(E) Site Approval.pdf

NAVFAC 11010/31, PART I

REQUEST FOR PROJECT SITE APPROVAL

NAVFACINST 11010.45A

Per NAVFACINST 11010.45A, Site Approval Request Process, NAVFAC 11010/31, Part 1, is required for both Category A and Category B Site Approval Requests (SAR), for both facilities and certain types of events, including those requiring waivers or exemptions. Site approvals are granted based on the conditions and circumstances shown in the SAR. The site approval becomes invalid if any of those conditions change.

Approvals become invalid if the project scope or location is altered in any manner from the information on which the SAR, certification, or endorsement was granted. Approvals become invalid if project proponent or owner fails to comply with conditions stipulated in the SAR. Category 2 SAR certifications, including requests for waivers and exemptions and other conditional endorsements, (e.g., explosive safety related site approvals granted under Safety Assessment for Explosives Risk (SAFER), Airfield Safety Waivers, etc.), may require periodic reviews and re-certification. Refer to Unified Facilities Criteria (UFC) 2-000-05N and other applicable versions, the NAVFAC Business Management System (BMS) for SARs, Installation Development Plan (IDP), other Systems Command (SYSCOM) and NAVFAC guidance, for additional information. (Complete this form using the PDF/electronic version and forward a copy of the final to all stakeholders for their records).

SECTION A - PROJECT INFORMATION (TO BE COMPLETED BY SAR POC)

Activity SAR Number: Date:

1. To:(Host Command): 2. From:(Sponsor):

3. Installation UIC: 4. Special Area Code: 5. SUID Code: 6. Building Number:

7.

Fiscal Year:

8.

eProjects Work Order No.:

9.

Project Amount($000):

10.

Navy "P" Number

11. Latitude: 12. Longitude: 13. Ground Elevation:

14. Project Name/Title: 15. Category Code:

16. Type of Project/Event (Check all that apply):

Repair Maintenance Construction Addition to Existing Facility Demolition

Event Change of Use (Category Code) Relocatable (Temporary Facility)

New Footprint Other (Specify)

NAVFAC 11010/31, Part I

Enclosure 1

17. Project/ Event Description:

NAVFACINST

11010.45A

NAVFACINST 11010.45A

18. Type of Request/Certification/Waiver and responsible authorities:

18(a) Category A, including events of temporary duration (e.g. Air Shows), and re-submittals:

YES NO

18(b) Category B SAR:

Airfield

Explosives

EMR (HERP/HERF/HERO)

EMR (EMI)

Radiological

Small Arms Range/Outdoor Live-Fire Range

Re-Submittal (Category B)

OTHER

N/A

18(c) Responsible authority(ies) for Category B SAR. (Check all that may apply):

Host Command (Category A)

FEC

REGCOM

NAVAIR

NAVSEA (NOSSA)

NAVSEA (NSWCDD)

NAVSEA (RASSO)

SPAWARSYSCEN (Atlantic)

CNIC

OPNAV

CNO

DUSD (I&E)

OTHER (Specify in Block 20)

N/A

18(d) Specify:

19. If construction related (or event), specify duration in which the certification, waiver, is required (Days/Weeks/Months). If "Permanent", so indicate. Otherwise, enter "Not Applicable":

20. Determination of Category of SAR, siting rationale, justification for request for endorsement, waiver, exemption, impact if not approved, etc:

23. Date SAR validated, forwarded for Signature/Endorsement/Certification, or Action Suspended:

24. Name/Title/E-mail Address(of PWD SAR POC):

25. Name/Title/E-mail Address (of SAR POC

SUPERVISOR):

SECTION B - PRELIMINARY EVALUATION OF CATEGORY B IMPACTS

(TO BE COMPLETED BY SAR POC)

NAVFACINST 11010.45A

NOTE: If Category A, skip Section B and C and complete applicable portions of Section D (Host Command Summary and Final Site Approval Request Action).

