S06 - 231123 Appendix A.pdf

ACCOMPANYING 36C25222B0028 0005

W N

A T

IO

N A

L A

V E

S 53RD ST CL

CL

R /W

R /W

8, 27

ENV

8, 27

ENV

8, 27

ENV

M

M M

M

M

14'

W

A Y F

E E

D

23'

N O

R T

H

JOB OWNER: ROBERT BARZACK - 414-944-5779

SECTION / TOWN / RANGE: SW1/4 SEC35, T7N, R21E

JOB INFO:

SITE VISIT COMPLETED BY: ANDREW GLATZEL

X

CONTRACTOR/BUILDER: CHRIS AT GUIDON - 402-304-4936

PLUMBER/ HVAC:

CUSTOMER: BILL AT VA MEDICAL - 414-712-8063

ELECTRICIAN:

MAIN CONTACTS

CUSTOMER'S SIGNATURE OF APPROVAL DATE

steel main. Questions call Larry Van Bogelen at 262-945-8914.

Connect the new PE service tracer wire to the existing

This is a rectified system. No 17# anodes needed.

CORROSION/CATHODIC PROTECTION NOTES:

CUSTOMER IS REQUIRED TO LOCATE ALL PRIVATE

WE ENERGIES WILL COMPLETE LAWN / PAVEMENT REPAIR ON:

ROAD ROW NEIGHBORING PROPERTY

NONE CUSTOMER PROPERTY

ROAD ROW NEIGHBORING PROPERTY

NONE CUSTOMER PROPERTY

WE ENERGIES WILL HAUL SPOIL FROM:

WE ENERGIES IS NOT RESPONSIBLE FOR ROOT DAMAGE

UNDERGROUND FACILITIES PRIOR TO INSTALLATION

X

CONTINGENCIES & COMMENTS:

DIGGERS HOTLINE REQUIRED

M

V10634

V10633

" S

T

D

W

ALK

DRIVEWAY

PARKING LOT

GRASS

W A L K

P R

IV

A T E R

O A

D

B O

C

B O

C

C U

C

SEW 4' S OF GAS MAIN

24" WAT MAIN 3' S OF N CURB LINE

#5000

BORE 528' OF 2" PE

INSTALL 3M AT 2PSIG L/R

MAIN TO L/L - 43'

L/L - METER - 485'

SHEET NO.

OF1 1

6/23/2021 1:48:42 PM U:\Data\@Work Management\Milwaukee\MSSC\@MSSC 4660000 - 4679999\4665353\4665353_C142248-4665353-1622217171325.dgn

FT. OF CORNER

SERV PIPE SIZE: MATERIAL:

CATV JOINT USE #: TEL JOINT USE #:

OPER MAP #: FEEDER/LINE #:

PREPARED BY:

OFFICE #: CELL #:

E-MAIL:

PAGER #:

EFV

CURB VLV

RELIGHT

ELECTRIC INFORMATION

PROPOSED GAS SERVICE INFORMATION

ELEC WR

GAS WR

CITY / TOWN / VILLAGE:

PROJECT ID: CGS #:

COMMON INFORMATION

STAKING REQUIREMENTS:

EASEMENT:

MAIN / SERVICE IN

SURVEYOR

DESIGNER

STAKED

NOT NEEDED

YES NO

RESTORE PRIVATE PROPERTY: WE ENERGIES CUSTOMER

WORK IS APPROX FT, DIRECTION OF CL OF

NEAREST CROSS STREET

(ALSO FOR GAS SERVICE TEE)

MTR LOC:

TIE IN PIPING

CUST/PROJ NAME:

PROJECT LOCATION:

WORK DESCRIPTION:

DATE PREPARED: DATE REVISED: CONSTRUCTION TYPE:

IO #:

MTR SIZE: MTR TYPE: PRES:

PHONE #:

X

MILWAUKEE / C

VA MEDICAL CENTER

5000 W NATIONAL AVE

INSTALL NEW SERVICE

ANDREW GLATZEL

ANDREW.GLATZEL@WECENERGYGROUP.COM

414-540-5839 414-588-4107

SNG012500

6-18-2021 BRICK

12 N SE

PE2"

S 53RD ST

14 E

X RAILROAD PERMITTING/FLAGGING REQUIRED YES NO RR NAME

3M AMR 2psig

CORROSION CONTACT: LARRY VAN BOGELEN 262-945-8914

MS 4665353

BY DESIGNER

ROUTE PRE STAKED

ACCOMPANYING 36C25222B0028 0005

E24030 Highlight

M

R

FT

REC

M

B

P

RI

T

NOTES:

Existing facilities should be field verified prior to excavation.

