HomeMy WebLinkAboutHealth Permit # 6/2/2010 NUMBER
COMMONWEALTH OF MASSACHUSETTS BHP-2010-0613
01 a e FEE
North Andover $100.00
Board of Health
BOWAB, LOUIS G JOYCE A BOWAB
SACidU4E
-------------------- --- NAME
44 MARIAN DRIVE
------------------------------------------------ADDRESS------------
IS HEREBY GRANTED A PERMIT
Trench for Soil Test Pits
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires September-02, 2010------_----unless sooner suspended or revoked.
----------------------------------------------------------------- Board of
June 02, 2010 ------------------ Health
--------------------------------
---------------- -------------I-----------------------------Board of Health Chairman
TOWN OF NORTH ANDOVER Permit Number
NORTH ANDOVER,.MASSACHUSETTS 01845
ttgrt*h Date Issued
O 4,�ea a O
Expiration Date
a ,N A At... ,Anp?
C Us
HEALTH E �
"t'O N OF NORT14 ANDOVER
HE I LT14 D PP RTMEN 9"
Jackie's Law Permit A 1Ca 1011
Pursuant to G.L. c. 82A §1 and 520 CAM 7,00 et seq.(as amended)
THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION
Name of Applicant I w t 14 Phone Cell
Street Address 6
City/Town MA ZIP
Name of Excavator(if different from applicant) Phone Cell
Street Address
City/Town MA ZIP
Name ofOwner(s)of Property Phone
Cell
Street Address " .._
71 /Town: MA ZIP
VIVO /Ki"k
Other Contact Permit Fee Received No Yes
Description,location and purpose of proposed trench:
Please describe the exact location of the proposed trench and its purpose(include a description of what is(or is intended)to
be laid in proposed trench(eg;pipes/cable lines etc..)Please use reverse side if additional space is needed,
Insurance Certificate#:
Name and Contact Information„of Insurer:
Policy Expiration Date: /— Jt o /
Dig Safe#:
Name of Competent Person(as defined 520 CMR 7,02):
Massachusetts Hoisting License#
License Grade: I 0a- Expiration Date:
BY SIGNING THIS FORM, THE APPLICANT, OWNER, AND EXCAVATOR ALL ACKNOWLEDGE
AND CERTIFY THAT THEY ARE FAMILIAR WITH, OR, BEFORE COMMENCEMENT OF THE
WORK, WILL BECOME FAMILIAR WITH, ALL LAWS AND REGULATIONS APPLICABLE TO
WORK PROPOSED,INCLUDING OSHA REGULATIONS,G.L. c. 82A, 520 CMR 7.00 et seq.,AND ANY
APPLICABLE MUNICIPAL ORDINANCES, BY-LAWS AND REGULATIONS AND THEY COVENANT
AND AGREE THAT ALL WORK DONE UNDER THE PERMIT ISSUED FOR SUCH WORK WILL
COMPLY THEREWITH IN ALL RESPECTS AND WITH THE CONDITIONS SET FORTH BELOW,
THE UNDERSIGNED OWNER AUTHORIZES THE APPLICANT TO APPLY FOR THE PERMIT AND
THE EXCAVATOR TO UNDERTAKE SUCH WORK ON THE PROPERTY OF THE OWNER, AND
ALSO,FOR THE DURATION OF CONSTRUCTION,AUTHORIZES PERSONS DULY APPOINTED BY
THE MUNICIPALITY TO ENTER UPON THE PROPERTY TO MONITOR AND INSPECT THE WORK
FOR CONFORMITY WITH THE CONDITIONS ATTACHED HERETO AND THE LAWS AND
REGULATIONS GOVERING SUCH WORK.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY
TO REIMBURSE THE MUNICIPALITY FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY
THE MUNICIPALITY IN CONNECTION WITH THIS PERMIT AND THE WORK CONDUCTED
THEREUNDER,INCLUDING BUT NOT LIMITED TO ENFORCING THE REQUIREMENTS OF STATE
LAW AND CONDITIONS OF THIS PERMIT,INSPECTIONS MADE TO ASSURE COMPLIANCE
THEREWITH,AND MEASURES TAKEN BY THE MUNICIPPALITY TO PROTECT THE PUBLIC
WHERE THE APPLICANT OWNER OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH
INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY
THE MUNICIPALITY.
THE UNDERSIGNED APPLICANT,OWNER AND EXCAVATOR AGREE JOINTLY AND SEVERALLY
TO DEFEND,INDEMNIFY,AND HOLD HARMLESS THE MUNICIPALITY AND ALL OF ITS AGENTS
AND EMPLOYEES FROM ANY AND ALL LIABILITY,CAUSES OR ACTION,COSTS,AND EXPENSES
RESULTING FROM OR ARISING OUT OF ANY INJURY, DEATH, LOSS, OR DAMAGE TO ANY
PERSON OR PROPERTY DURING THE WORK CONDUCTED UNDER THIS PERMIT.
