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Home My WebLink Aboutapplication/installation of utilities ____ _ . - �-� c + � ir - HC 5136 HENNEPIN COUNTY � }�� '� � � DEPARTMENT OF TRANSPORTATION � �� ' i 320 Washington Avenue South �I � Hopkins, Minnesota 55343 JUL I 8 I9�'� '' r- �, �!! APPLICATION FOR INSTALLATION OF U s J. � County Road No. Permit No. Municipality LOCATION AND/OR DESCRIPTION OF WORK Application is hereby made for permission to place, construct and thereafter maintain a along or across County Highway No. (from,at) to NAME of applicant Phone Address city state zip co e Party or organization performing work Address city state zip co e Phone (Business) Phone (Emergency) � 1. TYPE OF CONSTRUCTION—Submit five copies of detailed print showing type and location of installation. ❑ Underground ❑ Aerial ❑ Other 2. TYPE OF UNDERGROUND CONDUIT Size Depth Size Depth ❑ Multiduct ❑ Iron ❑ Plastic ❑ Copper ❑ Concrete ❑ Cable ❑ Steel ❑ other 3. METHOD OF INSTALLING UNDER ROADBEDS ❑ Boring—Jacking—Pneumagopher ❑ Casing—Required for all conduit exceeding 4 inches in diameter ❑ Open Cut—Explain why necessary 4. AREA TO BE DISTURBED TRAVELEDSURFACE SHOULDER BOULEVARD ❑ Concrete ❑ Bituminous ❑ Sod ❑ Bituminous ❑ Gravel ❑ Fieid Grass STRUCTURES ❑ Curb&Gutter ❑ Culverts ❑ Trees ❑ Sidewalk ❑ Road Signs ❑ Shrubs ❑ Signals ❑ Other 5. All work under this permit will be completed on or before Date (PERMIT IS VOID AFTER THIS DATE) If work cannot be completed within dates specified,a written request for permission of extension must be made to the Hennepin County Department of Transportation. Except for the negligent acts of the County, its agents and its employees,the Utility or Permittee shall assume all liability for and save the County, its agents and its employees, harmless from any and all claims for damages,actions or causes of action arising out of the work to be done herein and the continuing uses by the Permittee, including but not limited to the placing,constructing, reconstructing, maintaining and using of said utility under this application and Permit for construction. (1, We) the undersigned, herewith accept the terms and conditions of the regulations as laid down by the County of Hennepin and agree to fully comply therewith to the satisfaction of the Hennepin County Department of Transportation. Organization By Date � , /`' . . '... .. . , � .. PERTINENT REGULATIONS Safety 1. All warni�g devices and barricades shali conform to the Federal Highway Administration's manual on Uniform Traffic Control De- vices as amended by the State of Minnesota Manual Supplement. 2. All warning devices,barricades,flagmen and equipment shall be provided by parties or organizations performing the work. 3. Standard warning devices and barricades shall be placed as designated by the Hennepin County Department of Transportation. 4. Standard warning devices and barricades shall be kept clean and in good repair at all times. . 5. Detour routing shall require 72 hours advance notice to the Hennepin County Utility Sectio�. 6. Excavation shall be cribbed,sheeted and or fenced when necessary or as designed by the Hertnepin County Utility Section. 7. Indement weather shall be reason for delay of project start or suspension of project as determined by Hennepin County. OPERATIONS 1. Permit on Job — Permits or copies shall be kept on the site of the work while it is in progress in the custody of the individual in charge,and shall be exhibited upon request made by any county officiaL 2. Provisions and Specifications —These general provisions and specifications shall be considered as forming an integral part of each and every permit issued for operations on county roads.The work authorized by this permit shall be done at such time and in such manner as shall be consistent with the safety of the public and shall conform to all requirements and standards of the County of Hennepin as herein specified. If at any time it shall be found by the Hennepin County Department of Transportation that the work is not being or has not been properly performed,the permittee, upon being notified by the superintendent in writing, shall im- mediately take the necessary steps; at his own expense, to place the work in condition to conform to said requireme�ts or stan- dards. 3. Annulment — In the event of wilful failure or neglect by said permittee or his employees to perform and comply with the pre- scribed conditions, restrictions and regulations,the Department of Transportation may revoke and annul this permit and order said permittee to remove any and all structures or property belonging to said permittee from the legal limits of the highway or county property. In the event the permittee leaves the highway in a condition needing repair or construction the Hennepin County Depart- ment of Transportation may repair such highway and the costs of such repair or construction shall be paid by the permittee. 4. Execution —The permittee shall use diligence in the execution of the work authorized under this permit in order not to e�danger or unnecessarily obstruct travel along the said highway. Operations shall be so conducted at all times as to permit safe and reason- ably free travel over the roads within the limits of the work herein prescribed.All safety measures for the free movement of traffic shall be provided by the permittee at his own cost. 5. Conformity to Laws— The installation shall be made in conformity with all applicable laws,regulations and codes covering said in- stallations.All installations shall be made in conformity with regulations of governmental agencies for the protection of the public. 