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HomeMy WebLinkAboutC25-164 Application for Shooting Range ROW Renew with US Department of InteriorAPPLICATION FOR TRANSPORTATION, UTILITY SYSTEMS, TELECOMMUNICATIONS AND FACILITIES ON FEDERAL LANDS AND PROPERTY OMB Control Number: 0596-0249 Expiration Date: 1/31/2027 FORM APPROVED FOR AGENCY USE ONLY NOTE: Before completing and filing the application for an authorization (easement, right-of-way, lease, license or permit), the applicant should completely review this package, including instructions, and schedule a pre-application 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 pre-application meeting. Application Number Date Filed 2. Name and address of authorized agent if different from item 1 3. Applicant telephone number and email: Authorized agent telephone number and email: 4. As applicant are you? (check one) Individual a. Corporation* b. Partnership/Association* c. State Government/State Agency d. Local Government e. Federal Agency f. * If checked, complete supplemental page 5. Specify what application is for: (check one) New authorizationa. Renewing existing authorization numberb. Amend existing authorization numberc. d. Assign existing authorization number 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?Yes No 7. Project description (describe in detail): (a) Type of use or occupancy, (e.g., canal, pipeline, road, telecommunications); (b) related structures and facilities; (c) physical specifications (Length, width, grading, etc.); (d) term of days/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 activity/construction (Attach additional sheets, if additional space is needed.) 8. Attach a map covering area and show location of project proposal. 9. State or Local government approval:Attached Applied for Not Required 10. Nonrefundable application fee:Attached To be determined by agency Not required 11. Does project cross international boundary or affect international waterways?Yes 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. STANDARD FORM 299 (REV. 10/2023) 1.Name and address of applicant Eagle County Government c/o Eagle County Sheriff's Office PO Box 850 500 Broadway Eagle, CO 81631 970-328-8685 (a)7KHVXEMHFWUight-of-way (ROW),COC 58147/COCO106176800, is used as an access road WRa FHUWDLQ parcel of realproperty WKDWis owned by Eagle CountyDQGused as a shooting range by the Eagle County Sheriff's Office. (b)Two culverts are within the ROW/access road. (c)ROW is 30 feet wide, 1131 feet long, and contains 0.75 acres more or less. The access road thereon is gravel and is gradedby the Eagle County Road and Bridge Department ("R&B") approximately once every 5 years. (d)30 years, or as long as possible (e)ROW/access road is used year-round (f)N/A (g)N/A (h)R&B maintains the access road by occasionally plowing snow and by grading approximately once every 5 years. Such work occurs within the ROW. ✔ The road has already been constructed in approved right-of-way COC 58147/COCO106176800 and has been in use by the Sheriff's Office for approximately 30 years. The Eagle County Road and Bridge Department will perform any necessary or appropriate maintenance, which costs will be borne by Eagle County in accordance with the County's budgeting procedures and Colorado law. ✔ Docusign Envelope ID: 47067FB6-5A39-46CA-8252-2D78DC2E90C7 13a. Describe other alternative locations considered. 14. List authorizations and pending applications filed for similar projects which may provide information to the authorizing agency. (Specify number, date, code, or name) 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. 16. Describe probable effects on the population in the area, including the social and economic aspects, and the rural lifestyles. 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; and, (g) historic or archaeological resources or properties. 18. Describe the probable effects that the proposed project will have on (a) populations of fish, plant life, wildlife, and marine life, including threatened and endangered species; and (b) marine mammals, including hunting, capturing, collecting, or killing these animals. 19. State whether any hazardous material, as defined in this paragraph, would be used, produced, transported or stored on or in a federal building or federal lands or would be used in connection with the proposed use or occupancy. “Hazardous material” shall mean (a) any hazardous substance under section 101(14) of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), 42 U.S.C. § 9601(14); (b) any pollutant or contaminant under section 101(33) of CERCLA, 42 U.S.C. § 9601(33); (c) any petroleum product or its derivative, including fuel oil, and waste oils; and (d) any hazardous substance, extremely hazardous substance, toxic substance, hazardous waste, ignitable, reactive or corrosive materials, pollutant, contaminant, element, compound, mixture, solution or substance that may pose a present or potential hazard to human health or the environment under any applicable environmental laws. The holder shall not store any hazardous materials at the site without prior written approval from the authorized officer. This approval shall not be unreasonably withheld. If the authorized officer provides approval, this permit shall include (or in the case of approval provided after this permit is issued, shall be amended to include) specific terms addressing the storage of hazardous materials, including the specific type of materials to be stored, the volume, the type of storage, and a spill plan. Such terms shall be proposed by the holder and are subject to approval by the authorized officer. 