needed by the Forest Service to evaluate the requests to use National Forest
System lands and manage those lands to protect natural resources, administer the use, and ensure
public health and safety. This information is required to obtain or retain a benefit. The authority for
that requirement is provided by the Organic Act of 1897 and the Federal Land Policy and
Management Act of 1976, which authorize the secretary of Agriculture to promulgate rules and
regulations for authorizing and managing National Forest System lands. These statutes, along with
the Term Permit Act, National Forest Ski Area Permit Act, Granger-Thye Act, Mineral Leasing Act,
Alaska Term Permit Act, Act of September 3, 1954, Wilderness Act, National Forest Roads and Trails
Act, Act of November 16, 1973, Archeological Resources Protection Act, and Alaska National Interest
Lands Conservation Act, authorize the Secretary of Agriculture to issue authorizations or the use and
occupancy of National Forest System lands. The Secretary of Agriculture's regulations at 36 CFR
Part 251, Subpart B, establish procedures for issuing those authorizations.
BURDEN AND NONDISCRIMINATION STATEMENTS
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0596-0082. The time required
to complete this information collection is estimated to average 8 hours hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities
on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status,
familial status, parental status, religion, sexual orientation, genetic information, political beliefs,
reprisal, or because all or part of an individual's income is derived from any public assistance. (Not all
prohibited bases apply to all programs.) Persons with disabilities who require alternative means for
communication of program information (Braille, large print, audiotape, etc.) should contact USDA's
TARGET Center at 202-720- 2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence
Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can
contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642
(relay voice). USDA is an equal opportunity provider and employer.
The Privacy Act of 1974 (5 U.S.C. 552a) and the Freedom of Information Act (5 U.S.C. 552) govern
the confidentiality to be provided for information received by the Forest Service.
STANDARD FORM 299 (REV. 5/2009) PAGE 5
The Response to Question 15
The project will replace an existing old single lane wooden bridge that is without a safe
engineered weight load. The current bridge is supported by 15 piles located in the center
of the KRD canal which causes possibilities of blocking the canal. The new bridge will
serve about 100 existing and approved parcels and create a loop from Nelson Siding
Road to the Westside Side Road thereby access safe access for these parcels for life
safety issues.
(a) The placement and construction cost of the Bridge is estimated to be
approximately $200,000 ongoing operation and maintenance costs are estimated
to be $2,500.00 per year.
(b) Because of the physical location of the existing bridge, the existing roads, right of
ways, established easements and the location of the parcels accessed by these
established ways there is no other alternative available that can serve these parcels
and provide for fire/life/safety requirements.
(c) The expected public benefits for the construction of this bridge is that it will
upgrade the current bridge to a point where it can provide safe access for the land
that it serves and provide for access for fire/life/safety issues.
The Response to Question 16
Currently there exists limited access to the parcels that this new Replacement Bridge will
serve. The Replacement Bridge will allow residents and recreation users of the property
served by the bridge to freely and safely access their property and recreation area and in
case of fire or other emergency allow heavy emergency equipment a rout to this area
while simultaneously allowing residents and recreation users of the property safe access
out of the area. Kittitas County has zoned this area Rural Recreation with the uses and
parcels of land serviced by this bridge being approved by Kittitas County as meeting the
rural requirements of the Growth Management Act of the state of Washington.
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