6. Removal — If at any time the permitted structure or facility shall fail from any cause whatscever,the permittee shall have the same removed or repaired within 48 hours after receipt of written notice to do so,unless by reason of some extraordinary happening the superintendent may extend such time limit. 7. Existing Facilities—Applicant must protect all existing utility installations. 8. Private Property —The work permit or permit for construction as issued does not in any vrdy imply an easement on private prop- erty. 9. Damage to Roadway — If pavement or roadway is damaged,same shall be restored to its original or satisfactory conditio�,at the sole expense of the permittee. 10. Quality of Work — Finished surface, base and sub-base of road upon completion of work shall be at least equal to or better than specifications or original road. 11. Cutting Trees —The permission herein granted does not confer upon the permittee the right to cut, remove, or destroy trees or shrubbery within the legal limits of the highway or relieve permittee from obtaining any consent otherwise required from the owner of the property adjacent thereto. 12. Boring or Jacking— Installation of pipe under roadways,shall be jacked or bored as designated by the Hennepin County Depart- ment of Tra�sportation. 13. Liner or Casing Pipe—Shall be required for 4"or larger conduit. 14. Pressure Grouting—Shall be required as designated by Hennepin County Department of Transportation. 15. Drainage—All waterways and lines of drainage shall remain operative. 16. Pole Anchors—No pote anchors,anchors,braces or other construction on right of way except by permit authorization. 17. Driving Limitatioru—No driving onto highway from ditch or driving on shoulders or over curbs where damage will occur. 18. Lugs on Equipment—No lugs shall be used on equipment traversing road which will damage the road surface. 19. Clean-up —Street surface and roadside shall be kept clean,neat and presentable throughout construction as approved by Hennepin County Department of Transportation. 20. Dust Control—Shall be provided upon request of the Hennepin County Department of Transportation. 21. Trees and Vegetation —Bu�ning or disking operations and or the use of chemicals to control or kill trees,brush and other vegeta- tion is prohibited witbout prior approval from the superintendent. 22. Restoration — It shall be further u�derstood that the permittee will be responsiWe for maintenance of any failures due to settle- ment, erosion, lack of vegetation growth, rutting, or other job related problems for a period of three(3)years after completion of project. 23. Manholes—All manholes,shut-off valve covers,etc.,shall be placed 1/2"lower than finished grade. HC 5137 (4-84) HENNEPIN COUNTY < < DEPARTMENT OF TRANSPORTATION NO. �„ �� 320 Washington Avenue South Hopkins, Minnesota 55343 UTILITY PERMIT and SPECIAL PROVISIONS SPECIAL PROVISIONS 1. RESTORATION BASE SURFACE SHOULDER BOULEVARD -Ditch Type ` Type ` Type Topsoil Depth Depth Depth Sod Prime Joint Width Seed Tack Cure 2. TRAFFIC DIRECTION AS PER ATTACHED PLATE NO. 3. REMARKS ,:: NO WORK PERMITTED WITHIN ROADWAY SURFACE DURING WINTER, UNLESS "SPECIAL PERMISSION" IS OBTAINED. NO WORK WILL BE PERMITTED ON SATURDAYS, SUNDAYS OR HOLIDAYS, UNLESS "SPECIAL PERMISSION" IS OB- TAINED FROM THIS OFFICE. It is expressly understood that this permit is conditioned upon replacement or restoration of the roadway to its original or to a satis- factory condition. ALL LEGAL REQUIREMENTS SHOWN ON REVERSE SIDE AND ON ATTACHED "SPECIAL PROVISIONS"TO BE COMPLIED WITH. THE DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO HENNEPIN COUNTY DEPARTMENT OF TRANS- PORTATION PERMIT SECTION.TELEPHONE: 935-3381,Extension 377. � LIMITATIONS If the County shall make any improvement or change on all or any part of its right of way upon,over,under or along a county road, and such change or improvement requires the moving or changing of public utility facilities in such right of way,then,in that event, the applicant herein shall, after notice in writing by the County,alter,change,vacate or remove from the county road that part of its facilities necessary to conform to the improvement at its own cost and without any cost to the County. APPROVED: HENNEPIN COUNTY HIGHWAY DEPARTMENT By Date ' ----------+--------------------------------------------------------------------------------• NOTICE OF COMPLETION OF THE WORK HENNEPIN COUNTY DEPARTMENT OF TRANSPORTATION DATE MAINTENANCE DIVISION-PERMIT SECTION 320 WASHINGTON AVENUE SOUTH HOPKINS, MINNESOTA 55343 Dear Sir: Please be advised that the work authorized under Permit No. issued to for work in the City,Township or Village on Road was completed and is ready for inspection. By (Please complete this form and return it within 24 hours after completion of the work) SPECIAL PROVISIONS (ROADWAY SURFACE) � � A.CONCRETE PAVEMENTS 1. Openings The opening made in a concrete pavement must be so located that no side is within three (3) feet of a construction joint. If the side of the opening is within three (3) feet of a construction joint, the concrete pavement must be removed to the joint. Before breaking the concrete, the slab must first be cut with a concrete saw to a depth of not less than two (2) inches, and the exact location thereof must be approved by the Hennepin County Department of Transportation.All broken concrete must be removed from site and disposed of. NO OPENINGS SHALL BE MADE IN PORTLAND CEMENT CONCRETE DURING WINTER MONTHS EXCEPT FOR EMERGENCIES. IFOPENINGHASTOBEMADE,ADJACENTEDGESWILLHAVETOBE REMOVEDONE FOOTBEYOND ORIGINAL EXCAVATION THE FOLLOWING SPRING AND REPLACE� BY A PERMANENT PATCH. 