SECTION B(1) - AIRFIELD SAFETY

1. Is NAVAIR Airfield Safety Waiver required for a facility, construction, crane, or other event, including air shows.

Are there potential impacts to instrument approach/departure procedures? (If YES, complete Section B(1) and request NAVAIR airfield safety waiver and other clearance(s) via ICO memo using NAVAIR IBONS and other SYSCOM processes:

YES

NO

2. Is FAA OE/AAA (Notice of Proposed Construction) Required? (If YES, provide data to CPLO and attach FAA permit):

YES

NO

3.

Runway Number:

4. Select Runway Type (Class "A" or "B"):

5.

Airfield Elevation (ft):

For the following set of questions (Block 6 - 20), enter "N/A" for "Not Applicable", if that is the case:

6. Maximum Height of Facility (ft):

7. Maximum Height of Equipment at Location (ft):

8. Lateral Distance from Runway Centerline (ft):

9. Horizontal Distance to Runway Primary Surface (ft):

10.

Horizontal Distance from Clear Zone (ft):

11.

Horizontal Distance to Edge of Parking Apron (ft):

12. Allowable Height Based on Transitional Surface (ft):

13. Allowable Height Based on Approach-Departure Surface (ft):

14.

Allowable Height Based on Apron Clearance Criteria (ft):

15. Allowable Distance Based on Taxiway Clearance (ft)

16.

Existing Waiver Number

17.

Existing Waiver

18. Indicate Type of Construction Airfield Safety Waiver of interest. (Construction waiver includes request related to a facility violating airfield safety criteria):

Repair

Maintenance

Construction

Event (e.g. Air Show)

Other (Specify in Block 19)

Not Applicable

19. Airfield Safety Waiver (Other):

Contingency

Aids-to-Navigation

RDT&E

Other

20. If construction related (or event), specify duration of ASW (Days/Weeks/Months).

NOTE: A NAVAIR ASW is not a substitute for a UFC criteria waiver/exemption (e.g. Design waiver). The airfield safety waiver and FAA OE/AAA permit require coordination by AIROPS, Control Tower, CPLO, NAVREP, NAVFIG, CPLO, Base Security, Explosives Safety Officer, Base Communications, Public Works Utilities, etc. See Asset Management Bulletin 2013-03 for more information.

NAVFAC 11010/31, Part I

SECTION B(2) - EXPLOSIVES SAFETY

1. In coordination with Explosives Safety Officer, AIROPS, Port Ops, Base Communication, etc, are there potential impacts to/of explosives safety (or fuels)? (If there are no explosives safety impacts, check "No" and skip to next section).

YES

NO

2. What type of project or event is triggering review for explosives safety impacts?

(Select all that apply):

Repair

Renovation

Equipment Installation

Changes in operation(s)

New Construction

3. If there are explosives safety impacts, what type of NOSSA review is/are required for certification? (Select all that apply)

Construction Worker Authorization

Preliminary Explosives Safety Certification

Final Explosives Safety Certification

SAFER (Site Approval by Safety Assessment for Explosives Risk)

Deviation (from Explosives Safety Criteria)

NOTE (EXPLOSIVES SAFETY): Per Section B(2), if there are explosives safety impact(s), attach copy of NAVFAC 11010/31, Part I, GeoReadiness-generated Site Plan(s), and Automated Explosives Safety Site Planning (AESSP)-generated explosives quantity-distance arcs/maps endorsed by Explosives Safety Officer (ESO), etc. Forward request to NOSSA though ICO using WebSAR, the NOSSA online application for explosives SARS. WebSAR will automatically route and complete the NOSSA Part II, NOSSA Form 8020.22. Use this link for access to WebSAR.

SECTION B(3) - ELECTROMAGNETIC RADIATION (HERP, HERF, HERO & EMI) SAFETY

1. In coordination with Base Communication and the Spectrum Manager, are there potential EMR impacts (HERP, HERF, HERO, EMI)? (If there are no EMR impacts, skip to next section).

YES

NO

2.

System Location (Physical Address, and Zip Code):

3.

