HomeMy WebLinkAboutAgreement - Washington State - GMB 1117 Maintenance April 25, 2019
Tim Bruggman VP of Development LGI Homes
14205 SE 36th St., Suite 100
Bellevue, WA 98006 Subject: SR 9, MP 18.81 Addendum #01 UP 20591
Dear Mr. Bruggman: Utility Permit No. 20591 was issued to LGI Homes on October 9, 2018. On March 8, 2019 you on behalf of LGI Homes for the Kember Court East development notified Joan Oestreich, WSDOT of a
need for WSDOT to provide an easement to the City of Marysville over WSDOT State Route 9 limited
access right of way so that the City of Marysville could maintain the stormwater discharge facilities outfalling to SR 9 at MP 18.81. Both LGI Homes and the City of Marysville were then subsequently notified that WSDOT does not grant easements in regards to permitted utilities within state rights of way.
On April 4, 2019 the City of Marysville provided letter to WSDOT requesting a General Maintenance Agreement between WSDOT and the City of Marysville to maintain stormwater infrastructure discharging to SR 9 from plats within the City of Marysville. GMB 1117 gives the city permission to address both routine and emergency maintenance related to the outfall at SR 9 MP 18.81 originating
from the Kember Court East development. The City’s letter requesting the maintenance agreement also
let WSDOT know that the parcel number referenced in UP 20591 was incorrect. Addendum 01 is being issued to revise the parcel reference to which this permit is assigned, and to name the City of Marysville as the designated party responsible for maintenance of the facilities related to the stormwater discharge outfall to SR 9 at MP 18.81.
Please note Utility Permit 20591 Addendum #01 supersedes, Utility Permit 20591. JA 0103 LGI Homes reimbursable account will be billed for costs related to the following: A portion of the charges related to completion of the City of Marysville General Maintenance Agreement with
WSDOT, and all costs incurred by WSDOT for preparation, and execution of UP 20591 including the
revised Limited Access break naming the City of Marysville as party designated as responsible for maintenance of the outfall at SR 9 MP 18.81. Once all costs related to these items have been billed, and WSDOT has received all moneys owed, JA 0103 will be closed. Addendum No. 01 (revised permit documents labeled Addendum 01)The Application, and Exhibit “A” Special
Provisions, are amended as follows:
Page 1 of 2Page 1 of 2
UP 20591
ADDENDUM #01
Letter
“Application” The Exhibit section of the application page has been revised to reflect “Exhibit “A” pages 1-4. Number of pages has changed as a result of revisions and additions to special provisions.
“Exhibit A” Special Provisions Special Provision #35 was revised to reflect the correct parcel number, and address for Kember Court East.
Original Special Provision #16 was revised to include language that states that the City of Marysville has maintenance responsibilities for storm water facilities on the subject parcel through easement.
Original Special Provision #17 was revised to modify language to include “City of Marysville as designated party responsible for maintenance via GMB 1117”.
Original Special Provision # 20 was revised to require maintenance activities taking place from SR 9 to have an approved traffic control plan. Added language requiring traffic control submittal 14 working
days prior to any maintenance activities.
New Special Provision # 21 was added naming the City of Marysville via General Maintenance Agreement GMB 1117 as party designated as responsible for all maintenance activities related to UP 20571.
New Special Provision #22 tying limited access rights to the City of Marysville and maintenance of stormwater discharge facilities.
Please acknowledge receipt of UF 20591 Addendum #01 via return e-mail. Once WSDOT has confirmation that LGI Homes has received this addendum, the addendum is considered executed, and City of Marysville will then be responsible for all emergency and routine maintenance associated with this permit.
If you have any questions regarding this Addendum, please contact Joan Oestreich at (206) 440-4132. Sincerely,
Maria Mayrhofer WSDOT, NW Region Utilities Manager
MM:jko Enclosures cc: Area 3 Maintenance MS NB82-43
Mike Gallop MS NB82-240 Karen Latimer City of Marysville Brooke Ensor City of Marysville File
Page 2 of 2Page 2 of 2
UP 20591
ADDENDUM #01
Letter
Associated Reimbursable account = JZ 0103
DOT Form 224-696
Revised 08/2016
Application for Utility Permit or Franchise
Permit/Franchise No.
Applicant - Please print or type all information
Application is Hereby Made For: Permit Category 1 $500.00
Franchise Amendment Category 2 $300.00
Franchise Renewal $250.00 Category 3 $150.00
Franchise Consolidation $300.00
Intended Use of State Right of Way is to Construct, Operate, and Maintain a:
on a portion of
State Route (at/from) Mile Post to Mile Post in County,
to begin in the Section Township North: Range West/East W.M.
and end in the Section Township North: Range West/East W.M.
Fees in the amount of are paid to cover the basic administrative expenses incident to
the processing of this application according to WAC 468-34 and RCW 47.44 and amendments thereto.
The applicant promises to pay any additional costs incurred by the Washington State Department of
Transportation (Department) on the behalf of the applicant.
Check or Money Orders are to made payable to “Washington State Department of Transportation”
Applicant (Referred to as Utility)
Address
City State Zip Code
Telephone
Email
Applicant Reference (WO) Number
Applicant Authorized Signature
Print or Type Name
Title
Dated this day of ,
Federal Tax ID or Social Security
Authorization to Occupy Only if Approved Below
The Department hereby grants this Permit or Franchise, as applicable, subject to the terms and conditions
stated in the General Provisions, and Exhibits attached hereto and by this reference made a part hereof.For Department Use Only
Exhibits Attached
Department Accounting Reference Number
In accepting this Franchise Amendment No. to Franchise No. , Utility agrees that the General Provisions to the
original Franchise and any previous Amendments shall be replaced in their entirety with the General Provisions as included
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Exhibit 'A'Pages 1-3 of 3Stormwater Permit Special
Provisions
Exhibit 'B'Page 1 of 1
Pages 1-2 of 2
Pages 1-3 of 3
Page 1 of 1
Page 1 of 1
Page 1 of 1
Pre-Construction NotificationExhibit 'G'
Maintenance NotificationExhibit 'F'
WSDOT Trench DetailExhibit 'E'
Utility Work PlanExhibit 'D'
Right Of Way PlanExhibit 'C'
Utility Facility Description NWR Utilities Manager
10/9/2018
DOT Form 224-696
Revised 08/2016
Application for Utility Permit or Franchise
Permit/Franchise No.
Applicant - Please print or type all information
Application is Hereby Made For: Permit Category 1 $500.00
Franchise Amendment Category 2 $300.00
Franchise Renewal $250.00 Category 3 $150.00
Franchise Consolidation $300.00
Intended Use of State Right of Way is to Construct, Operate, and Maintain a:
on a portion of
State Route (at/from) Mile Post to Mile Post in County,
to begin in the Section Township North: Range West/East W.M.
and end in the Section Township North: Range West/East W.M.
Fees in the amount of are paid to cover the basic administrative expenses incident to
the processing of this application according to WAC 468-34 and RCW 47.44 and amendments thereto.
The applicant promises to pay any additional costs incurred by the Washington State Department of
Transportation (Department) on the behalf of the applicant.
