FA301618B0005_Attachment_SOW_Apendix_D.pdf

FA301618B0005

Appendix D

Digging Permit

DIGGING PERMIT FOR FT SAM HOUSTON/CAMP BULLIS

502D Civil Engineer Squadron

CONTROL NUMBER: _______________________ PROJECT (ACES) NUMBER: _______________________ DATE: _____________________

Note: This form is used to coordinate required work with key post activities, protect underground utilities and keep customer inconvenience to a minimum. Completed Digging Permit is valid a maximum of 30 days before excavation / construction start. Contractor is responsible for maintaining all markings and setting off-sets as required. THIS IS NOT A ROAD CLOSURE OR UTILITY OUTAGE REQUEST. Requestor is responsible for assuring that required road closures and utility outage requests are processed separately and timely. Please print clearly or type.

PROJECT TITLE & DESCRIPTION REASON FOR DIGGING:

Clearance is requested to proceed under Contract No.: ___________________________ involving excavation at the location shown on attached drawing. (Contractor shall attach 5 annotated copies of site plan (civil site and utility plans) that shows entire area to be disturbed)

Requestor:_____________________________________ Contractor/Company Name: __________________________________________________ Phone: ________________________________________ The following date and time has been scheduled by 502D Civil Engineer Squadron (502D CES) for the contractor to meet and coordinate with locate personnel, (10 working days are required for scheduling).

DATE: __________________________________________________ TIME: ___________________________________________ MEETING LOCATION: _______________________________________________________________________________________________ (Date requested by contractor MAY be adjusted by the 502D CES representative to avoid overbooking of locate personnel)

ORGANIZATION

502D Civil Engineer Squadron

LOCATE PERSONNEL PRINTED

NAME/SIGNATURE

MARKED

(CIRCLE

ONE)

DEPTH /REMARKS

Water, Sewer, & Drainage:

(210) 221-0207

YES / NO

Electrical: (210) 221-3212 YES / NO Road & Grounds:

(210) 221-3209/295-4980

YES / NO

HVAC: (210) 221-3212 YES / NO

*** CONTRACTOR IS RESPONSIBLE FOR NOTIFYING/ SCHEDULING THE FOLLOWING CLEARANCES/LOCATES*** 502D Communications Squadron 808-6912

DIG TESS ( 800)-344-8377:

CPS (Gas Lines, Electr.);

Southwestern Bell;

Time Warner Cable

YES / NO

YES / NO

YES / NO

YES / NO

San Antonio Water System (Recycled Water Line):

locates@saws.org

YES / NO

Sprint (Lodging) (800)-669-8344

YES / NO

*CONTRACTOR SHALL ALSO CALL DEPARTMENTS LISTED BELOW BEFORE DIGGING AND OBTAIN CONCURRANCE* 502D CES, Natural Resources Management Section (Environmental, Bldg. 4196): (210) 221-4842

(1) Compliance Signature:_______________________________________________

Historical Signature:_______________________________________________

(2) 502D Fire Emergency Services Flight, Fire Dept. (210) 221-5452 Signature________________________________________________

(3) 502D Security Forces Squadron, Traffic Officer : (210) 221-0212 Signature________________________________________________

(4) 502D Air Base Wing Safety Office: (210) 221-3836 Signature:_______________________________________________ If site is located at OR near BAMC the following contacts also need to be made:

(14) Facilities Management: (210) 916-3534 Signature:_______________________________________________

(15) Provost Marshall: (210) 916-1007 Signature:_______________________________________________

(16) Safety Manager: (210) 916-1427 Signature: _______________________________________________

CONTRACTOR SHALL RETURN THIS FORM TO 502D CIVIL ENGINEER SQUADRON, FORT SAM HOUSTON (Bldg. 4196)

FOR FINAL APPROVAL UPON COMPLETION OF ALL ABOVE COORDINATION AND SIGNATURES.

Quality Assurance Representative: ________________________________________________ Phone: _________________________________ (Government Point of Contact)

FINAL APPROVAL: _________________________________________________________ DATE: _________________________________ 502D CES, Fort Sam Houston REVISED: 28Jul15,CENMP

***INSTRUCTIONS***

1. The contractor shall fill out the permit and attach the contract utility plans, site/grading plan and any other plan sheets showing limits of excavation to scale (5 complete copies) and submit to his/her Quality Assurance Representative or credit card holder.

2. Clearance date is the date the contractor will meet locate personnel at the site to witness locating of known utility lines and obtain signatures.

a. Allow up to 10 working days to schedule 502D Civil Engineer Squadron, Ft Sam Houston personnel and for review of existing utility plans.

b. Clearances will be accomplished on MONDAY THROUGH FRIDAY at either 0900 or 1300 Hours in most cases.

3. Contractor is responsible for notifying the following agencies on Fort Sam Houston as noted on front of permit, see location below:

a. 502D Civil Engineer Squadron, Natural Resources Management Section (Environmental) in Bldg. 4196, See form for phone number/contact information.

b. 502d Security Forces Squadron, Traffic Officer, Fort Sam Houston in Bldg. 2244/Call the phone number on the front of the permit to ensure the appropriate person is going to be in the office before you go.

c. 502D Air Base Wing Safety Office in Bldg. 4196, Call the phone number on the front of the permit to contact.

d. Brook Army Medical Center (BAMC) Facilities Management, Provost Marshall and Safety Manager for projects in the BAMC area in

Bldg. 3600. Call the phone numbers on the front of the permit for directions and to make contact.

4. Locate personnel must accomplish the following on the clearance date:

a. Known utilities must be located and marked

b. Original digging permit must be legibly annotated as follows:

(1) Name of Individual who marked/cleared permit. (Printed name and signature)

(2) Indicate if utility is present and marked.

(3) Any necessary remarks (i.e. Depth of Line or state unknown)

5. Requestor shall be accompanied by his government point of contact (Quality Assurance Representative or Contracting Officer

Representative- COR) at all times during the processing of the digging permit in Bldg. 4196.

6. Quality Assurance Representative must also sign and date the permit.

7. Completed form (upon initial request) is submitted by the Quality Assurance Representative and contractor (together) for scheduling to the 502 CES Representative in Bldg 4196. Final form with signatures is returned to the same office for final approval and signature. FINAL APPROVAL is required prior to start of construction/excavation.

8. Short suspense’s will be reviewed and processed on a case by case basis.

9. Digging permits shall be initiated no more than 30 days prior to start of construction.

10. Contractor is required to set offsets and maintain all markings from completion of digging permit and during entire construction period.