Type of Transmitter:

4. Distance to Nearest Fueling Facility Operation (ft). Enter N/A, if not applicable:

NOTE 1 (HERP, HERF, HERO): Attach copy of NAVFAC 11010/31, Part I, copy of EMR Data Form, site plan, etc., and forward the request for impacts of Hazards of Electromagnetic Radiation to Personnel (HERP), Hazards of Electromagnetic Radiation to Fuels (HERF), and Hazards of Electromagnetic Radiation to Ordnance (HERO) for all Navy site approval requests through the Chain-of-Command to Naval Surface Warfare Center, Dahlgren Division (NSWCDD), using the Electromagnetic Environmental Effects, E3 Online LINK, off the NSWCDD website.

NOTE 2 (EMI): Attach copy of NAVFAC 11010/31, Part I, copy of EMR Data Form, site plan, etc., and forward the request for impacts of Hazards of Electromagnetic Radiation, Electromagnetic Interference (EMI), for all Navy site approval requests through the Chain-of-Command to SPAWARSYSCEN Atlantic: SPACE AND Naval Warfare Systems Center, SPAWARSYSCEN Atlantic, ATTN CODE 59440, PO Box 190022, North Charleston, SC 29419-9022 (Phone: (843) 218-5273;

DSN: 588-5273)).

NAVFAC 11010/31, Part I

Enclosure 1 https://nossa.nmci.navy.mil https://e3.nswc.navy.mil

SECTION B(4) - SMALL ARMS RANGE

1. Does the project construct a new weapons range or add to the capacity of an existing weapons range.

YES

NO

2. In coordination with Weapons Officer, Range Safety Officer, Industrial Hygienist, Explosives Safety Officer, AIROPS, Port Ops, Base Communication, CPLO, etc, are there potential impacts on an existing range?:

YES

NO

NOTE (SMALL ARMS RANGE): If answer to Block 1 or 2 is "YES", attach copy of NAVFAC 11010/31, Part I, site plan, etc., and forward SAR memo to CNO through the Chain-of-Command.

SECTION B(5) - RADIOLOGICAL SAFETY

1. In coordination with activity CROPM (Contractor Radiological Oversight Program Manager), COT (the Contractor Oversight Technicians (COT), NAVFAC Safety Officer, Industrial Hygienist, Base Communication, etc., does the project install, impact, or provide capabilities for the operation of radioactive materials or radiation-generating devices? (If "NO", skip to next section).

YE

S

NO

NOTE (RADIOLOGICAL SAFETY): If answer to Block 1 is "YES", provide copy of NAVFAC 11010/31, Part I, site plan, etc., to activity CROPM, per NAVFACINST 5104.1. The CROPM will initiate memo for approval by by ICO or NAVSEA/ Radiological Affairs Support Office (RASO), depending on determination by CROPM and COT at the installation.

SECTION B(6) - ADDITIONAL COMMENTS

1. Provide name of organization at Activity and POC, and comments:

2. Provide name of organization at Activity and POC, and comments:

3. Provide name of organization at Activity and POC, and comments:

NAVFAC 11010/31, Part I

SECTION C - FEC/LANT/PAC/SYSCOM EXTERNAL REVIEW FOR

CATEGORY B SAR (TO BE COMPLETED BY REVIEW/ENDORSEMENT/

CERTIFICATION AUTHORITY)

NAVFACINST 11010.45A

In accordance with NAVFAC Instruction 11010.3/11010.45A, for program management and reporting purposes, please provide a brief summary of your review actions on this form, prior final review and approval of SAR by the ICO (in Section D). Please make a copy and attach to NAVFAC SAR package, if additional reviews are required by agency(ies)).

1. Review Agency (Name of Agency) 1(1) Date Received

1(2) Summary Evaluation of Category B SAR:

1(3) Reviewer's Name/Code/Phone No./E-Mail Address: 1(4) Date Forwarded

2. Review Agency (Name of Agency) 2(1) Date Received

2(2) Summary Evaluation of Category B SAR:

2(3) Reviewer's Name/Code/Phone No./E-Mail Address: 2(4) Date Forwarded

3. Review Agency (Name of Agency prior to submittal to ICO) 3(1) Date Received

3(2) Summary Evaluation of Category B SAR:

3(3) Final Determination by Review/Endorsement/Certification Organization/Agency

Endorsed/Certified (Forwarded to Activity)

Not Endorsed (Activity to Re-Submit)