Check or Money Orders are to made payable to “Washington State Department of Transportation”
Applicant (Referred to as Utility)
Address
City State Zip Code
Telephone
Email
Applicant Reference (WO) Number
Applicant Authorized Signature
Print or Type Name
Title
Dated this day of ,
Federal Tax ID or Social Security
Authorization to Occupy Only if Approved Below
The Department hereby grants this Permit or Franchise, as applicable, subject to the terms and conditions
stated in the General Provisions, and Exhibits attached hereto and by this reference made a part hereof.For Department Use Only
Exhibits Attached
Department Accounting Reference Number
In accepting this Franchise Amendment No. to Franchise No. , Utility agrees that the General Provisions to the
original Franchise and any previous Amendments shall be replaced in their entirety with the General Provisions as included
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Exhibit 'A'Pages 1-3 of 3Stormwater Permit Special
Provisions
Exhibit 'B'Page 1 of 1
Pages 1-2 of 2
Pages 1-3 of 3
Page 1 of 1
Page 1 of 1
Pre-Construction NotificationExhibit 'F'
Maintenance NotificationExhibit 'E'
Utility Work PlanExhibit 'D'
Right Of Way PlanExhibit 'C'
Utility Facility Description
Addendum 01
1-4 of 4
For major Repair. Anytime Work is underway within the right of way, during the non-working hours, equipment
and materials shall not be located or stored within the work zone clear zone (WZCZ) area. Minimum WZCZ
distances will be measured from the edge of the traveled way (the portion of the roadway intended for the
movement of vehicles, exclusive of shoulders and lanes for parking, turning, and storage for turning) and will be
determined as follows:
The Utility agrees that, in the event any construction and/or maintenance of the highway facility becomes
necessary within the proximity of the utility installation, it is expressly understood that, upon request from the
Department’s representative, the Utility will promptly identify and locate by suitable field markings any and all of
its underground facilities so that the Department or its contractor can be fully apprised of their precise locations.
“Routine Maintenance” of the Drainage System shall include cleaning and repair and/or replacement of any
minor failures to structure and /or components and repair of any damage to the state-owned right of way caused
by the maintenance and operation of the Drainage System. Routine Maintenance will not require notification to
the STATE.
For major repair and/or replacement work, not defined within Routine Maintenance, the Utility shall provide the
Department notification of the need for such repairs and/or replacement work. The Utility is responsible to
determine the method of repair to the Drainage System and shall restore Department’s right of way to current
Department maintenance standards, at the sole cost and expense to the Utility. The Department reserves the
right to review damages occurring to the state-owned right of way, as a result of failure of the Drainage System,
and oversee the restoration.
Traffic Control Plans shall be submitted with the notification, and approved, prior to any major repair and or
replacement work is done.
The Department shall not be responsible for damages to the Drainage System caused by Utility employees or
the Utility’s contractors working within state-owned right of way. Should the Utility or its contractors damage the
Drainage System, it agrees to notify the Department as soon as practical. The Utility and Department will work
together in good faith to agree upon the required repairs. The Utility agrees to make such repairs at its sole cost
and expense.
Maintenance access of this facility will be from SR , only.
No Work (for the intent of this Permit, operation or maintenance) provided for herein shall be performed until the
Utility is authorized by the following Washington State Department of Transportation (Department)
Representative(s):
The Department assumes no responsibility or liability in any manner for any effect its highway drainage system
may have on the Utility’s system.
The utility agrees to assume all liability and responsibility, including fines and taxes, for the water quality related
to its runoff collection system and for any damages caused by increased flows (that portion of the total rate of
flow that is in excess of the natural rate of surface runoff in the undeveloped state) and pollutants discharged.
Further, the Utility agrees to accept the liability for the augmented flows added to the Department’s system (such
as downstream flooding, manhole overflows or any other instance resulting from those added flows)
The utility agrees to assume all liability and responsibility associated with the design, construction, maintenance,
and operation of its Stormwater management and drainage system(s).
Construction of all Stormwater management facilities shall be part of the initial construction of the system under
this Permit.
For major repair or replacement work, as defined in Special Provisions 11, the Utility shall provide Traffic Control
Plans, for approval, and FAX the complete attached “Notification of Maintenance” to the identified Department
Representative(s) at least fourteen (14) working days (Monday through Friday excluding any holidays), in
advance of commencing Work on state-owned highway right of way.
Upon receipt of the Maintenance Notification, the Department will advise the Utility if there are any restricted
Work timeframes within the state-owned highway right of way. No Work shall be allowed on Saturday, Sunday, or
holidays, without prior approval by the Department. In addition, the Utility shall be off the highway by noon the
day prior to a holiday unless authorized by the Department. If a holiday falls on a Saturday, the preceding Friday
is counted as the holiday, and the Utility shall be off the highway by noon Thursday. When the Holiday falls on a
Monday the Utility shall be off the right of way at noon on the preceding Friday. Nothing in this section shall limit
the authority of the Department to further restrict work within state-owned highway right of way at the
Department’s discretion. The hours of closure are subject to change if, required by the Department.
Stormwater Permit
Special Provisions
Applicable provisions are denoted by )(
DOT Form 224-157
Revised 07/2014 Page 1 of 2
UP 20591
Posted Speed Distance From Traveled Way (ft)
35 mph or less 10
40 mph
45 to 55 mph
60 mph or greater
15
20
30
Minimum Work Zone Clear Zone Distance
1.
DOT Form 224-157
Revised 07/2014
X
2.
3.
4.
Name:
Title:
Street:
City:
Phone:
Fax:
State:Zip:
Cell:
5.
6.
7.
Name:
Title:
Street:
City:
Phone:
Fax:
State:Zip:
Cell:
Michael Gallop
Developer & Utility Inspector
15700 Dayton Ave, N.
Seattle
WA 98133
206-440-4913
Page 2 of 2
Permit No.
E-mail Notification to oestejk@wsdot.wa.gov
UP 20591
Exhibit 'A'
Stormwater Permit
Special Provisions
Page 1 of 3
UP 20591 Addendum 01
Exhibit 'A'
Stormwater Permit Special
Provisions
Page 1 of 4
For major Repair. Anytime Work is underway within the right of way, during the non-working hours, equipment
and materials shall not be located or stored within the work zone clear zone (WZCZ) area. Minimum WZCZ
distances will be measured from the edge of the traveled way (the portion of the roadway intended for the
movement of vehicles, exclusive of shoulders and lanes for parking, turning, and storage for turning) and will be
determined as follows:
The Utility agrees that, in the event any construction and/or maintenance of the highway facility becomes
necessary within the proximity of the utility installation, it is expressly understood that, upon request from the
Department’s representative, the Utility will promptly identify and locate by suitable field markings any and all of
its underground facilities so that the Department or its contractor can be fully apprised of their precise locations.
“Routine Maintenance” of the Drainage System shall include cleaning and repair and/or replacement of any
minor failures to structure and /or components and repair of any damage to the state-owned right of way caused
by the maintenance and operation of the Drainage System. Routine Maintenance will not require notification to
the STATE.
