ATTACH Eb Dig Permit Request Form - HIANGSEP2020EDIT.pdf

01MAR2021-HIANG EDIT JBPHHINST 11013.1

1 Enclosure (1)

FY21 DIG PERMIT REQUEST FORM

Joint Base Pearl Harbor-Hickam Instruction 11013.1, Facilities Management Division

Project Title:

FOR FACILITIES USE ONLY

Permit No:

The Dig Permit is required for any excavation work that may disrupt utility services, vehicular or aircraft traffic flow, protection provided by fire and intrusion alarm systems, or routine activities of Joint Base Pearl Harbor-Hickam (JBPHH). The process intends to identify, as much as practical, any known, potentially hazardous work condition and is to help prevent accidents. It also informs key Base activities of the digging work and coordinates the required work with these activities to keep customer inconvenience to a minimum. The Dig Permit and CATEX (as required) must be approved prior to the start of work.

1. INSTRUCTIONS:

The contractor/excavating activity shall complete blocks 2-14 and is responsible for obtaining the necessary approvals/signatures (blocks 15-19). The submitted packages shall include this form and accompanying plans and/or drawings showing the location, width, and depth of excavation. Once the approvals/signatures have been obtained, the contractor/excavating entity shall submit the dig permit package for final approval/signature to the respective Area Assistant Public Works Officer (APWO) via the Team Facility Operations Specialist. Allow at least 20 Working Days before commencement of work for review and potential for 14 day message notification to base personnel (duration can be shorter if message is not required-APWO determination). Upon receipt of the approved and signed Dig Permit, the contractor/excavating activity may proceed with the excavation and shall follow all precautionary notes and directions as provided.

2. SITE LOCATION; Please Identify Site on Vicinity Map. 3. TARGET START DATE:

4. REQUESTOR SUPERVISOR or GOV’T SPONSOR POC (FEAD/SPAWAR/etc): 5. PHONE NO:

6. REQUESTOR POC: 7. POC PH.#: FAX #:

ADDRESS:

8. CONTRACT NO. or (N/A) FOR SHOP WORK: 9. WORK ORDER/JOB NO.:

10. TYPE OF WORK INVOLVED: (check all that apply)

UNDERGROUND UTILITIES:

WATER SEWER DRAIN ELECTRICAL TELECOMMUNICATIONS FIBEROPTIC

EXCAVATION: TRENCHING FOUNDATION/SLAB DE-WATERING SOIL BORING/TEST PIT

OTHER:

11. The contractor/excavating activity shall perform a general site survey prior to any excavation. Contractors are Required to Tone Area; for all in-house work JBPHH shops will tone the proposed area. Every effort must be made to locate unknown utilities posing a conflict with work insofar as the utilities fall within the proposed excavation limits and are detectable by industry-standard underground utility locating equipment. If water valves; sewer, drain, or electrical manholes; recent trenching scars; or pavement trench patches are found where no utility line is shown on the drawings/sketches provided, the contractor/unit shall contact the undersigned prior to any excavation. . Initial/Date

12. There are known existing primary utilities shown for the area in question Yes No

. Initial/Date

13. The equipment operator shall closely monitor the excavated material for significant changes in color, size (gradation) and type of material. Such changes may indicate the presence of an unmarked utility. If such changes are noted, the contractor/unit shall cease all excavation by equipment and probe by hand. If any questions arise, contact the undersigned. . Initial/Date

NOTE: ALL CONTRACTORS ARE REQUIRED TO TONE THE PROPOSED AREA.

FOR ALL IN-HOUSE WORK JBPHH SHOPS WILL TONE THE PROPOSED AREA.

2 Enclosure (1)

DIG PERMIT REQUEST FORM

Joint Base Pearl Harbor-Hickam Instruction 11013.1, Facilities Management Division

Project Title: FOR FACILITIES USE ONLY

Permit No:

14. DESCRIPTION OF WORK:

* Provide a work description including the method of excavation (use of hand tools or type of heavy/powered equipment)

* Provide description of any precautionary measures to be followed and safety devices to be used such as shoring.