Not Endorsed (Returned to Activity)

3(4) Reviewer's Name/Code/Phone No./E-Mail Address: 3(5) Date Forwarded to

ICO

SECTION D - HOST COMMAND SUMMARY & FINAL SITE APPROVAL ACTION

1. Date Received 2. What Category SAR? (If A, proceed to Block 5:

A B

3. Category B SAR Endorsement/Certification Received from (Attach copy of documentation):

FEC NAVFAC LANT NAVFAC PAC REGCOM NAVAIR NAVSEA (NOSSA) NAVSEA (NSWCDD)

NAVSEA (RASO) SPAWARSYSCEN (Atlantic) CNIC OPNAV CNO DUSD (I&E) OTHER

4. Type of Category B SAR Endorsed/Certified

4(1). Airfield Safety Waiver (ASW

Repair

Maintenance

Construction

Contingency

Aids-to-Navigation

RDT&E

Other Event

Not Applicable

4(2). Explosive Safety Certification

Construction Waiver Authorization

Preliminary Explosives Safety Certification

Final Explosives Safety Certification

Not Applicable

4(3). Electromagnetic Radiation (NAVSEA)

HERO

HERP

HERF

Not Applicable

4(4). Electromagnetic Radiation (SPAWARSYSCEN (Atlantic))

EMI

Not Applicable

4(5). Small Arms Range Safety

YES

Not Applicable

4(6). Radiological YES

Not Applicable

5(1). Duration/Begin Date. (Enter N/A if Not Applicable):

5(2). Duration/End Date. (Enter N/A if Not Applicable):

6. If SAR is being recommended for approval (with/without condition(s), briefly state:

7. Recommendation by Public Works Officer, Asset Management Branch Head, or Delegated Authority (Name/Title/E-mail Address/Signature):

8.

Date:

NAVFAC 11010/31, Part I

9. Host Command Final Decision on Site Approval Request (*Select one action item):

Approved Disapproved Deferred/Returned

10. Comments

11. Name/Title/Signature of ICO (or Delegated Authority):

12. Date

*To be signed by Installation Commanding Officer (ICO), or Delegated Authority, for both Category A and B SAR. To complete the electronic signature, sign using your DOD CAC card, then lock the document. Signature should be visible on the completed form.

For addition information and assistance, visit the Site Approval Request webpage on the HQ NAVFAC/Asset Management portal (https://hub.navfac.navy.mil/webcenter/portal/am/).

(Version 2.0) 17 May, 2018 https://hub.navfac.navy.mil/webcenter/portal/am/page1848/page139?_afrLoop=191605820565554&addToRoster=y&_adf.ctrl-state=16mw1wkvgy_4#!%40%40%3F_afrLoop%3D191605820565554%26addToRoster%3Dy%26centerWidth%3D100%2525%26lastReviewedDate%3D10%252F02%252F14%26leftWidth%3D0%2525%26pocEmail%3Dkofi.newman%2540navy.mil%26rightWidth%3D0%2525%26showFooter%3Dfalse%26showHeader%3Dfalse%26_adf.ctrl-state%3D1b6j68ci8u_117

Site Plan NF20-1644 (DLA Storage Facility)

8 FOOT HIGH

CHAIN LINK FENCE

BITUMINOUS CONCRETE AT

EXISTING PAVEMENT (TYP.) C-502

A2

BITUMINOUS CONCRETE

PAVEMENT (TYP.) C-502

A1

C-502

B1 CONCRETE WALKWAY

(TYP.)

REPAIR ALL DISTURBED

LANDSCAPE AREAS WITH

LOAM AND SEED (TYP.)

LANDING AT

BUILDING ENTRANCES

(TYP.)

C-502

A5

4.5' X 2.5' CONCRETE

EQUIPMENTC-502

B5

BOLLARD

(TYP. @ 4)C-502

C1

LANDING AT BUILDING

ENTRANCES (TYP.)C-502

A5

C-502

B1CONCRETE WALKWAY

(TYP.)

REPAIR ALL DISTURBED

LANDSCAPE AREAS WITH

LOAM AND SEED (TYP.)