For major repair and/or replacement work, not defined within Routine Maintenance, the Utility shall provide the
Department notification of the need for such repairs and/or replacement work. The Utility is responsible to
determine the method of repair to the Drainage System and shall restore Department’s right of way to current
Department maintenance standards, at the sole cost and expense to the Utility. The Department reserves the
right to review damages occurring to the state-owned right of way, as a result of failure of the Drainage System,
and oversee the restoration.
Traffic Control Plans shall be submitted with the notification, and approved, prior to any major repair and or
replacement work is done.
The Department shall not be responsible for damages to the Drainage System caused by Utility employees or
the Utility’s contractors working within state-owned right of way. Should the Utility or its contractors damage the
Drainage System, it agrees to notify the Department as soon as practical. The Utility and Department will work
together in good faith to agree upon the required repairs. The Utility agrees to make such repairs at its sole cost
and expense.
Maintenance access of this facility will be from SR , only.
No Work (for the intent of this Permit, operation or maintenance) provided for herein shall be performed until theUtility is authorized by the following Washington State Department of Transportation (Department)Representative(s):The Department assumes no responsibility or liability in any manner for any effect its highway drainage system may have on the Utility’s system.The utility agrees to assume all liability and responsibility, including fines and taxes, for the water quality relatedto its runoff collection system and for any damages caused by increased flows (that portion of the total rate offlow that is in excess of the natural rate of surface runoff in the undeveloped state) and pollutants discharged.Further, the Utility agrees to accept the liability for the augmented flows added to the Department’s system (suchas downstream flooding, manhole overflows or any other instance resulting from those added flows)The utility agrees to assume all liability and responsibility associated with the design, construction, maintenance,and operation of its Stormwater management and drainage system(s).Construction of all Stormwater management facilities shall be part of the initial construction of the system underthis Permit.For major repair or replacement work, as defined in Special Provisions 11, the Utility shall provide Traffic ControlPlans, for approval, and FAX the complete attached “Notification of Maintenance” to the identified DepartmentRepresentative(s) at least fourteen (14) working days (Monday through Friday excluding any holidays), inadvance of commencing Work on state-owned highway right of way.Upon receipt of the Maintenance Notification, the Department will advise the Utility if there are any restrictedWork timeframes within the state-owned highway right of way. No Work shall be allowed on Saturday, Sunday, orholidays, without prior approval by the Department. In addition, the Utility shall be off the highway by noon theday prior to a holiday unless authorized by the Department. If a holiday falls on a Saturday, the preceding Fridayis counted as the holiday, and the Utility shall be off the highway by noon Thursday. When the Holiday falls on aMonday the Utility shall be off the right of way at noon on the preceding Friday. Nothing in this section shall limitthe authority of the Department to further restrict work within state-owned highway right of way at theDepartment’s discretion. The hours of closure are subject to change if, required by the Department.Stormwater PermitSpecial ProvisionsApplicable provisions are denoted by )(DOT Form 224-157Revised 07/2014 Page 1 of 2
Posted Speed Distance From Traveled Way (ft)
35 mph or less 10
40 mph
45 to 55 mph
60 mph or greater
15
20
30
Minimum Work Zone Clear Zone Distance
DOT Form 224-157
Revised 07/2014
X Name:Title:Street:City:Phone:Fax:State:Zip:Cell:
8.
9.
10.
11.
12.
13.
Name:Title:Street:City:Phone:Fax:State:Zip:Cell:
Page 2 of 2
Permit No.
UP 20591
Exhibit 'A'
Stormwater Permit
Special Provisions
Page 2 of 3
UP 20591 Addendum 01
Exhibit 'A'
Stormwater Permit Special
Provisions
Page 2 of 4
UP 20591 SR 9 MP 18.81
Stormwater Discharge
ADDENDUM 01
14. This permit supersedes in full Utility Permit 20327.
15. This permit is assigned to the identified parcel(s) served by the storm water facility,
and shall remain appurtenant to the identified parcel(s). Should the identified parcel(s)
be inherited, sold, assigned, or transferred in any way, this permit shall run with the
land to the extent that the identified parcel(s) remain in compliance with the terms of
this permit, unless the permit is revoked, modified, or closed by the Department as
provided by law or the current Permit Holder requests the cancellation of the permit.
Identified parcel is 00590700005400, 5505 87th Ave NE, Maryville, WA 98270 also
known as Kember Court East.
16. The sump on the upstream end of the discharge pipe, located on the parcel
associated with this stormwater discharge permit shall be visually inspected, and
cleaned out annually. Should the sump on the upstream end of the discharge pipe fail,
the permit holder, shall be responsible for the all damages, clean-up, and restoration
to state right of way resulting from sump failure. The permit holder has assigned
easement for maintenance responsibilities for storm water facilities within the
identified parcel to the City of Marysville.
17. The outlet end of the discharge pipe, and splash pad shall be visually inspected, at
a minimum annually or as needed to ensure its intended function. Should the outlet
end of the pipe produce a build-up of material at the end of the pipe or fill the ditch,
the City of Marysville as the designated party responsible for maintenance via
Maintenance Agreement GMB 1117 shall be responsible to remove all excess
material from state right of way, and restore the Utility’s and the Department’s
stormwater system to its original condition. Should the splash pad become clogged
with debris resulting in the ditch filling, the permit holder, the City of Marysville as
designated party responsible for maintenance shall be responsible for removing the
accumulated debris from state right of way.
18. Installation of the Stormwater Discharge Pipe and Splash Pad shall conform with
the WSDOT 2018 Standard Specifications. Specifically the following sections:
• For Discharge Pipe installation see Chapter 7 Section 7-08 (3) General Pipe
Installations.
• Discharge Pipe shall meet the requirements of Chapter 9 Section 9-05 Drainage
Structures and Culverts.
• Backfill over Discharge Pipe shall be in accordance with Chapter 7 Section 7-08.3(3) and
Chapter 2 Section 2-03(140)C.
• The rock placed for the splash pad shall meet the requirements of Chapter 9 Section 9-
13.4 Rock for Erosion and Scour protection
19. Restoration to be completed by LGI Homes after installation of discharge pipe
shall consist of matching existing adjacent roadside treatment (seeding bark etc.). Full
Stormwater Permit
Special Provisions (Continued)
UP 20591 Addendum 01
Exhibit 'A'
Stormwater Permit Special
Provisions
Page 3 of 4
UP 20591 SR 9 MP 18.81
Stormwater Discharge
ADDENDUM 01
roadside restoration including bushes/trees in the vicinity of MP 18.81 shall be
completed per UTB 1540 Vegetation Mitigation Agreement.
20. No access for construction, or maintenance of discharge pipe, and splash pad
shall take place from the lanes or shoulders of SR 9 without an approved traffic
control plan. Please provide a traffic control plan for review 14 working days prior to
any maintenance activity.
21. The City of Marysville via General Maintenance Agreement GMB 1117, has
agreed to take on maintenance responsibilities associated with the Kember Court
East parcel number 00590700005400 SR 9 stormwater discharge outfall at MP 18.81
and is the party designated as responsible for all maintenance activities related to this
permit.
22. The designated limited access break at SR 9 MP 18.81 is related to maintenance
of the stormwater discharge facilities at SR 9 MP 18.81. The City of Marysville, as the
party designated as responsible for maintenance shall have sole use of the limited
access break for the purposes of maintenance of the stormwater discharge facilities
located at SR 9 MP 18.81. No other entities related to parcel 00590700005400 such
as a Homeowners Association shall have access rights to or from SR 9.
UP 20591 Addendum 01
Exhibit 'A'
Stormwater Permit Special
Provisions
Page 4 of 4
Utility Facility Description
Applicant Field Contact Person
Brian Kalab
Field Contact Phone Number
(425) 303-9363
Applicant Reference (WO) Number Permit/Franchise No.
UP 20591
State Route
9
Highway Scenic Class
B
Access Control
Full
Begin MP
18.81
End MP
18.81
Reference MP
19
Distance and Direction (From nearest reference MP)
0.19 miles from MP 19
Facility Description
Stormwater Outfall from parcel 0059070003100
Facility Detail
MP to MP
Lt/
Rt/
Xing
Offset Distance Description R/W
Width
Remarks
Including Pertinent Topography Info. (Turnouts,
Road Approaches, Intersections, Cut, Fill, Culvert,
Guardrail, etc.) Xing Technique, Control Zone Obj.,
Enter-Leave R/W
From
Centerline
From
Traveled
Way
Depth/
Height
Item to be Installed / Constructed
Left
Right
18.81 18.81 Approx 75’ of 12” discharge pipe
12’ x 6’ x 2’ Rock (Quarry Spall) Splash Pad
DOT Form 224-697 Revised 12/2014 Exhibit “B”
Page 1
of 1 Pages
UP 20591
Utility Facility Description
Exhibit 'B'
Page 1 of 1
Rock to meet requirements of WSDOT Standard Specifications
Section 9-13.4 Rock for Erosion and Scour Protection see Special Provision #18
t
Outfall
UP 20591
Right Of Way Plan
Exhibit 'C'
Page 1 of 2
RW/Property Boundary LA
hatchures should havebeen shown here.
Location of 12"
discharge pipe andsplash pad
GC #
Exhibit "A"
UP 20591
Utility Work Plan
Exhibit 'D'
Page 1 of 3
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UP 20591
Utility Work Plan
Exhibit 'D'
Page 2 of 3
Discharge Pipe and Rock Pad shall meet the
requirements of Special Provision #18 to this permit
UP 20591
Utility Work Plan
Exhibit 'D'
Page 3 of 3
Accommodation No.: UP 20591 State Route No: SR 9
Expiration Date: ‐‐‐‐‐‐‐‐From Mile Post: 18.81
WO/Charge Code: W.O. #### / JA 0103 Grp 02 To Mile Post: 18.81
Contact:Joan Oestreich
Phone:206‐440‐4132
E‐Mail:OESTEJK@wsdot.wa.gov
Alt. Contact:NWR Utilities Office
Alt. Phone:206.440.4120
Anticipated Start Date: Estimated Duration:
Permit/Franchise Holder
CONTACT NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E‐MAIL:
OFFICE PHONE
Contractor
CONTACT NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E‐MAIL:
OFFICE PHONE
SIGNATURE:
NWR UTILITIES OFFICE
DATE:
TITLE
THE PERMIT/FRANCHISE HOLDER OR THEIR REPRESENTATIVE SHALL NOTIFY NORTHWEST REGION UTILITIES UP 20591
IMMEDIATELY IF THEY ARE UNABLE TO START WORK ON THE DATE INDICATED ABOVE.EXHIBIT 'F'
FAILURE TO PROVIDE NOTIFICATION MAY RESULT IN INSPECTION CHARGES BEING INCURRED.PAGE 1 OF 1 M
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Maintenance Notification
Update and re‐use this form as needed for in‐kind repair or replacement of EXISTING primary and secondary
facilities associated with the referenced utility permit or franchise number ONLY. Maintenance activities are subject
to the general and special provisions of the referenced utility permit or franchise, a WSDOT‐approved, site‐specific
Traffic Control Plan, and submittal of this Notification Form.
In accordance with Washington State Department of Transportation (WSDOT) Special Provisions for Permits and
Franchises, provide the project information below to the following WSDOT representative ten (10) working days
prior to the beginning of construction. Use Alternate Contact or surface mail if phone or e‐mail are no longer in
effect.
Provide Description of Work Activity
No work shall take place until the Utility has received written or verbal authorization from WSDOT to proceed.
This form does NOT apply if there will be an upgrade, change in capacity, location/route, appurtenances, or
subcontracted/ outsourced work. Please call the NW Region Utilities Office if you have questions.
WSDOT Authorization
WSDOT NW REGION UTILITIES
15700 DAYTON AVE. N., NB82‐113
P.O. BOX 330310
SEATTLE, WA 98133‐9710
Provide Utility Contacts
UP 20591
Maintenance Notification
Exhibit 'F'
Page 1 of 1
UP 20591
Maintenance Notification
Exhibit 'E'
Page 1 of 1
Accommodation No.: UP 20591 State Route No: SR 9
Expiration Date: ‐‐‐‐‐‐‐‐From Mile Post: 18.81
WO/Charge Code:W.O. #### / JA 0103 Grp 02 To Mile Post: 18.81
WSDOT Inspector (notify at least five (5) days prior to starting work)
NAME:Michael Gallop
TITLE:WSDOT Inspector
PHONE:206‐440‐4913/206‐940‐2736
E‐MAIL:GALLOPM@wsdot.wa.gov
WSDOT Traffic Control (notify at least ten (10) days prior to starting work)
NAME:N/A
TITLE:WSDOT NWR CTCO Engineer
PHONE:N/A
E‐MAIL:N/A
Anticipated Start Date:Estimated Duration:
Permit/Franchise Holder
NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E‐MAIL:
OFFICE PHONE
Contractor
NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E‐MAIL:
OFFICE PHONE
THE PERMIT/FRANCHISE HOLDER OR THEIR REPRESENTATIVE SHALL NOTIFY NORTHWEST REGION UTILITIES UP 20591
IMMEDIATELY IF THEY ARE UNABLE TO START CONSTRUCTION ON THE DATE INDICATED ABOVE.EXHIBIT 'G'
FAILURE TO PROVIDE NOTIFICATION MAY RESULT IN INSPECTION CHARGES BEING INCURRED.PAGE 1 OF 1
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Pre‐Construction Notification
In accordance with Washington State Department of Transportation (WSDOT) Special Provisions for Permits
and Franchises, provide requested information to below‐designated WSDOT construction contacts prior to the
beginning of construction. Use Alternate Contact or surface mail if phone or e‐mail are no longer in effect. This
form is NOT for maintenance work.
WSDOT Construction Contacts
Construction Contacts and Schedule
Construction Traffic Coordination Office
15700 Dayton Ave. N.
P.O. BOX 330310, NB82‐125
Seattle, WA 98133‐9710
NW Local Agency & Development Services Office
15700 Dayton Ave. N.
PO BOX 330310, MS 82‐240
Seattle, WA 98133‐9710
No work shall take place until the Utility has participated in the Pre‐Construction conference.