* Provide drawings or sketch showing the depth, width and length of the excavation and any known utilities that may interfere with the work. (continue on additional sheet if required)

Attached Sketch: Yes No (if no, explain)

DETAILED DESCRIPTION OF WORK:

3 Enclosure (1)

FY21 CLEARANCE REVIEW

(JBPHH DEPARTMENTS)

Project Title: FOR FACILITIES USE ONLY

Permit No:

ORGANIZATION SPECIAL INSTRUCTIONS AKNOWLEDGEMENT /

DATE

15. Environmental Reviews:

A. EV2 Cultural Resources Jeffrey Pantaleo , 471-1171 x368 jeff.pantaleo@navy.mil

NOTE: REPORT ALL INADVERTANT DISCOVERIES TO

THE CULTURAL RESOURCES MANAGER. Refer to CATEX for archaelogical requirements if available.

B. EV3 Environmental Restoration Justin H. Lam, (808) 471-4859 justin.h.lam@navy.mil

A CATEX has been approved and received YES NO N/A If NO or N/A, explain why:

16. UEM: ELECTRIC, WATER, SEWER

Gordon Vergara, 474-2062 gordon.vergara@navy.mil

NOTE: EXCAVATION WITHIN 2 FEET OF MARKED

UTILITES MUST BE HAND DUG UNTIL UTILITIES ARE

FULLY EXPOSED

(SHIPYARD ONLY: SALT WATER, HIGH/LOW PRESSURE

AIR, CHILL WATER)

17. FLEET LOGISTICS COMMAND (FUELS)

Benjermin T. Hecker, 473-7823 benjermin.hecker@navy.mil

Fuel Lines: Active Non Active N/A

18. HAWAII ONE CALL CENTER (HOCC)

1-866-423-7287 or 811

For all other commercial utilities (HT, HECO, Gas, BWS, Wastewater, etc)-

Notification only- no signature required

19. TELECOMMUNICATIONS (BCO)

Rebecca J.Buijten, DSN 315-453-6596,653-6596 rebecca.buijten@navy.mil

CONTACT AT&T/JHITS FOR TONING REVIEW

808-471-4131

The contractor/excavating activity shall have an approved Digging Permit at the work site at all times during excavation.

The Digging Permit does NOT relieve the contractor/excavating activity from responsibility for any damage to underground utilities encountered during excavation.

All known existing primary utilities are shown on the attached sketches/drawings. Those not shown in the original sketches/drawings were added. The contractor/excavating activity shall locate each intersecting line and all other lines in the general vicinity of the excavation prior to any excavation. The utility lines shown on the drawings/sketches represents approximate locations only.

In case of emergency:

During off-hours: contact the CDO at 375-4692 and the emergency service desk at 449-3100.

During working hours: Contractors- Contact your FEAD CME, ET, or other Gov’t sponsor for non-FEAD work.

In House- Contact your Shops Project Manager .

NOTE:

If the actual work differs from the written Description of Work (Item No. 12 above), this Digging Permit will be voided and MUST be Resubmitted.

This Dig Permit shall be TERMINATED 60 days after the signed approval date below if work has not started unless otherwise noted.

Digging Permit No.# _________ is hereby: Approved Disapproved

APWO, Date Facilities Management Division

APWO Completes Information Below:

If dig permit is in their area, has CM/Shops/APWO Notified:

AIRFIELD MANAGEMENT Bldg 2050, Rm. 105 @ 449-0022/0023 Yes No N/A PORT OPERATIONS (JB3) CDR Pitkin, 473-2974 or LT Correy Sommer, 473-1137 corey.d.sommer@navy.mil Yes No N/A Documents prior to APPROVING this Dig Permit.

(a) A Work Induction receipt (Appendix C) has been received and approved by an APWO YES NO N/A

If NO or N/A, explain why:

(b) A site Approval has been approved and received YES NO N/A

If NO or N/A, explain why: