Utility Connection Permit Application.pdf

September 28, 2021

MEMORANDUM

From: PWC Code 600 To: _____________

Subject: Utility Connection Permit Application

Ref: (a) PWCNORVA INSTRUCTION 11300.10F

Enclosed: (1) Utility Permit Connection Application

(2) Utility Permit Connection Instructions

1. In accordance with reference (a), Enclosures (1) and (2) are forwarded per your request for a utility connection. Please fill out the application completely according to the instructions. Submit the completed enclosure (2) and construction or design drawings and specifications to PWC Code 600 for review and approval.

2. If the application is acceptable, a permit will be issued by memo to the requesting activity. If the proposed utility work is not acceptable, the requestor will be notified of specific changes or additional information needed. Response time to the application is within 30 days. If actual construction of permitted utility connections differ from the approved application, PWC Utilities must be notified of these changes.

3. Digging permits are required prior to any excavation work being performed to allow for locating and marking existing utilities in the area. A digging permit must be requested by calling 445-8558 ext. 329. If a Utility Connection Permit (UCP) is required for work associated with the excavation, a digging permit will not be granted unless the requestor has been issued a UCP.

4. If there are any questions or if additional information is needed, please contact me at 445-8558 ext. 318.

Signature

UTILITY CONNECTION PERMIT APPLICATION Tracking #:___________

SECTION A - GENERAL INFORMATION

1. Requesting Activity: ____________________________________________________

2. Point of Contact: _____________________ Phone Number: ___________________

3. Project Location: _______________________________________________________

4. Type of Work: (Check all that apply.)

New Construction Building Addition Renovation

Demolition/Utility Disconnection Repair Utility Upgrade

5. Work will involve the following utilities: (Check all that apply.)

Water Sewer Electric Steam Gas

a. If Sewer is checked, will the connection be permanent or temporary?

Permanent Temporary (Proceed to question 6)

b. If a permanent connection is required and this project involves construction, contact the NAVFAC XXXXXX Environmental Business Line (Code EV) to determine if CTC/CTO is required before proceeding.

6. Work to be performed by:

ROICC Contract NAVFAC XXXXXX Maintenance Department Contract NAVFAC XXXXXX Utilities and Energy

Management Product Line Other: ______________________________________________________________

7. Contract Title:_________________________________________________________

Contract/J.O./MAXIMO Number: ______________Drawing Number: _____________

NAVFAC FEAD Design Activity Other:____________

NOTE: Submit a complete set of drawings with the application. Include specifications if available.

SPECIFICATIONS INCLUDED: YES NO

DESIGN CALCULATIONS INCLUDED: YES NO

8. Designed by Firm/Activity:_______________________________________________

Point of Contact: _____________________________ Phone: _________________

9. Submitted by: (This is usually the Engineer in Charge (EIC) or AIC.):

Name: __________________________ Signature: ___________________________

Title: __________________ Request Date: ________ Phone: __________

10. Reviewed by:__________________________ Date:________

Approved Disapproved

SECTION B - WATER

PART A - DOMESTIC WATER SERVICE CONNECTIONS

Complete the following for all domestic water service connections to water distribution system lines.

1. Number of Domestic Water Service Connections

(a) Existing service connections disconnected from water line __________

(b) New service connections connected to water line ___________

2. List the following for all new domestic water service connections to water distribution system lines. See Instructions for clarification.

(a) Pipe Size(s) _________________________________________

(b) Pipe Material(s) _________________________________________

(c) Pipe Class or Schedule _________________________________________

(d) Required Capacity (in gpm) _________________________________________

(e) Required Pressure (in psi) _________________________________________

(f) Meter Size(s) _________________________________________

(g) Meter Type(s) _________________________________________

(h) Backflow Preventer (Yes/No) _________________________________________

PART B - FIRE PROTECTION (HIGH PRESSURE/NON-POTABLE) WATER SERVICE

CONNECTIONS

Complete the following for all fire protection (high pressure/non-potable) water service connections to fire protection system lines.

1. Number of Fire Protection (High Pressure/Non-Potable) Water Service Connections

(a) Number of existing service connections disconnected from fire protection line _________

(b) Number of new service connections connected to fire protection line

2. List the following for all new fire protection (high pressure/non-potable) water service connections to fire protection system lines. See Instructions for clarification.

(a) Pipe Size(s) ________________________________________

(b) Pipe Material(s) ________________________________________

(c) Pipe Class or Schedule ________________________________________

(d) Required Capacity (in gpm) _________________________________________

(e) Required Pressure (in psi) _________________________________________

(f) Backflow Preventer (Yes/No) _________________________________________

SECTION C - SANITARY SEWER

PART A - SANITARY SEWER LATERAL CONNECTIONS

Complete the following information for work involving all sanitary sewer lateral connections to sanitary sewer mains.

1. Number of Sanitary Sewer Laterals

(a) Existing laterals disconnected from sanitary sewer main __________

(b) New laterals connected to sanitary sewer main __________

2. List the following for all new sanitary sewer lateral connections. See Instructions for clarification.

(a) Pipe Size(s) _________________________________________

(b) Pipe Material(s) _________________________________________

(c) Pipe Class or Schedule _________________________________________

(d) Total Added Design Capacity (gpm)____________________________________

3. Type of Discharge from New Sanitary Sewer Laterals

(a) Building Type: (Check all that apply)

Office Residential Housing Recreational Warehouse Food Service Fuel Depot Commercial Barracks Trng. Facility Medical Industrial Aircraft Hangar Other (Specify)________________________________

(b) Indicate below any of the operations occurring in the above buildings: (Please check all that apply. If none of these apply, check N/A.)

N/A Food Preparation Operations Photo Processing or X-Ray Operations Laboratory or Clinics Industrial Laundry or Dry Cleaning Printing Operations (other than copy machines for office use) Handling or Collecting Used Oils, Solvents, Degreasers, or HW Grease Traps

PART B - SANITARY SEWER MAINS

Complete the following information for work involving all sanitary sewer mains.

1. Number of sanitary sewer manholes abandoned __________

2. Number of sanitary sewer manholes installed __________

3. Linear feet of sanitary sewer main abandoned __________

4. Linear feet of sanitary sewer main installed __________

5. List the following for all new sanitary sewer mains:

(a) Pipe Size(s) _____________________________________________________

(b) Pipe Material(s)_____________________________________________________

(c) Pipe Class or Schedule_______________________________________________

PART C - SANITARY SEWER PUMP STATIONS

Complete the following information for work involving all sanitary sewer pump stations.

1. Number of sanitary sewer pump stations abandoned __________

2. Number of sanitary sewer pump stations installed __________

3. Number of pumps installed at each pump station _________________________

4. Size of each pump installed ____________________________________________

5. Attach details for pump station cut sheets, pump/ system curves, visible and audible alarms/ channels, bypass pump connections, valve and check valve connections, and wet well level monitoring systems.

SECTION D - ELECTRIC

PART A - PRIMARY

If the work involves the primary, complete the following:

1. System Voltage: 34.5 KV 19.9KV 13.2 KV 11.5 KV

4.16 KV 2.4 KV 2.3 KV

TRANSFORMER:

2. Installation: New Upgrade Existing Repair

3. Type: Pad mount Unit Substation Pole mount Station

4. Primary BIL: 200 KV 150 KV 95 KV 60 KV Secondary BIL: 150 KV 95 KV 60 KV 30 KV

5. Rating:_______________KVA

6. Primary Connection: Live Front Dead Front

PRIMARY CONNECTION:

7. Overhead Underground

8. Conductor Size: ____________ Copper Aluminum

9. Type: _______________________________________

10. Insulation Level: 133% 100%

11. Point of Connection to Utility: (Check all that apply)

Existing Distrib. Switch Splice in Manhole Overhead Line Tap

New Distribution Switch Other. (Specify.) _____________________

Primary Circuit to be connected to (if known):_________________________

PART B - SECONDARY

If the work involves the secondary, complete the following:

12. Installation: New Upgrade (Load study required) Repair

13. Transformer Load Study Performed: Yes (Provide) No - Date expected:

14. Watt-hour meter: Form________________________________________________

Type: Transformer rated Self-contained

SECTION E - STEAM

1. Purpose of new line/service: (Please check all that apply.)

Building Heating Water Heating AC/Humidity Control Other (Specify)_______________________________________________________

