6630204 - Excavation/Ground Disturbance Permit
  • PCL

    PCL

  • EXCAVATION/GROUND DISTURBANCE PERMIT

  • Start Date*
     / /
  • Permit expires*
     - -
  • Format: (000) 000-0000.
  • Utilities Present in Excavation Area*
  • Special Precautions/Requirements (Check Those That Apply)

  • COMPETENT PERSON CHECKLIST

  • Soil Classification*
  • Have all procedural requirements been met and documented?*
  • Is the excavation close to utilities, buildings, footings, pilings, source of vibration?*
  • Have utilities, etc., been located?*
  • Has a check for the previous excavations in the area been made?*
  • Have adequate supplies of equipment, PPE, shoring material, signs, barricades, machinery, etc. been assured and checked?*

  • Size of excavation:

  • Do vehicular and machinery operation patterns need to be changed?*
  • Will water removal operations/equipment be needed?*
  • Have trench boxes or trench shields been checked?*
  • Entrance/exit means (maximum travel distance to exit 25 ft. (7.62 m) Note: Sloping/benching for excavations deeper than 20 feet (6.1 m) must be designed by a PE.*

  • Note: Sloping/benching for excavations deeper than 20 feet (6.1 m) must be designed by a PE.

  • Date*
     / /
  • Should be Empty: