Quantico Tower RFP - Attachment 2 - Excavation Permit Request.pdf

Public Works Branch, Requirements Section MCBO 11000.3 MCB Quantico, VA EXCAVATION PERMIT REQUEST FORM – Updated Sept 2011

Expiration date Of permit:___________ _ Permit # ______________ Date: ______________

1. REQUESTER:

NAME: ______________________

COMPANY: ______________ _ __________

PHONE: _______________________________

CONTRACT #____ ____________

Estimated Depth of Excavation ____ Ft.

Planned Mobilization Date _____________

Planned Completion Date _______________

2. LOCATION OF AREA TO BE EXCAVATED:

**(NOTE: A to-scale drawing of the excavation site must be submitted along with this form. Excavation route must be staked or flagged by the requester every 10 feet.)**

3. TYPE OF WORK TO BE PERFORMED: _______________________________________________________

4. MISC INFORMATION:

a. This excavation permit is used for any work that may disrupt underground utilities, communications, right of ways or any routine activities. Processing of this permit will take approximately 10-14 days. Requester must have an approved excavation permit prior to commencement of work & permit must be kept on-site.

b. If utilities or communications have been located in the area to be excavated, hand digging will be used within a 10-foot radius until the exact location of all lines have been determined. It is the responsibility of the requester to maintain the markings after utilities have been located and marked.

c. The Government reserves the rights to have on-site personnel present during excavation & will specify on this permit precautionary measures if needed.

d. The requester shall take reasonable precautions to protect from damage all existing improvements, utilities, communications, & vegetation at or near the work site. The requester shall be liable for all damages to persons or property that occurs as a result of the requester's fault or negligence.

* e. Emergency requests are delivered directly to Public Works Work Reception Office and/or FMS Utilities Shop for expeditious action. Requester is still required to contact Miss Utility, G-6, Ameresco, & HMX-1 Security (If applicable).

f. Any questions regarding this excavation permit may be directed to the PWB Requirements Section at (703) 784-1405. Any utility emergency encountered during excavation must be reported to the Base Trouble Desk (24/7) at 703-784-2072.

g. A Water Distribution System Permit is required in addition to this excavation permit for any and all connections to the MCB potable water distribution system.

Contact Patty Greek, Commodities Engineer, at (703) 432-2466, or in person at 2004 Barnett Avenue in the 2nd deck Engineering/Planning Suite.

h. Approval of this excavation permit does not constitute Government approval of any underlying development project that it supports.

"I HAVE FULLY READ AND UNDERSTAND THE ADVISORIES AND REQUIREMENTS NOTED ABOVE."

PERMIT EXPIRES**: ______________ PERMIT#:______________ DATE APPROVED:

Signature of requester/POC Date

5. REQUIRED ACTION: PLANNED MOBILIZATION DATE: ______________

PERMIT#:______________ ESTIMATED DEPTH OF EXCAVATION: ______ Ft.

a. Requirements Office _________________ Work Order # _______________________

b. FMS M&R Utilities Shop Pipefitters ___________Date:________ Marked No Conflict

Linemen _______________Date:________ Marked No Conflict

c. Ameresco (Mainside, MCAF, OCS) _____ Marked No Conflict

d. G-6 _______Expires:______ Marked No Conflict

e. HMX-1 Physical Security (MCAF) ____

f. Miss Utility Work Order #___________

g. NREAB (NEPA Action) Approved _________________________ Disapproved Field Investigation Required

h. PWB Planning Office Approved ______________________ ___ Disapproved _______________________

i. PPV – Lincoln Property Company ______

DIRECTIONS FOR REQUESTER ACTION:

1. Requirements 3252 Barnett Ave.; Submit excavation permit applications to

(703) 784-1405 Requirements Section for processing at least 14 days prior to commencement of work. Requester MUST obtain an APPROVED permit prior to commencing work.

2. FMS 3252 Barnett Ave.; contact Maria Self if there are concerns or

(703) 784-1405 questions about Base-owned utilities prior to excavation.

3. Ameresco 7 Zeilin Rd (south end). POC: Alix Hidalgo or Jim McCoy.

(703) 630-0363 Emergency contact (571) 221-0153.

4. G-6 1999 Elliot Rd.; obtain signature from Assistant Chief of Staff,

(703) 784-2500 G-6, Telephone Branch. G-6 clearance must be updated every 10 days.

5. HMX-1 MCAF, Hangar 2134, Room W-127; obtain signature @ Physical Security

(571) 494-4959 Office.

6. Miss Utility Call Miss Utility at least 3 WORKING DAYS IN ADVANCE of excavation.

Call 811 Provide them an address of the area to be excavated; they will issue a ticket number to the requestor. Each prime contractor and each subcontractor MUST have their own Miss Utility Ticket Number, regardless of who holds this Quantico permit. Miss Utility clearance must be updated every 15 days.

7. NREAB/PWB Requirements will forward all excavation permit applications to Planning/PPV the Natural Resources & Environmental Affairs Branch (NREAB) for

National Environmental Policy Act (NEPA) review, to the Public Works Branch (PWB) Planning Office for site approval and/or architectural review, and to Lincoln Property Company for approval in Public Private Venture (PPV) military housing areas, as applicable.