2024 Dig Permit - (Purpose) Template.pdf

Request for Permit to Excavate Date:_____________

From:

To:

Subject: REQUEST FOR EXCAVATION PERMIT PURSUANT TO:

1. Purpose and Date of Excavation: ________________________________________________________________________

2. Description & location of Excavation: (Attach sketch/plan) ______________________________________________________

3. Other Pertinent Information: ______________________________________________________________________________

Const. Rep. (CM/ET) Name & Phone Number: _________________________________________________________________

Contractor Rep. Name, Title & Phone Number: ________________________________________________________________

From: Public Works APWO To: _______________________________________ Date: ____________________

4. Approved, subject to completing “Other Actions Required” and the following change (s):

5. Disapproved, due to the following reasons:

Other Actions Required & Comments:

1. “Call Before You Dig” at 1-800-922-4455 or submit a E-Ticket at https://www.cbyd.com/.

2. Contact (860)367-3854 to identify Navy owned phone lines (Fiber optic or copper & voice or data).

3. Is dig location in or near a Subase Installation Restoration (IR) site? (Yes No )

If “Yes”, STOP HERE, you are required to contact the Subase Environmental Div., IR Program Manager at 860-694-5164 for further information before continuing.

3a. Preliminary IR Approval Attached & Validated within past year? (Yes No N/A )

Signature by IR Program Manager required before continuing: _________________________________________________

4. Diving involved? (Yes No ) Refer to MOA RSG-NRMD-4

5. Is location in a RADCON site? Yes No , If “Yes”, STOP HERE, you are required to contact the NRMD RE at 860-694-1312, 860-694-1314, or 860-908-3974 for further information before continuing.

5a. Approved IR-RADCON Excavation PreDesign Form attached & validated within the past year? Yes No 5b Have radiological conditions changed? Yes No , (If “Yes” go to 5c below, If “No” go to 5d below.)

5c. DISAPPROVED, radiological conditions have changed and Release for Unrestricted Use surveys may be required.

Signed: ______________________ Date:________

5d. APPROVED, Release for Unrestricted Use has been completed or no radiological surveys are required for this excavation.

Signed: ______________________ Date:________

6. Return form to APWO for final approval. Is contracted utility line location required? (Yes No ) If “Yes”, STOP HERE, contact the Contracting Officer for further info.

6a. Preliminary Line Location Approval Attached & Validated within past year? (Yes No ) Signature by Contracting Officer required before continuing: ___________________________________________

7. See attached plan(s) for location of existing utilities. This Dig Permit & utility location drawing(s) must be on site during excavation.

8. Additional Comments/Requirements:

9. ALL DIGGING TO BE IN ACCORDANCE WITH ATTACHED SUBASE DIG PROCEDURE

PWD APWO Signature Subsurface Utility Technician Signature

Public Works, Contractor and Visitor personnel will promptly obey any posted, verbal or written radiological control instructions including “Stop Work” and “Evacuate” orders. Deviations outside of approved work areas must be resubmitted for evaluation.

Dig Permit Number:_____________

December 2022

SUBASE Digging Procedures

The signed copy of both pages of this dig permit including all enclosures must be at the site at all times when excavation is taking place. No excavation shall commence until all utilities are marked out. Any changes to the dig permit will require the approval of Public Works Facilities Asset Management Branch.

If any known or marked utilities cannot be located, notify Public Works Facilities Planning Division prior to beginning work in that area. In addition, if any unknown or unmarked utilities are found, notify Public Works Facilities Planning Division prior to continuing on with any work in that area.

These precautions are intended to prevent damage to underground utility lines and to prevent personnel injury due to contact with energized wiring and pressurized piping. We have made every attempt to identify all known utilities in the area specified on the dig permit. Please be advised that drawing locations could be off location as much as ten feet due to as-built conditions, drawing scale, or inaccurate record data. Drawing location errors could also be substantially more than ten feet in some areas and therefore extreme caution must be taken when excavating in the vicinity of electrical, steam or gas lines. There is also the possibility that unidentified lines may be encountered during excavation. These lines should be considered energized until Public Works Facilities Planning Division confirms the identity and the status of the lines. If unidentified buried concrete structures are encountered during excavation, it must be assumed that these could be energized concrete encased electrical duct banks and therefore work should cease until Public Works Facilities Planning Division identifies the electrical structure.

Digging within two feet of known buried utility lines must be done by hand only. For work immediately adjacent to or for excavations exposing a utility or other buried obstruction, excavate by hand. Start hand excavation on each side of the indicated obstruction and continue until the obstruction is uncovered or until clearance for the new grade is assured. Movement of construction machinery and equipment over pipes and utilities shall be minimized and in any case shall be at the contractor's risk.

Support uncovered lines or other existing work affected by the excavation until the Contracting Officer grants approval for backfill. Work adjacent to non-Government owned utilities shall be performed in accordance with procedures outlined by the utility company. Report damage to utility lines or subsurface construction immediately to the Contracting Officer.

Report all changes to design conditions and any errors identified on existing utility maps to Public Works Facilities Planning Division. These as-built changes will be incorporated into the database to ensure that plotted locations of buried utilities are accurate. Unless you are 100% sure this is a safe location call, “Call Before you dig.”

Soil reuse: Excavation work shall be documented on the soil tracking form provided as Attachment 1 of the SUBASE Soil Management SOP, and the completed soil tracking form shall be submitted to the PWD Environmental Division (EV) in accordance with the requirements detailed in the SOP. All excavated soil that can be reused at the immediate project site shall be placed back in the same location, i.e., excavated hole, from which it was removed. Excess soil that cannot be reused at the immediate project site must be tested by an accredited laboratory. Contact EV for specific testing requirements and for reuse criteria. If the digging area is located in or near an IR site, per Section 3 of the Request for Permit to Excavate, follow additional IR Site Excavation Procedures.

Unanticipated discoveries: In the event of an inadvertent discovery of archaeological deposits including human remains, monuments, artifacts, tools, or other similar archeological, Native American, or historic objects during excavation activities, immediately stop work, secure the site, and notify EV.

Work activities in the area of the resource(s) shall not resume without approval from EV.

IF YOU ARE A CONTRACTOR:

Please note that the people approving your dig permit are NOT contracting officers. They are not authorized to increase your contract scope or your reimbursement amount. If any requirements in this dig permit are perceived to exceed your contract requirements, do not proceed with the work until it is contractually resolved with your contracting officer.