20. Name all the Federal Department(s)/Agency(ies) where this application is being filed. 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. Signature of Applicant Date Title 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. 10/2023) PAGE 2 None b.Why were these alternatives not selected? Any alternative would require a new ROW and construction of a new road. c. Give explanation as to why it is necessary to use or occupy Federal assets (lands or buildings). The ROW provides access to a parcel of real property owned by Eagle County. This parcel is completely surrounded by BLM land and thus a BLM ROW is needed for access. No hazardous materials Docusign Envelope ID: 47067FB6-5A39-46CA-8252-2D78DC2E90C7 4/29/2025 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 utility systems telecommunication installations 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. Wired and wireless 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 filed 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) 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) Alaska Regional Office 709 West 9th Street Juneau, Alaska 99802 Telephone: (907) 586-7177 Department of the Interior Alaska State Office Bureau of Land Management 222 West 7th Avenue #13 Anchorage, Alaska 99513 Public Room: 907-271-5960 FAX: 907-271-3684 (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 (NPS) Alaska Regional Office 240 West 5th Avenue Anchorage, Alaska 99501 Telephone: (907) 644-3510 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 Officer, P.O. Box 120, 1675 C Street, Anchorage, Alaska 99513. 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 department/agencies may authorize the use of this form by applicants for transportation, utility systems, telecommunication installations 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 locations in as much detail as possible, discussing why certain locations were rejected and why it is necessary to use Federal assets will assist the agency(ies) in processing your application and reaching a final decision. Include only reasonable alternate locations 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 with 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. STANDARD FORM 299 (REV. 10/2023) PAGE 3 Docusign Envelope ID: 47067FB6-5A39-46CA-8252-2D78DC2E90C7 PUBLIC BURDEN STATEMENT The Federal agencies collect this information from proponents and applicants requesting a right-of-way, permit, license, lease, or certification for use of Federal assets. The Federal agencies use this information to evaluate a proponent's or applicant's proposal to use Federal assets. A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995 unless the information collection has a currently valid Office of Management and Budget (OMB) Control Number. The approved OMB Control Number for this information collection is 0596-0249. Without this approval, we could not conduct this information collection. Public reporting for this information collection is estimated to be approximately 8 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. All responses to this information collection are voluntary. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to the USDA Forest Service email address SM.FS.InfoCollect@usda.gov and include the OMB Control Number in the subject line. Disclosure of the information is voluntary. If all the information is not provided, the proposal or application may be rejected. Concerns about this form can be sent to Director, Lands, Minerals, and Geology Management Staff, 1st Floor Southeast, 201 14th Street, SW, Washington, DC 20250-1124 USDA NONDISCRIMINATION STATEMENT In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible agency or USDA's TARGET Center at (202) 720-2600 (voice and TYY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. 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. 10/2023) PAGE 4 Docusign Envelope ID: 47067FB6-5A39-46CA-8252-2D78DC2E90C7 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 filing 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. 10/2023) PAGE 5 Docusign Envelope ID: 47067FB6-5A39-46CA-8252-2D78DC2E90C7 4/10/25, 1:49 PM image.png https://mail.google.com/mail/u/0/#search/sexton/CllgCHrkVgqvlGrtpxkWlmwTgVLqPlGJgFmcWxLvJZwTTRkfGHrnhSDDqmhdxgjhtmWdLKWXQkg?pr…1/1 Docusign Envelope ID: 47067FB6-5A39-46CA-8252-2D78DC2E90C7