2. Size of New Line_________________________________________________________

3. Size of Existing Line at Connection Point________________________________

4. Required Capacity (lbs./hr.)_____________________________________________

5. Required Pressure (psi)__________________________________________________

6. Meter model/size: _______________________________________________________

SECTION F - NATURAL GAS

1. Size of New Line_________________________________________________________

2. Size of Existing Line at Connection Point________________________________

3. Pipe Material____________________________________________________________

4. Required Capacity _______________________________________________________

5. Required Service Pressure________________________________________________

6. Meter model/size:________________________________________________________

Enclosure (2)

INSTRUCTIONS FOR COMPLETION OF A UTILITY CONNECTION PERMIT APPLICATION

All questions must be answered. DO NOT LEAVE BLANKS. If a question is not applicable, indicate so on the form. Instructions for answering the questions on the permit form are given below.

SECTION A - GENERAL INFORMATION

1. Enter the name of the activity having financial responsibility for the facility being served by the proposed utility work.

2. Enter the name and phone number of an activity point of contact responsible for the proposed utility work.

3. Enter the building number and name that is served by the proposed utility work.

4. Check the categories that correspond to the majority of the work. Abandonment of utilities should be considered demolition. Check all that apply.

5. Check each utility that is being altered, added, or upgraded. For each utility checked, please complete the appropriate section in the application. For telephone connections, please contact Activity Providing Telecommunications Service Department, Code N-36, NAVCTAMSLANT Norfolk at 322-2069

6. Indicate the activity performing the construction or responsible for the administration of the construction contract.

7. Indicate the project title. Enter the construction contract number or job order number that identifies the construction project. Enter the NAVFAC, PWC, and/or design activity drawing number. Indicate the type of drawing (e.g. NAVFAC, PWC, etc.) Attach all existing design drawings or sketches showing proposed work to the utility systems. Indicate if specifications are included.

8. Enter the name of the organization, a point of contact, and a phone number for the party responsible for the design of the proposed work.

9. Enter the name, job title, application submission date, phone number, and signature of the EIC OR AIC completing the application.

SECTION B - WATER

PART A - DOMESTIC WATER SERVICE CONNECTIONS

1a. Enter the number of existing domestic water service connections disconnected from the PWC Code 600-owned water distribution system involved in the proposed work.

1b. Enter the number of new domestic water service connections connected to the PWC Code 600-owned water distribution system involved in the proposed work.

2a. Indicate the size(s) of the water pipe to be tied into the domestic water distribution system.

2b. Indicate the type(s) of water pipe material to be tied into the domestic water distribution system (e.g.

ductile iron, PVC, copper).

2c. Indicate the class of water pipe that is to be tied into the domestic water distribution system (e.g.

Class 150, Class 250, Schedule 40, Schedule 80).

2d. Indicate the design capacity for all new domestic water service connections tying into Code 600-owned water lines.

2e. Indicate the design pressure for all new domestic water service connections tying into Code 600-owned water lines.

2f. Indicate the size(s) of the water meter to be installed.

2g. Indicate the type(s) of water meter to be installed (e.g. positive displacement, turbine, dual flow).

2h. Indicate whether a backflow prevention device is to be installed.

PART B - FIRE PROTECTION (HIGH PRESSURE/NON-POTABLE) WATER SERVICE

CONNECTIONS

1a. Enter the number of existing fire protection (high pressure/non-potable) water service connections disconnected from the PWC Code 600-owned fire protection water distribution system involved in the proposed work.

1b. Enter the number of new fire protection (high pressure/non-potable) water service connections connected to the PWC Code 600-owned fire protection water distribution system involved in the proposed work.

2a. Indicate the size(s) of the water pipe to be tied into the fire protection (high pressure/non-potable) water distribution system.

2b. Indicate the type(s) of water pipe material to be tied into the fire protection (high pressure/non-potable) water distribution system (e.g. ductile iron, PVC, copper).

2c. Indicate the class of water pipe that is to be tied into the fire protection (high pressure/non-potable) water distribution system (e.g. Class 150, Class 250, Schedule 40, Schedule 80).

2d. Indicate the design capacity for all new fire protection (high pressure/non-potable) water service connections tying into Code 600-owned fire protection water lines.

2e. Indicate the design pressure for all new fire protection (high pressure/non-potable) water service connections tying into Code 600-owned fire protection water lines.