APPLIC �GNATURE
DATE °A?
EXCAVATOR SIGNATURE(IF DIFFERENT)
DATE
OW ER'S SIGNATURE DIFFERENT)
DATE:
2 1 P a g e -
Summary offtavation and Trench Safety Regulation(520 CMR 14.00 et seq.)
This summary was prepared by the Massachusetts Department of Public Safety pursuant to Q,L,c.82A and does not
include all requirements of the 520 CMR 14.00. To view the full regulation and G.L.c.82A,go to www/mass.gov/dps
Pursuant to M.G.L. e. 82, § 10 the Department of Public Safety,jointly with the Division of Occupational Safety,
drafted regulations relative to trench safety. The regulation is codified in section 14.00 of title 520 of the Code of
Massachusetts Regulations, The regulation requires all excavators to obtain a permit prior to the excavation of a
trench made for a construction-related purpose on public or private land or rights-of-way, All municipalities must
establish a local permitting.authority for the purpose of issuing permits for trenches within their municipality,
Trenches on land owned or controlled by a public(state)agency requires a permit to be issued by that public agency
unless otherwise designated,
In addition to the permitting requirements mandated by statute, the trench safety regulations require that all
excavators,.whether public or private,take specific precautions to protect the general public and prevent unauthorized
access to unattended trenches. Accordingly,unattended trenches must be covered, barricaded or backfilled, Covers
must be road plates of least'/"thick or equivalent;barricades must be fences at least 6'high with no openings greater
than 4" between vertical supports; backfiilling must be sufficient to eliminate the trench. Alternatively, excavators
may choose to attend trenches at all times,for instance by hiring a police detail,securi
will be present during times when the trench will be unattended by the excavator, ty guard or other attendant who
The regulations further provide that local permitting authorities,the Department of Public Safety,or the Division of
Occupational Safety may order an immediate shutdown of a trench in the event of a death or serious injury;the failure
to obtain a permit; or the failure to implement or effectively use adequate protections for the general public. The
trench shall remain shutdown until re-inspected and authorized to re-open provided, however,the excavators shall
have the right to appeal an immediate shutdown. Permitting authorities are further authorized to suspend or revoke a
permit following a hearing. Excavators may also be subject to administrative fines issued by the Department of
Public Safety for identified violations.
Summary of 1926 CFR Subpart P-OSHA Excavation Standard
This is a worker protection standard,and is designed to protect employees who are working inside a trench,
summary was prepared by the Massachusetts Division Of-Occupational Safety and not OSHA his
Purposes only and does not constitute an official interpretation by OSHA of their regulafions for informer on T;and may not include all
aspects Of the standard.
For further information or a full copy of the standard go to www_os „v
Trench Definition per the OSHA standard:
• An excavation made below the surface of the grotutd,narrow in relation to its Iength.
fifteen
• In general,the depth is greater than the width,b
feet. ut the width of the trench is not.greater than
• Protective Systems to-prevent soil wall collapse are always required in trenches deeper t
required in trenches less man 5'deep when the competentperson determines that a hazard exists. Protection
options include: p than 5',and are also
o Shoring. Shoring must be used in accordance with the OS
equipment manufacturer's tabulated data,or designed by a registered professional engineer
HA Excavation standard appendices,the
o Shielding(Trench Boxes). Trench boxes must be used in accordance with the equipment
manufacturer's tabulated data,or a registered professional engineer.
o Slopirig or.Benching. In Type C soils(what is most
oxtend horizontally 1 `/feet for eve foot of trench deg th lly both encountered)the for excavation must
and'/foot for rY P
o A registered Professional g
engineer must design sides, �E soils,
20'in depth, Protective systems for all excavations greater than
continued
4 I P-a
e Ladders must be used in trenches deeper than 4'.
• Ladders must be inside the trench with workers at all times,and located within 25'of unobstructed
lateral travel for every worker in the trench.
• Ladders must extend 3'above the top of the trench so workers can safely get onto and off of the
ladder.
• Inspections of every trench worksite are required:
o Prior to the start of each shift,and again when there is a change in conditions such as a rainstorm.
o Inspections must be conducted by the competent person(see below).
• Competent Person(s)is:
• C ale(i.e.,trained and knowledgeable)in identifying existing and predictable hazards in the
trench,and other working conditions which may pose a hazard to workers,and
• Authorized by management to take necessary corrective action to eliminate the hazards. Employees
must be removed from hazardous areas until the hazard has been corrected.