Utility information shown are from plans and have not been field verified.

Maintain 12" min vertical clearance at crossing of existing electrical facilities.

Maintain 6" min vertical clearance at crossing of other existing facilities.

Maintain 18" min vertical clearance at crossing of existing storm sewer pipes.

Maintain 5' clearance from storm sewer inlets.

Staking of route or ROW by surveyor required prior to construction.

Clearances shown are min distances - reference permit for specific clearance requirements.

Additional information on excavation, backfilling & clearances can be found in the Gas CRS 201.

Restore all pavement, ROW, sidewalks, and customer's private property.

12" WATTLE or 12"/20" SEDIMENT LOG or 9.5"/20" EROSION EEL

SILT FENCE

VEGETATIVE BUFFER

ENV

8, 27

A/B/C/D restoration of pre-construction soil stratification, and restoration to pre-construction elevations.

surface.

Waterways navigable waterways/streams.

Threatened and Endangered Species harass, harm, or kill a protected species under state and federal regulations. Proper precautions shall be taken to ensure harm to individuals is avoided.

between November 5 and March 15.

Invasive Species

Council on Forestry Transportation and Utility Rights-of Way Best Management Practices

Cultural and Historical Resources, cont.

potentially having Native American artifacts, burial mounds or burial sites, which could be encountered during construction.

immediately. Contact the Environmental Department who will contact the State Burial

Sites Preservation Office and determine the next steps that must be taken in order to comply with state law. Work at that site MAY NOT PROCEED until the Environmental

Department authorizes it.

Code HS 2.04 (6), must be present to monitor all ground disturbing activities.

Frac-out Contingency Plan contingency plan shall incorporate the following components.

and appropriately.

b. Containment materials (e.g. silt fence, straw bales, sand bags, etc.) shall be on site

13. All excess spoils shall be removed from wetlands and placed in a suitable upland location.

27. A frac-out contingency plan shall be on-site and implemented accordingly. The

25. If human bone or any artifacts are discovered during construction, work must cease

24. The project is within or adjacent to an area that is identified by the State of Wisconsin as precautions are legally required to prevent the spread of these species. The Wisconsin

22. A qualified biologist must be present when conducting work at this location.

21. Exclusion fencing must be installed at the work area prior to March 15.

20. In order to protect the threatened or endangered species, work must be conducted

19. Threatened or endangered species are known to occur in the work area. It is illegal to

18. Any disturbed soil within 75-feet of the ordinary high water mark of any navigable waterways/streams shall be stabilized within 24 hours of construction completion.

15. Poles scheduled to be removed, and that occur within wetland, shall be cut at the ground

a. Continuously inspect the bore paths for frac-outs in order to respond quickly

26. A "qualified archaeologist," as specified under Wis. Stats 157.70 (1) (i) and Wis. Admin.

23. State regulated invasive species are known to occur in the work area. Reasonable and available should a frac-out occur.

14. Trenching and pit excavations within wetlands shall include soil segregation to facilitate should be followed: (http://council.wisconsinforestry.org/invasives/transportation/).

17. No crossing of navigable waterways with equipment can occur. Foot traffic is allowed.

16. No work can be performed within the banks or below the ordinary high watermark of any

WE ENERGIES WORK REQUEST ENVIRONMENTAL NOTES (Notes 1 through 7 apply to ALL work requests)

APPENDIX A

Spills

Notes 8 through 27 apply as noted at specific points within each work request:

Dewatering

Wetlands

1. If WDNR and/or USACE permits were obtained for the project, all permit conditions shall be met during construction of the project.

2. If soil disturbance occurs on slopes or channels/ditches leading to wetlands or waterways, or within wetlands, the disturbed areas shall be stabilized and appropriate erosion control

Best Management Practices (BMP's) shall be implemented.

3. Erosion Control BMR's shall meet or exceed the approved WDNR Storm Watter Management

Technical Standards (http://dnr.wi.gov/topic/stormwater/standards/const_standards.html).

Refer to We Energies Construction Site Sediment and Erosion Control Standards.

4. Inspect installed erosion control BMP's at least one time per week and after 12" rain events:

repair as necessary.

5. When temporary stabilization is required (e.g. for winter or short-term construction) prior to final restoration, soil stabilizer shall be installed wherever possible. Erosion mat shall be used temporarily only where appropriate, in accordance with state standards, and when approved by the

Operations Supervisor.

6. Whenever soil exhibiting obvious signs of contamination (e.g., discoloration, petroleum or solvent odor, free liquids other than water, buried containers or tanks, or other obvious signs of environmental impacts) is encountered during excavation or installation, cease work immediately, take appropriate immediate precautions to ensure worker health and safety, and contact the Operations Supervisor or Inspector.

7. If an oil spill occurs during construction, call the Environmental Incident Response Team

(EIRT) at 414-430-3478:

a. Any quantity of oil is spilled into surface water;

b. Any oil spill greater than 50 ppm PCB into a sewer, vegetable garden, or grazing land;

c. Any oil spill containing greater than 500 ppm PCB;

d. Five gallons or more of oil spilled to the ground;

e. Any oil spill involving a police department, fire department, DNR, or concerned property owner.

8. Dewatering of pits or trenches shall be done in accordance with state standards. Use an approved sediment bag, a straw bale dewatering basin, a combination of both, or equivalent.

9. As much as practicable, the majorityof the work shall be staged from the public roadways and road shoulders, keeping equipment out of adjacent wetlands.

10. All work shall be conducted to minimize soil disturance. No rutting will be allowed within the wetlands.

11. If soils are not frozen or stable to a point that avoids rutting, timber mats, mud tracks, or equivalent shall be utilized to access pole locations.

12. Excavated soils cannot be stockpiled in wetlands.

General

Erosion Control

Contaminated Soils

EROSION CONTROL LEGEND

INLET PROTECTION, TYPE

STONE DITCH CHECK

SOIL STABILIZER, TYPE B

TIMBER MAT

SAND or ROCK BAG

SURFACE WATER FLOW

TRACKING PAD

EROSION MAT CLASS I, TYPE A

EROSION MAT CLASS I, TYPE B

EROSION MAT CLASS I, TYPE B URBAN

EROSION MAT CLASS II

MULCH

EROSION MAT CLASS III

EROSION MAT CLASS I, TYPE A URBAN

WE ENERGIES - GAS OPERATIONS

APPROXIMATE LOCATION FOR

UNDERGROUND FACILITY EXCAVATION

DW

BASIN LOCATION

APPROXIMATE DEWATERING

CONVENTIONAL SYMBOLS

- Outside Meterset

- Inside Meterset

- Valve (Boxed)

- Valve (Buried)

- Transition Fitting

- Reducer

- Support Clamp or Squeeze Point

- Coupling

- End of Main

- Regulation Pit

- Insulator

- Bottom/Side/Half Line Stopper Fitting

- Save-A-Valve

- No Blow/Punch/HVTT/MVTT/EF Tee

- Anode

- Cap with Anode

- Cap

- Retirement Symbol

- Full Open Tee

- 45° Elbow

- 90° Elbow

- Depth Change Elbow

- Marker Post

- Multi Wire Test Stand

- Single Wire Test Stand

- Main Jump Symbol

- Valve Pit

- Regulation Station

- Farm Tap

- Blow Down

- Pressure Monitoring Device

- Riser Used for Corrosion Reads

- Test Stand

- Rectifier

- River Weight - Pressure Point

Cleared a minimum 10-foot-wide path along the service route from the property line to the meter location on my building. I've made sure things like dirt piles and construction materials aren't in the way.

l Submitted payment, if applicable.

re you ready for natural gas service? we

Important! The natural gas ready for service card must be completed when you are ready for natural gas service and returned to us before we can begin your new service installation.

I understand that the following items need to be completed before installation begins.

ck Located, marked or exposed any private buried obstructions or under-ground facilities — such as a well, drain tiles, septic/mound system and/or underground yard lighting — with stakes, spray paint or flags.*

Note to customer: We Energies and/or its agents will not be held responsible for damage that occurs to customer-owned underground facilities that are not properly located and marked before natural gas service installation.

QiPrepared the ground around my building and along the service route to within 4 inches of final grade.

cliBuilt/framed wall and marked exact location on the building with spray paint, flag or stake to identify where the natural gas meter will be placed.

Sent my signed sketch Of applicable) and informed We Energies of any planned decks, patios or pools before my service is installed.

Once my service is installed, it would be my responsibility to pay any costs to move my natural gas facilities to accommodate future structures. Note: Building over the top of natural gas facilities (including the natural gas meter) may cause serious safety or code violations.

* If you are unable to properly locate and mark your privately owned buried facilities, you can hire a contractor to do it for you.

Natural gas ready for service card Please complete, sign and return this card when all of the items above have been completed.

Name:

(please print)

Installation address:

City:

(please print)

State: ZIP code:

Daytime phone:

certify that I am the owner or authorized representative of the owner.

Signature:

QOPlease hold my ready for service card and schedule installation after March 31.

(For We Energies office use only) Order number:

Date:

Additional charges for natural gas service installation apply from Dec. 1 through March 31.

For new service questions, visit www.we-energies.com/newservice or call 262-574-6400 or 866-423-0364 (toll free).

WR 4665353