HomeMy WebLinkAbout2019 Encroachment PermitCITY OF
!;An WIS OBISPO
C A L I F 0 R N I A
Public Works Department - 919 Palm Street • San Luis Obispo, CA 93401-3218
Location: 1475 Sydney St
X-streets: Johnson, Augusta
Project Name: Sewer lateral replacement
Contractor:
Sewer: T: 0 B: 5
Mark Alonzo Construction (SLO Trenchless)
Mark Alonzo
805-801-2616
_ Frontage Improvements Complete/Upgraded
_ Curb Ramp Complete/Upgraded
_ City Fiber _ Bus Route ✓ Sewer Wye
ENCROACHMENT PERMIT
Right of Way
ENCR-4339-2019
USA#: N/A
Other permits required:
Bldg Dept
Description of Work:
Replace sewer lateral to the main in the sideyard easement using trenchless
technology. Trenchless lateral replacements require a video submittal (on
USB) after replacement. All work to be done to City Standard Specifications &
Engineering Standards. Contact the Public Works inspection hotline at
805-781-7554 two working days prior to the start of work and one working day
prior to each subsequent inspection. Permittee is responsible for calling for
final inspection so the permit can be closed. Also, please contact the Utilities
Department at 805-781-7215 to coordinate wye installation two working days in
advance.
All work performed within the right-of-way shall conform to the City of San Luis Obispo Engineering Standard Details
and Standard Specifications.
You are responsible for liability for personal injury and / or property damage caused by this work or your failure to do what you are
obligated to do. If a claim of such liability is made against the City or any of its departments, officers, or employees, you shall, and
hereby agree to, defend and indemnify the City and hold the City harmless from any claims, including costs of defense and attorney
fees.
All work shall be completed and the right-of-way restored by: August 02, 2019
AGREEMENT: I have read this permit and acknowledge receipt of the City of San Luis Obispo Encroachment Permit
General Provisions and _ pages of attached special conditions which I have read, agree to, and acknowledge as a
part of this per
S1gnature Date
Print Name
ImBLI RKS
Issued By Dat
Final Inspection By Date
UL� The City of San Luis Obispo is committed to include the disabled in all of its services, programs and activities.
Telecommunications Device for the Deaf (805) 781-7410.
Water Pollution Prevention Tracking Information
Municipal Stormwater BMP E.10.a Compliance Form
Construction Company:
Contractor's License Num.:
QSP Num (for SWPPP):
Responsible Person:
Mailing Address:
Office Phone Number:
Cell Phone Number:
Email Address:
Water Pollution Control Manager Information
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Project Information
Project Location: S S
Description of Work:
tP
W
Distance to Nearest Creek or Storm Drain:
Area of Disturbance
Construction Phase (circle one) / Off -Site On -Site
Construction Permit Type (completed by City Staff)
❑ Encroachment Permit Permit Number:
❑ Building Permit
❑ Capital Improvement Plan
Date Permit Issued:
Estimated Completion Date:
Permit Number:
Spec. Number:
Construction Permit Status (completed by City Staff)
Pollution Prevention Plan Type (completed by City Staff)
❑ SWPPP Approval Date:
❑ WPCP (Included with Plans) Approval Date: V
❑ WPCP (Minor) Approval Date:
S5-
Water Pollution Control Plan for Minor Projects
Best Management Practices (BMP)
BMP to be Implemented Standard BMP Description
Specification
Good Housekeeping BMPs
O
Equipment Maintenance
13-4.03C
Maintain, repair, fuel, storage location, inspect vehicles
❑x
_
Stockpile Management
13-4.03C(3)
Cover Stockpile, Place Waddles
Sweeping
13-4.03F
Sweep work area daily and prior to rain events
_
Spill Management
13-4.03
Plan and materials for mitigating spills onsite
Waste Management BMPs
❑x
Saw -cut Slurry
13-4.03E(7)
Vacuum slurry and contain
❑x
Washout
13-9
Plastic lined washout areas for concrete and tools
9
Portable toilets
13-4.03D(4)
Provide and ensure secondary containment
0
Solid waste
5-1.31
Contain and remove trash from site daily
Work Specific BMPs (check and add all that apply)
❑ Creek Protection Controls 13-10 BMPs and Controls to protect adjacent waterways
❑ Storm Drain Inlet Protection 13-6 Gravel bags and entrance
❑ Construction Entrance 13-7 BMPs to eliminate tracking from construction site
U
BMP Maintenance
0 Inspect, Document, Clean & Repair Fin-1.03 Daily maintenance of required BMPs
Acknowledgment
I have read, understood, and agree to the requirements of:
1. This WPCP
2. City of San Luis Obispo's Engineering Standard and Specifications
3. State of California's General Construction Permit
I understand and agree that:
1. Additional BMPs maybe required during the course of the work to ensure the protection of local water quality
2. You must take corrective actions to protect local water quality
3. Failure to comply with all requirements could cause:
a. All construction work to be stopped until compliance is achieved
b. Permit to be revoked
c. Lose the privilege to work within the City right-of-way for 2 years
Water Pollution Control Manager
Water Pollution Control Manager Printed Name