LUC Area Construction Permit BLANK 2018-1003.pdf
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- Attached to
- DESIGN BUILD CONSTRUCTION FOR UTILITY INFRASTRUCTURE, ROADS & CLINIC AT USCG BASE CHARLESTON, SOUTH CAROLINA
- Solicitation number
- 70Z04725RPCNI0007
About this file
This document is a Charleston Naval Complex Land Use Controls (LUC) Area Construction Permit form, designed to provide detailed information and certifications for construction activities in areas with potential environmental contamination. The form requires the requestor to document proposed work details, current land use controls, and certify compliance with multiple environmental and safety requirements, including acknowledging residual contamination, controlling personnel hazards, managing groundwater and soil testing, and ensuring that construction activities will not negatively impact existing environmental remedies. The form includes sections for general project information, proposed work scope, land use controls, and requires signatures from the requesting official and Navy reviewers, with a revision date of 10/03/2018.
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Text version
CHARLESTON NAVAL COMPLEX LUC AREA CONSTRUCTION PERMIT
GENERAL INFORMATION:
County Parcel No: Date of Request:
Contractor: Subcontractors: SWMUs/AOCs Impacted:
PROPOSED WORK:
Scope of Work: (Attach sketches, drawings & information outlined in Process to Conduct Construction Activities Document)
LAND USE CONTROLS:
Current Land Use Controls on Construction Area:
Frequency and Date of Next LUC Inspection for Construction Area:
Potential Effect of Proposed Construction on LUCs:
CERTIFICATIONS:
As a representative of the property owner of the subject property, I hereby certify that: (check all that apply)
I possess an updated copy of the CNC LUC Areas Map and Interim Measures Work Plan.
I acknowledge that residual contamination exists on the subject property.
Information regarding SWMUs/AOCs, and contaminants will be provided to all contractors and subcontractors.
The proposed construction will not change the land use (i.e., from industrial to residential) Personnel hazards will be controlled where construction activities have the potential to interfere with existing remedies.
Dewatering will not affect migration of contaminants, and water under groundwater use restriction will be tested and properly disposed.
Excess soil under digging restriction will be tested and properly disposed.
Exposure assumptions used in deriving LUCs will not be altered.
Impacts to the remedy as a result of construction activities will be monitored (I.e., groundwater flow direction, vertical migration of residual contamination, and potential for migration to indoor air.)
Any previously unknown contamination will be reported immediately to the Navy.
Signature of Requesting Official: Printed Name and Phone Number: Date:
Navy Review:
Requestor Authorized to Proceed Signatures:
Further Information is Requested ___________________________________ CH2M-Hill Permit Denied ___________________________________ Navy RPM/BEC
Date out: _____________ Serial No: _____________ (Authorization to proceed does not constitute approval of methods by which environmental, safety, and other regulations are satisfied.)
Revised 10/03/2018
Requestor:
Location:
(Bldg Nos. and Streets)
Sheet1
File details come from the government source that posted it. Updated .