UP 20591
Pre-Construction Notification
Exhibit 'G'
Page 1 of 1
UP 20591
Pre-Construction Notification
Exhibit 'F'
Page 1 of 1
Page 1 of 2
June 13, 2019
Cindy Jackson
Pacific Ridge-DRH, LLC
17921 Bothell Everett Hwy, Suite 100
Bothell, WA 98012
Subject: SR 9 MP 18.71 to MP 18.71
Installation of Storm Drain System
Utility Permit S1-19-12
Dear Cindy Jackson,
Enclosed is your approved Utility Permit for installing 63 LF of 12” storm drain pipe and rock pad
outfall. Construction of your utility must begin within one calendar year and be completed within three
years of the date of approval shown on the application. Please note that the Traffic Control Plan for
work within WSDOT right-of-way, Exhibit 'D', was approved as noted on May 30, 2019 and is valid for
four months from that date. The Traffic Control Plan requires 5-day notice be provided to Ken Seguin at
WSDOT’s Construction Traffic Coordination Office:
Ken Seguin
Construction Traffic Coordination Office
15700 Dayton Ave. N., NB82-120
P.O. Box 330310
Seattle, WA 98133-9710
206-440-4470
BIGJ@wsdot.wa.gov
Prior to any construction equipment or personnel entering WSDOT right-of-way, a pre-construction
conference is required with WSDOT’s inspector, Michael Gallop. The utility shall notify Michael
Gallop a minimum of 5 working days in advance:
Michael Gallop
NW Local Agency & Development Services Office
15700 Dayton Ave. N., MS 82-240
Seattle, WA 98133-9710
206-440-4913/206-940-2736
GALLOPM@wsdot.wa.gov
Contact WSDOT NW Region Radio at (206) 440-4490 five minutes prior to start of all traffic closures
and again upon reopening to traffic. A copy of the approved Utility Permit must be on-site.
Pacific Ridge-DRH, LLC 6/13/2019
S1-19-12
Page 2 of 2
Please note, WSDOT invoice account number MT0595 GRP 01 WO0101 CS1700Y will continue to be
charged for personnel time for inspection activities and attendance to the pre-construction conference.
For your convenience, here is the link to the WSDOT’s Standard Specifications of Road, Bridge, and
Municipal Construction: http://www.wsdot.wa.gov/Publications/Manuals/M41-10.htm
If you have any questions regarding your application, please contact me at 206-440-4130 or
PHAMK@wsdot.wa.gov.
Sincerely,
Khoi Pham
Utilities Accommodations/Project Delivery Engineer
KP:kp
Enclosures
cc: Michael Gallop, NW Local Agency & Development Services Office
File
DOT Form 224-693
Revised 07/2018
Stormwater Discharge General Provisions
This Permit is issued pursuant to the terms of RCW 47.32, RCW 47.44, and WAC 468-34, and amendments thereto.
Provisions for the CONSTRUCTION of stormwater discharge facilities (facilities):
1. A copy of this Permit must be on the job site, protected from the elements, at all times during any construction
authorized by this Permit.
2. The Utility agrees to pay the reasonable costs of the Department for investigating, handling, and granting the
Permit, including but not limited to basic overhead charges and for providing an inspector during construction
and/or maintenance of the Utility’s facilities. Further, the Utility agrees that it shall be responsible for and pay the
Department’s expended direct and indirect costs associated with applicable provisions of the Permit.
(a) The Department will assign a reimbursable account to the Utility as a means of invoicing the Utility for the costs
associated with this Permit.
(b) The Department will invoice the Utility and the Utility agrees to pay the Department within thirty (30) calendar
days of the invoice date.
3. Upon approval of this Permit, the Utility shall diligently proceed with the Work and comply with all Stormwater
Discharge General and Special provisions herein. Construction of facilities proposed under this Permit shall begin
within one (1) year and must be completed within three (3) years from date of Department approval. “Work” under this
Permit shall mean construction, operation, and maintenance of the Utility’s facilities as authorized herein.
4. Should the Utility breach any of the conditions and requirements of this Permit, or should the Utility fail to proceed with
due diligence and in good faith with the Work as authorized by this Permit, the Department may cancel or revoke the
Permit upon thirty (30) calendar days written notice to the Utility.
5. The Utility shall notify the Department representative in special provision 1 of the name, address, and telephone
number of its contractor when the Work is going to be performed with other than its own forces. When the Utility uses
a contractor, an authorized representative of the Utility shall be present or available at all times unless otherwise
agreed to by the Department representative. A list of authorized representatives shall be submitted prior to the
6. The Utility agrees to schedule and perform its Work in such a manner as not to delay the Department’s Maintenance
activities or the Department’s contractor’s work when the Department has a contractor performing work in the vicinity
of the Utility’s Work.
7. All contact between the Department and the Utility’s contractor shall be through the Utility representative. Where the
Utility chooses to perform the Work with its own forces, it may elect to appoint one of its own employees engaged
in the Work as its representative. The Utility, at its own expense, shall adequately police and supervise all Work
performed by itself, its contractor, subcontractor, agent, and/or others, so as not to endanger or injure any person
or property.
the location of survey control monuments within the area in which the Utility will be working. In the event any
monument or right of way marker will be altered, damaged, or destroyed by the Utility, the Department, prior to Utility
Work, will reference or reset the monument or right of way marker. During the Work, upon discovery of a monument or
right of way marker, the Utility shall cease Work in that area and immediately notify the Department of the discovery.
The Department will coordinate with the Utility to ensure that the monument or right of way marker is recorded
or replaced. The Utility agrees to pay all Department costs to perform monument or right of way marker work, as
provided in this provision, in accordance with Stormwater Discharge General Provision 2.
DOT Form 224-693
Revised 07/2018
9. In the event any milepost, fence, or guardrail is located within the limits of the Utility’s Work and will be disturbed
during Utility Work, the Utility agrees to carefully remove these highway facilities prior to Utility Work and reset or
replace these highway facilities after the Utility Work, to the Department’s sole satisfaction and at the sole cost of the
Utility Work.
10. The Utility agrees that all Work shall be done to the satisfaction of the Department. All material and workmanship shall
and amendments thereto, and shall be subject to Department inspection. All Department acceptance and inspections
any third party. The Utility agrees that it shall pay all Department inspection costs in accordance with Stormwater
Discharge General Provision 2.
11. The Utility shall provide proof of insurance coverage prior to performing any Work within state-owned highway right of
way, as follows:
(a) Commercial General Liability covering the risks of bodily injury (including death), property damage, and personal
injury, including coverage for contractual liability, with a limit of not less than $3 million per occurrence and in
the aggregate;
(b) Business Automobile Liability (owned, hired, or non-owned) covering the risks of bodily injury (including death)
and property damage, including coverage for contractual liability, with a limit of not less than $1 million per
accident; and
(c) Employers Liability covering the risks of Utility’s employees’ bodily injury by accident or disease, with limits of
not less than $1 million per accident for bodily injury by accident and $1 million per employee for bodily injury
by disease.