MATCHLINE

SEE SHEET C-106

CANTILEVERED

SLIDING GATEC-503

C1

BITUMINOUS CONCRETE AT

EXISTING PAVEMENT (TYP.) C-502

A2

BITUMINOUS CONCRETE A1

5.

0'

2.

0'

4.5'12.0'9.5'12.0'4.5'

5.

0'

5.0' 5.0'

4' SINGLE LEAF SWING

GATE W/ LATCH AND

DROP BARS

C-503 A1

C-503 A1

BOLLARD

(TYP. @ 4)C-502

C1

3.0'

3.

0'

R6.0'R6.0'

R6.0'

R3.0'

.0

12.0'

.0

11.0'

C-503 A3

C-503 B3

25.0'

SATISFACTORY TO DATE

APPROVED

ACTIVITY

FOR COMMANDER NAVFAC

SEAL

A/E INFO

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B

C

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NLEGEND

NOTES:

1. DIMENSIONS SHOWN OFF THE BUILDING ARE FROM THE EXTERIOR

FACE OF THE FOUNDATION WALL.

2. DIMENSIONS SHOWN IN THE PARKING LOTS AND ROADWAYS ARE

FROM THE FACE OF CURB, CENTERLINE OF STRIPING, AND EDGE OF

PAVEMENT.

3. DIMENSIONS SHOWN IN THE CONCRETE WALKWAYS ARE FROM

SCORE JOINTS, EXPANSIONS JOINTS, AND EDGE OF CONCRETE.

4. COORDINATE THE EXACT LOCATION OF THE MECHANICAL

EQUIPMENT AND PAD WITH THE MECHANICAL PLANS. CONFIRM PAD

SIZE WITH THE SELECTED PRODUCT(S) PRIOR TO INSTALLING.

5. SEE ARCHITECTURAL PLANS FOR EXACT BUILDING DIMENSIONS

AND LOCATIONS OF DOORS.

6. INSTALL SITE FEATURES AND FURNISHINGS TO MEET ABA

REQUIREMENTS FOR ACCESSIBILITY. NOTIFY THE CONTRACTING

OFFICER OF POTENTIAL CONFLICTS PRIOR TO INSTALLING.

7. PRIOR TO SOIL REUSE AND/OR DISPOSAL, OBTAIN APPROVAL FROM

NAVFAC PW: NSB-NLON ENVIRONMENTAL RESTORATIONS DIVISION PER

SUBASENLON INSTRUCTIONS, POLICIES, AND PROCEDURES.

CONCRETE EQUIPMENT PAD

CONCRETE WALKWAY

SEED

BOLLARD

LA

YO

UT

A

ND

M

AT

ER

IA

LS

P

LA

N I

1" = 10'

C-105

B

PROPOSED BUILDING

BITUMINOUS CONCRETE

PAVEMENT

CHAIN LINK FENCE

OVERHEAD ROLLER GATE

12848440

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CONNECTICUT COORDINATE SYSTEM (NAD83 2011 (EPOCH 2010.00)

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STATION #1 SPIKE SET N 703304.26 E 1183256.08 ELEV=24.91

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STATION #3 SPIKE SET N 703184.01 E 1183200.42 ELEV=22.06

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NAVFAC MIDLANT

Approximately 30 SY of sidewalks will be constructed adjacent to the new facility. The sidewalks lead from the east and west pedestrian exit doors and connect to the pavement on the south side of the building. Approximately 100 SY of pavement will be constructed on the south side of the building. The new pavement will connect building to the DLA access roadway.

Electrical service will be run underground and will be fed from DLA building 549 (Fuel Operation Building). Sewer and telecommunictions will enter the building on the south side and connect to existing sewer and telecommunications utilities.

A new sliding gate will also be installed at the entrance to the DLA site and approximately 95 LF of security fencing will be installed.

3(d) Any project, real estate action, or proposed use of property that proposes changing the functional use of a facility, or the land use, or physical layout of an area.

3(e) Any proposed use of property, permanent or temporary, that involves placing or removing a facility or structure.

This is a category A site approval (non-explosive safety)

Peter Daddona/Asset Management Branch Head/peter.c.daddona.civ@us.navy.mil