2f. Indicate whether a backflow prevention device is to be installed.

SECTION C - SEWER

PART A - SANITARY SEWER LATERAL CONNECTIONS

1a. Enter the number of existing sanitary sewer laterals disconnected from the PWC Code 600-owned sanitary sewer collection system involved in the proposed work.

1b. Enter the number of new sanitary sewer laterals connected to the PWC Code 600-owned sanitary sewer collection system involved in the proposed work.

2a. Indicate the size(s) of the sanitary sewer pipe to be tied into the sanitary sewer collection system.

2b. Indicate the type(s) of sanitary sewer pipe material to be tied into the sanitary sewer collection system (e.g. ductile iron, PVC).

2c. Indicate the class or schedule of sewer pipe that is to be tied into the sanitary sewer collection system (e.g. DR 35, DR 18, SDR 32.5, SDR 17).

2d. Indicate the design capacity for all new sewer laterals connected to code 600-owned sanitary sewer collection system.

3a. Check all building types that will be served by the proposed sanitary sewer connections. If there is a building type that applies and is not listed, check "Other" and indicate type of building.

3b. Check all choices that may discharge to the sanitary sewer through the proposed connections. If none of these apply, check "N/A."

PART B - SANITARY SEWER MAINS

1. Enter the number of sanitary sewer manholes abandoned in the proposed work.

2. Enter the number of sanitary sewer manholes installed in the proposed work.

3. Enter the quantity (in linear feet) of sanitary sewer main abandoned in the proposed work.

4. Enter the quantity (in linear feet) of sanitary sewer main installed in the proposed work.

5a. Indicate the size(s) of the sanitary sewer pipe to be used for the new sanitary sewer main.

5b. Indicate the type(s) of the sanitary sewer pipe material to be used for the new sanitary sewer main (e.g. ductile iron, PVC).

5c. Indicate the class of pipe that is to be used for the new sanitary sewer main (e.g. DR 35, DR 18, SDR

32.5, SDR 17).

SECTION D - ELECTRIC

PART A - PRIMARY ELECTRICAL SYSTEM

Complete this section only when a new transformer is being installed or when an existing transformer is being upgraded, relocated or repaired.

1. Check the primary system to be added to or modified.

2. Indicate if the job is to install a new transformer or to upgrade or repair an existing transformer.

3. Indicate the type of transformer to be installed.

4. List the BILs for the primary and secondary side of the transformer.

5. Indicate the transformer rating in KVAs.

6. Indicate if primary connection will be live front or dead front.

7. Indicate if primary connection is overhead or underground.

8. Indicate the size of the conductors to be installed.

9. Indicate type of the conductors (e.g. ERP, XLP).

10. Check the insulation level of the conductors.

11. Indicate if the connection to the utility is to be a termination on an existing distribution switch, a primary cable splice in a manhole, a tap to an existing overhead circuit, or a new distribution switch. If the connection to the utility is by some means other than those listed, check other and indicate the proposed method. Indicate primary circuit to be tapped if known. Use PWC Utility Department circuit designations.

PART B - SECONDARY ELECTRICAL SYSTEM

12. Indicate if work is to install a new transformer and secondary load, or if work is to upgrade or repair an existing transformer due to a secondary load addition.

13. Indicate if a load study has been performed on the transformer that is having the secondary load increased. If yes, provide a copy of the study. If no, indicate when the study will be completed.

14. Indicate the watt-hour meter form and type to be provided.

SECTION E - STEAM

1. Check all services to be supplied by the proposed connection.

2. Indicate the size of the new steam line.

3. Indicate the size of the existing steam line to which service is to be connected.

4. Indicate the design capacity for the system to be supplied by the new connection.

5. Indicate the design pressure of the system to be supplied by the new connection.

6. Indicate model and size of meter being installed.

SECTION F - NATURAL GAS

1. Indicate the pipe size of the new gas line.

2. Indicate the pipe size of the existing gas line to which service is to be connected.

3. Indicate the pipe material of the new gas line to which service is to be connected.

4. Indicate the design capacity for the system to be supplied by the new connection.

5. Indicate the required service pressure for the system to be supplied by the new connection.

6. Indicate meter model and size to be installed.