Transportation as an additional insured on all general liability, automobile liability, employers’ liability, and excess
material change to the policy(ies) as such relate(s) to this Permit.
allowable under its coverage, the city or county shall name the Washington State Department of Transportation as an
additional insured for the coverage required by this section.
representative for approval prior to construction or maintenance Work. No lane closures shall be allowed except as
approved by the Department’s representative. Approvals may cause revision of Special Provisions of this Permit,
including hours of operation.
completion of the Work, the Utility shall notify the Department’s representative within ten (10) calendar days for the
within ninety (90) calendar days of Work completion, if the originally approved Permit construction plans have been
revised during the course of construction.
15. The Utility shall not excavate or place any obstacle within the state-owned highway right of way in such a manner as
to interfere with the Department’s construction, operation, and maintenance of the state-owned highway right of way
16. The Utility agrees to maintain, at its sole expense, its facilities authorized by this Permit in a condition satisfactory
to the Department.
DOT Form 224-693
Revised 07/2018
the construction and restoring the highway pavement or related transportation equipment or facilities to a permanent
Department for trenching work not completed and for compensating the Department for the loss of useful pavement
life caused by trenching as required by RCW 47.44.020.
18. Upon completion of all Work, the Utility shall immediately remove all rubbish and debris from the state-owned
highway right of way, leaving the state-owned highway right of way in a neat, presentable, and safe condition to the
Department’s satisfaction. Any Workrelated rubbish and debris clean up, or any necessary slope treatment to restore
and/or protect the state-owned right of way, not done within one (1) week of Work completion, unless otherwise
agreed to by the Department, will be done by the Department at the expense of the Utility. The Utility agrees to pay
the Department’s expended costs and expenses for performing the work in accordance with Stormwater Discharge
General Provision 2.
19. The Utility shall comply with the Department’s Temporary Erosion and Sediment Control Manual (M 3103.01) and any
revisions thereto, for erosion control and/or to mitigate any erosion occurring as a result of the Work. If the Utility Work
highway right of way, the Utility shall, at its own expense, make all corrections and/or provisions the Department
drainage restoration, the Department reserves the right to make such changes as necessary to restore the original
drainage function at the sole cost of the Utility, and the Utility agrees to pay the Department’s expended costs and
expenses for performing the work in accordance with Stormwater Discharge General Provision 2.
20. The Utility shall be responsible for securing all necessary permits, including but not limited to, federal, state, and
local regulatory, tribal, environmental, archeological, and railroad permits and permits from the Washington State
Department of Ecology, the Washington State Department of Fish and Wildlife, and/or the U.S. Army Corps of
Engineers prior to beginning the Work authorized by this Permit. The Utility shall be responsible for mitigation
noncompliance with the permit(s) conditions or for failure to obtain the required permits. In addition, the Utility, on
arising out of, or in any way resulting from, the Utility’s failure to (1) obtain any required permit for the Utility Work or
(2) comply with permit conditions. Further, the Utility shall be responsible for compliance with all federal, state, and
local laws, regulations. Utility also agrees to pay any costs incurred by the Department, including attorneys fees,
pursuant to the provisions of this section in accordance with Stormwater Discharge General Provision 2.
21. For any of the Utility’s Work that requires permit coverage under the “CONSTRUCTION STORMWATER GENERAL
PERMIT – National Pollutant Discharge Elimination System and State Waste Discharge General Permit for
Stormwater Discharges Associated with Construction Activity” (Construction Stormwater General Permit), the Utility
shall obtain said permit coverage and shall comply with all requirements of the Construction Stormwater General
Permit. Upon the Department’s request, the Utility shall provide a copy of the Construction Stormwater General
agencies, persons, and/or property, arising out of, or in any way resulting from, the Utility’s failure to (1) obtain
coverage under the Construction Stormwater General Permit for Utility Work or (2) comply with the Construction
Stormwater General Permit requirements. Utility also agrees to pay any costs incurred by the Department, including
attorneys fees, pursuant to the provisions of this section in accordance with Stormwater Discharge General
Provision 2.
DOT Form 224-693
Revised 07/2018
22. This Permit does not authorize the Utility, or its employees, contractors, or agents, any right to cut, spray, retard,
owned highway right of way. Should the Utility anticipate that its Work will alter the appearance of the state-owned
highway right of way vegetation, the Utility shall notify the Department representative listed in special provision 1
to obtain the Department’s prior written approval of the Utility’s proposed work. If the Department permits the Utility
to modify the state-owned highway right of way vegetation, it agrees that any vegetation cutting and/or trimming
activities shall be conducted in such a manner that the state-owned highway right of way vegetation appearance
will not be damaged. Should the Utility damage the appearance of the state-owned highway right of way vegetation
without the Department’s prior written approval, the Utility is subject to penalties provided for in RCWs 47.40.070,
47.40.080, and 4.24.630, as applicable.
Provisions for Stormwater Discharge OCCUPANCY of state-owned right of way:
removed from, or relocated within the state-owned highway right of way as necessary, incidental, or convenient for
the construction, alteration, improvement, repair, relocation, or maintenance of the state highway, or for the safety of
the traveling public, the Utility, its successors and assigns, shall, at its sole cost and expense, upon written notice by
the Department, modify, relocate, or remove any or all of its facilities within or from the state-owned highway right of
and/or removals as the Department directs, to avoid highway project impacts or delays and in such manner as will
of the highway.
24. Should the Utility fail or refuse to comply with the Department’s direction, pursuant to Stormwater Discharge General
Provision 23, to modify, remove, or relocate any Utility facility, the Department may undertake and perform any
The Utility agrees to pay the Department’s expended costs and expenses for performing the work, in accordance with
Stormwater Discharge General Provision 2.
25. If the Department determines in good faith that emergency maintenance work on the Utility’s facility is needed to (a)
protect any aspect of the state highway right of way or (b) secure the safety of the traveling public due to a failure
of the Utility’s facility, the Department may perform the necessary work without the Utility’s prior approval, and the
Utility agrees to pay the Department’s expended costs and expenses for performing the work in accordance with
Stormwater Discharge General Provision 2. The Department will notify the Utility of the emergency work performed as
soon as practicable.
26. The Department may amend, revoke, or cancel this Permit at any time by giving written notice to the Utility. If the
Permit is amended, the Utility will have thirty (30) calendar days to modify the facility as the Permit amendment(s)
Utility shall immediately remove all facilities from the right of way. Any facilities remaining upon the right of way thirty
(30) calendar days after written notice of Permit revocation or cancellation may be removed by the Department at the
expense of the Utility. The Utility agrees to pay the Department’s expended costs and expenses for performing the
work in accordance with Stormwater Discharge General Provision 2.
27. The Utility shall not assign or transfer this Permit without the Department’s prior written approval. The Utility
understands that any assignment or transfer requires the assignee or transferee to have the means to assume all
obligations, duties, and liabilities of the terms and conditions of this Permit , and the Utility will advise the assignee
or transferee of its obligation to apply for an updated or replacement Permit. If the Department does not approve
the assignment or transfer, this Permit shall automatically terminate, and the Utility shall be subject to the terms of
RCW 47.44.060.