• Underground Utilities must be:
• Identif=ied prior to opening the excavation(e.g.,contact Dig Safe).
• Located by safe and acceptable means while excavating.
• Protected,supported,or removed once exposed.
• Spoils must be kept back a minimum of 2'from the edge of the trench.
• Surface Encumbrances creating a hazard must be removed or supported to safeguard employees. Keep
heavy equipment and heavy material as far back from the edge of the trench as possible.
• Stability of Adjacent Structures:
• Where the stability of adjacent structures is endangered by creation of the trench,they must be
underpinned,braced,or otherwise supported.
• Sidewalks,pavements,etc.shall not be undermined unless a support system or other method of
protection is provided.
Protection from water accumulation hazards:
o It is not allowable•for employees to work in trenches with accumulated water, If water control such
as pumping is used to prevent water accumulation,this must be monitored by the competent person.
o If the trench interrupts natural drainage of surface water,ditches,dikes or other means must be used
to prevent this water from entering the excavation.
• Additional Requirements:
• For mobile equipment operated near the edge of the trench,a warning system such as barricades or
stop logs must be used.
• Employees are not permitted to work underneath loads. Operators may not remain in vehicles
being loaded unless vehicles are equipped with adequate protection as per 1926.601(b)(6).
• Employees must wear high-visibility clothing in traffic work zones,
• Air monitoring must be conducted in trenches deeper than 4'if the potential for a hazardous
atmosphere exists. If a hazardous atmosphere is found to exist(e.g.,02<19.5%or>23.5%,20%
LEL,specific chemical hazard),adequate protections shall be taken such as ventilation of the space.
• Walkways are required where employees must cross over the trench. Walkways with guardrails
must be provided for crossing over trenches>6'deep.
• Employees must be protected from loose rock or soil through protections such as scaling or
protective barricades.
5 P a g e -..._._._._.. .._._._...--
VIA
VISION' -7
CONDITIONS AND RE,QUIREMENTS PURSUANT T0`G.LC.*2A AND S2OCMR 7,O0etseq.
(as amended)
By signing the application,the applicant understands and agrees m comply with the following:
i '
No trench may,be excavated unless the requirements of sections 40 through 40D of chapter 82,and any
accompanying regulations,have been met and this permit is invalid unless and until said requirements
have been complied with by the excavator applying for the permit including,but not limited to,the �
establishment~.,valid excavation"^=^w=~m the underground plant damage prevention synteo oo
|i,
said� �
mm/ade�noJ/nom�|oo76Dofv6ay�r164ODI8OA0�| ' �
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Trenches may pose uoi8o{flmmt health and safety hazard. Pursuant tuSa*aoo1 of Ch 8Jufthe �
~_~~~~.,~^~^^.~~,=="^a^^""`^"",v�yvpnuu,�cu000ueuueuv�Umo¢�m�mokbo�mv��
reasonable effort tn eliminate any recognized safety hazard that may exist as a result of leaving said
open trench unattended. Excavators should consult°regulations promulgated Department of
Public Safety io order to familiarize themselves with the recognized safety hazards associated with �
excavations and open trenches and the procedures required or recommended by said department in
order to make every reasonable effort to elirmnate said safety hazards which may include covering,
G�. open trenches from accidental entry.
Persons engaging bo any in trenching operation shall familiarize themselves with the federal safety
standards promulgated"x the vcvupxnuom Safety and Health Administration vu excavations:29CFR
il026.650»t.00q,on�1cdQu&pa�p'Excavo600m».iv.
Excavators n��� ��v�
� � chapter, _� ^goperation who"uuzuov�ucgoro��mecUuu�nloqn�me�
uu ~: to l40e6u8oulyumplqyim86ddoalslicouu*dtoupmmtemoidequ/pooenthy the
Department of Public Safety pursuant to said chapter and this permit must be presented to said licensed
operator before any excavation/000mouau*ud'
V.
'
By applying fox
excavations:they have read and understands the regulations promulgated by the Department of Public Safety with
regard to construction related excavations and trench saf ty; (2)that he ha re d
federal safety standards promulgated by the Occupation e s ad an understands the
al Safety and Health Administration on
� .-'�~~ ^'~~'~^"=^seq. entitled Subpart ubpart P'Tu*uvuUouo"nx well uo any other
«mmxmadoo/*quo*m*otsosta6Do6e6hyVdamoni^ipu/ity;aod(3)d6utboimmvureufuud6u s with private property or Proposed excavation of a»(~ town
public . that forms the basis oY the permit application,complied with the rogv(r��c�Nn . om O'40Dof 8%A.
—
This permit shall b*posted in plain view on the site uf the trench, '
For additional iufbuuuduu please visit the Department uf Public Safety's vve6sit*/o
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