DOT Form 224-693
Revised 07/2018
28. The Utility, its successors and assigns, shall indemnify, defend at its sole cost and expense, and hold harmless the
its agents, contractors, and/or employees, in the use of the state-owned highway right of way as authorized by the
terms and conditions of this Permit , or (2) are caused by the breach of any of the terms or conditions of this Permit
by the Utility, its successors and assigns, and its contractors, agents, and/or employees. The Utility, its successors
or employees, if the claim, suit, or action for damages both to persons and/or property is caused by the sole acts or
Utility, its successors or assigns, agents, contractors, and/or employees, or involves those actions covered by RCW
4.24.115, the indemnity provisions provided herein shall be valid and enforceable only to the extent of the acts or
omissions of the Utility, its successors or assigns, agents, contractors, and/or employees.
29. The Utility agrees that its obligations under this Permit extend to any claim, demand, and/or cause of action brought
by, or on behalf of, any of its employees or agents while performing Work under this Permit while located on state-
owned highway right of way. For this purpose, the Utility, by MUTUTAL NEGOTIATION, hereby waives, with respect
to the State of Washington only, any immunity that would otherwise be available to it against such claims under the
Industrial Insurance provisions in chapter 51.12 RCW.
30. The Insurance requirements in Stormwater Discharge General Provisions 11 and 12 shall also apply to the Utility’s
occupancy of the state-owned highway right of way.
termination of this Permit.
32. Any action for damages against the State of Washington, its agents, contractors, and/or employees, arising out of
damages to a utility or other facility located on state-owned highway right of way, shall be subject to the provisions
and limitations of RCW 47.44.150.
33. This Permit shall not be deemed or held to be an exclusive one and shall not prohibit the Department from granting
rights of like or other nature to other public or private utilities, nor shall it prevent the Department from using any of the
full supervision and control over all or any part of the state-owned highway right of way or properties, none of which is
hereby surrendered.
X
X
X
X
X
X
X
S1-19-12
Exhibit 'A'
Special Provisions for
Permits and Franchises
Page 1 of 4
Name: ___________________________________
Title: ___________________________________
Street: ___________________________________
City: ___________________________________
State: _________________ Zip: __________
Phone: _________________ Cell: ____________
Email: __________________________________
Michael Gallop
WSDOT Inspector
15700 Dayton Ave. N., MS 82-240
Seattle
WA 98133-9710
206-440-4913 206-940-2736
GALLOPM@wsdot.wa.gov
Special Provisions for
Permits and Franchises
S1-19-12
Page 3
14. This permit is only for an installation of the new storm sewer facilitiies that discharge runoff on to
WSDOT owned ditch on SR 9, as shown in the utility facility description.
15. This permit is assigned to the identified parcel(s) served by the stormwater facility and shall remain
appurtenant to the identified parcel(s). Should the identified parcel(s) be inherited, sold, assigned, or
transferred in any way, this permit shall run with the land to the extent that the identified parcel(s) remain in
compliance with the terms of this permit, unless the permit is revoked, modified, or closed by WSDOT as
provided by law or the current Permit Holder requests the cancellation of the permit.
Identified parcel is 00590700006701, 5411 87th Ave NE, Marysville, WA 98270.
16. Installation of the Stormwater Discharge Pipe and Splash Pad shall conform with the Washington State
Department of Transportation 2018 Standard Specifications. Specifically the following sections:
For Discharge Pipe installation see Chapter 7 Section 7-08 (3) General Pipe Installations.
Discharge Pipe shall meet the requirements of Chapter 9 Section 9-05 Drainage Structures and
Culverts.
Backfill over Discharge Pipe shall be in accordance with Chapter 7 Section 7-08.3(3) and Chapter 2
Section 2-03(140)C.
The rock placed for the splash pad shall meet the requirements of Chapter 9 Section 9-13.4 Rock for
Erosion and Scour protection.
17. The sump on the upstream end of the discharge pipe, located on the parcel associated with this stormwater
discharge permit shall be visually inspected, and cleaned out annually. Should the sump on the upstream
end of the discharge pipe fail, the permit holder, shall be responsible for the all damages, clean-up, and
restoration to state right of way resulting from sump failure. The permit holder has assigned easement for
maintenance responsibilities for storm water facilities within the identified parcel to the City of Marysville.
18. Stormwater runoff shall be properly detained and treated per the NPDES Permit requirement before
Discharge into the Department-owned drainage system.
19. The Permit Holder shall be responsible for maintenance and repair of the side-drain connection,
including the pipes and yard basins.
20. No access for construction, or maintenance of discharge pipe, and splash pad shall take place from the
lanes or shoulders of SR 9 without an approved traffic control plan. Please provide a traffic control plan for
review 14 working days prior to any maintenance activity.
21. The outlet end of the discharge pipe, and splash pad shall be visually inspected, at a minimum annually or as
needed to ensure its intended function. Should the outlet end of the pipe produce a build-up of material at the
end of the pipe or fill the ditch, the City of Marysville as the designated party responsible for maintenance via
Maintenance Agreement GMB 1117 shall be responsible to remove all excess material from state right of
way, and restore the Utility’s and the Department’s stormwater system to its original condition. Should the
splash pad become clogged with debris resulting in the ditch filling, the permit holder, the City of Marysville
as designated party responsible for maintenance shall be responsible for removing the accumulated debris
from state right of way.
22. Restoration to be completed by Pacific Ridge-DRH, LLC after installation of discharge pipe shall consist of
matching existing adjacent roadside treatment (seeding bark etc.). Full roadside restoration including
bushes/trees in the vicinity of MP 18.71 shall be completed per UTB 1540 Vegetation Mitigation Agreement.
Special Provisions for
Permits and Franchises
S1-19-12
Page 3
23. No access for construction, or maintenance of discharge pipe, and splash pad shall take place from the
lanes or shoulders of SR 9 without an approved traffic control plan. Please provide a traffic control plan for
review 14 working days prior to any maintenance activity.
24. The City of Marysville via General Maintenance Agreement GMB 1117, has agreed to take on maintenance
responsibilities associated with the R4-8 Single Family High Sunny Side Five Acre Tracts parcel number
00590700006701 SR 9 stormwater discharge outfall at MP 18.71 and is the party designated as responsible
for all maintenance activities related to this permit.
25. The designated limited access break at SR 9 MP 18.71 is related to maintenance of the stormwater
discharge facilities at SR 9 MP 18.71. The City of Marysville, as the party designated as responsible for
maintenance shall have sole use of the limited access break for the purposes of maintenance of the
stormwater discharge facilities located at SR 9 MP 18.71. No other entities related to parcel 00590700006701
such as a Homeowners Association shall have access rights to or from SR 9.
Utility Facility Description
S1-19-12
SnagMP (Link)LP T, R, Sec:T30/R5E/S36
18.66
Facility Description Remarks and Installation
Comments
18.66 18.66 LT 75'65'*Install 12" storm drain 75'B LP
pipe & culvert outfall.Enters WSDOT RW.
* Pipe daylights to ex. ditch.
From
Edge of
Traveled
Way
(Fogline)
Depth
or
Height
Access Control:
Accommodation Number:
State Route Number:
End Mile Post:18.66
SR 9
All Greyed Out Areas are For Department Use Only
BScenic Class:Begin Mile Post:
Facility to be Installed/
Deactivated/ Upgraded
(indicate size and/or diameter,
and material)
Left Right
1.) Indicate where item enters/leaves R/W.
2.) Include pertinent topography info
(turnouts, Rd. approaches, intersections,
culvert, guardrail, xing method, split
grade/under/overpass, etc.)
Facility Description - Provide a summary of the proposed work: (press ALT+Enter to insert line break)
Work inside WSDOT RW: Install 61 LF of 12" storm drain pipe and culvert outfall.
Additional Notes:
Begin
Mile
Post
End
Mile
Post
Left,
Right
or
Xing
Offset Distances (feet)Right of Way
Scenic
Class
Access
ControlFrom
Center
Line
DOT Form 224-697
Rev. 02/2019 Page 1
Vicinity Map
S1-19-12 Hunter’s Landing SR 9 MP 18.71
BEGIN/END
PROJECT MP 18.71
LGI Homes LLC 422+22 & 427+85 Lt. (Maintenance Agreement GMB 1117)21
No. 21. The privilege of access to areas within the right of way
is permitted from outside the right of way to the user designated,
solely for use authorized by and subject to the conditions of the
Franchise, Permit, or Agreement specified. No Access will be
allowed to the traveled highway lanes or ramps.
City of Marysville
Hunter’s Landing Project Location
S1-19-12 SR 9 MP 18.71
WSDOT RW
(Approx.)
Install rock pad outfall
inside RW.
Install 12” storm drain pipe
Enters RW.
SOUTHBOUND
NORTHBOUND
SR 9
Pipe
Input Output
Q (cfs)0.00 2.15
n 0.012 0.012
d (ft)1.00 1.00 1 0 /16 inches
y (ft)0.55 0.55
S (ft/ft)0.009 0.009
A (sf)0.443
Pw (ft)1.672 V (ft/s)4.846
R (ft)0.265
Critical y (ft) =
Qmax @ y (ft) =0.9382
Vmax @ y (ft) =0.8128
Job:Hunter's Landing Description:Oufall Protection Sizing
By:YM Date:5/22/2019
D
Sy
Page 1
ROCK PAD SIZE: 8' L X 7' W X 2' D
PVC
100 YR DEVELOPED FLOW
Accommodation No.: S1-19-12 State Route No:SR 9
Expiration Date: N/A From Mile Post:18.71
WO/Charge Code:Hunter's Landing / MT0595 GRP 01To Mile Post: 18.71
WSDOT Inspector (notify at least five (5) days prior to starting work)
NAME:Michael Gallop
TITLE:WSDOT Inspector
PHONE:206-440-4913/206-940-2736
E-MAIL:GALLOPM@wsdot.wa.gov
WSDOT Traffic Control (notify at least five (5) days prior to starting work)
NAME:Ken Seguin
TITLE:WSDOT NWR CTCO Engineer
PHONE:206-440-4454
E-MAIL:SEGUINK@wsdot.wa.gov
Anticipated Start Date:Estimated Duration:
Permit/Franchise Holder
Pacific Ridge-DHR NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E-MAIL:
OFFICE PHONE
Contractor
NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E-MAIL:
OFFICE PHONE
THE PERMIT/FRANCHISE HOLDER OR THEIR REPRESENTATIVE SHALL NOTIFY NORTHWEST REGION UTILITIES S1-19-12
IMMEDIATELY IF THEY ARE UNABLE TO START CONSTRUCTION ON THE DATE INDICATED ABOVE.EXHIBIT 'E'
FAILURE TO PROVIDE NOTIFICATION MAY RESULT IN INSPECTION CHARGES BEING INCURRED.PAGE 1 OF 1
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Pre-Construction Notification
In accordance with Washington State Department of Transportation (WSDOT) Special Provisions for Permits
and Franchises, provide requested information to below-designated WSDOT construction contacts prior to the
beginning of construction. Use Alternate Contact or surface mail if phone or e-mail are no longer in effect. This
form is NOT for maintenance work.
WSDOT Construction Contacts
Construction Contacts and Schedule
Construction Traffic Coordination Office
15700 Dayton Ave. N.
P.O. BOX 330310, NB82-125
Seattle, WA 98133-9710
NW Local Agency & Development Services Office
15700 Dayton Ave. N.
PO BOX 330310, MS 82-240
Seattle, WA 98133-9710
No work shall take place until the Utility has participated in the Pre-Construction conference.
Accommodation No.:S1-19-12 State Route No:SR 9
Expiration Date: N/A From Mile Post:18.71WO/Charge Code:Hunter's Landing / MT0595 GRP 01 To Mile Post: 18.71
Contact:Khoi Pham
Phone:206-440-4130
E-Mail:PHAMK@wsdot.wa.gov
Alt. Contact:NWR Utilities Office
Alt. Phone:206.440.4120
Anticipated Start Date:Estimated Duration:
Permit/Franchise Holder
Pacific Ridge-DHR CONTACT NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E-MAIL:OFFICE PHONEContractor
CONTACT NAME:
COMPANY
TITLE:
STREET ADDRESS
PHONE:
CITY, STATE ZIP
E-MAIL:
OFFICE PHONE
SIGNATURE:
NWR UTILITIES OFFICE
DATE:
TITLE
THE PERMIT/FRANCHISE HOLDER OR THEIR REPRESENTATIVE SHALL NOTIFY NORTHWEST REGION UTILITIES S1-19-12
IMMEDIATELY IF THEY ARE UNABLE TO START WORK ON THE DATE INDICATED ABOVE.EXHIBIT 'F'
FAILURE TO PROVIDE NOTIFICATION MAY RESULT IN INSPECTION CHARGES BEING INCURRED.PAGE 1 OF 1 M
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Maintenance Notification
Update and re-use this form as needed for in-kind repair or replacement of EXISTING primary and secondary facilities
associated with the referenced utility permit or franchise number ONLY. Maintenance activities are subject to the
general and special provisions of the referenced utility permit or franchise, a WSDOT-approved, site-specific Traffic
Control Plan, and submittal of this Notification Form.
In accordance with Washington State Department of Transportation (WSDOT) Special Provisions for Permits and
Franchises, provide the project information below to the following WSDOT representative ten (10) working days
prior to the beginning of construction. Use Alternate Contact or surface mail if phone or e-mail are no longer in
effect.
Provide Description of Work Activity
No work shall take place until the Utility has received written or verbal authorization from WSDOT to proceed.
This form does NOT apply if there will be an upgrade, change in capacity, location/route, appurtenances, or
subcontracted/ outsourced work. Please call the NW Region Utilities Office if you have questions.
WSDOT Authorization
WSDOT NW REGION UTILITIES
15700 DAYTON AVE. N., NB82-113
P.O. BOX 330310
SEATTLE, WA 98133-9710
Provide Utility Contacts