2. Backfill and Compaction After the excavation has been completed, the requirements for the backfill, i.e.,kind of material,compaction,etc.,shall be the same as specified for the repairs made for "Trenching or Sub-surface Operations". (See paragraph "C" below). 3. Replacement of Concrete The �oncrete used for the final surface repair shall consist of 3A42 high early strength concrete to meet Minnesota Department of Transportation Specification dated 1983, Spec. No. 2301. This concrete to be secured only from commercial plants which can furnish a mixture that is approved by Hennepin County. The final finish must be burlap dragged or broomed so that it will match the surface of the adjoining concrete slab, and cured with plastic paper. All construction joints shall be replaced. The fresh concrete patch shall be protected from all traffic contacts for at least 72 hours after it has been finished. B. BITUMINOUS PAVEMENTS 1. Openings When necessary to cut openings in Bituminous surfaced roadways, the size of opening and location thereof must conform to size and location specified in the permit, or to size specified by Hennepin County.When cutting the opening,the edges are to be cut in a straight line, and sides to be smooth and vertical. No ragged edges permitted. Cutting to be done with saw, jack- hammer, spades or similar approved tools. All excavated bituminous material to be removed from site and disposed of. No open- ings shall be made in bituminous pavements during winter months except for emergencies. 2. Backfill and Compaction After the excavation has been completed, the requirements for backfill, i.e., kind of material, compaction, etc., shall be the same as specified for the repairs made for "Trenching or Sub-Surface Operations". (See paragraph "C"below.) 3. Replacement of Concrete Base Use procedures listed under A-3. Allow the concrete to cure for 48 hours before placing bituminous materials. 4. Bituminous Tack Coat A tack coat shall be applied to all adjacent bituminous and concrete faces before placing the bituminous surface course. 5. Restoration of Blacktop All blacktop surfaces are to be restored as soon as possible after backfilling has been completed. Bituminous surfacing material may be obtained from most commercial "Blacktop" plants. The kind and grade must be approved by the Hennepin County Department of Transportation. Replacement of the bituminous material shall be made in layers not to exceed two (2) inches in depth,each layer to be compacted with an approved roller or vibrating tamper unless otherwise specially authorized. 6. Damage to Blacktop Any blacktop area which has been scarred by equipment, lugs, cleats, teeth, etc., shall be replaced or repaired as directed by Hennepin County. C. TRENCHING OR SUB-SURFACE OPERATIONS 1. Openings Trenches for conduits, water, steam, oil and gas pipes, sewers and other utilities placed within the right of way shall be located as approved by Hennepin County. Trenches for construction along the highway shall not be opened for a distance of more than 300 feet at any one time,unless especially authorized. 2. Storage of Excavated Materials Excavated or other material shall be placed or stored on the side of the operation farthest from the traveled road unless other- wise authorized by Hennepin County,and in such manner that there will be no interference with the flow of water in any gutter, drain,pipe,culvert,ditch or other waterway. 3. Backfill and Compaction After excavation has been completed, it may be refilled with the excavated material which has been removed,with the following exceptions: If the excavated material consists of mucky,soft or unstable soil,boulders,or large rock,it must be removed and disposed of outside the county right of way,and replaced with granular (sandy) material. The refilling of the trench shall be done with Class 3 gravel or other approved material compacted by the ordinary compaction method and shall follow as rapidly as possible the placing of sub-surface structures and shall be completed in such manner as will conform to the earth shoulder or subgrade or as directed by the Hennepin County Department of Transportation. 4. Replacement of Gravel Base % The gravel base shall be replaced with approved material and compacted. All compaction must be in accordance with the Minne- sota Department of Transportation Specifications dated 1983,Section 2105.3F2"Ordinary Compaction Method". r " � MINNEGASCO MAIN JOB ' -� / o G / Z z G 3 ? � 3 MAqR MINOR SUFFIX W LL.L"J PRO,IECT LOCATN �� 9 �I � �./J � Z � WORK ORDER SIZE TYPE � . ,(O l 3 � � � . � � i I ,(GT Z � ' , SG4,(E': /�"=ZOO' � , . ; i i v � �, I � � �ot�� o j-�.�o��'f��Y/B � ----- ------ auT.�oT�- � -- �� ' .�o r � � w� � ST 1i�_�_i� c,t-� � , ` -.4� Z'2 �v. ,B.G�?'a/� �, � / � �' � , `y.� � I 1 � / / � I — / � Proposed �y -• � -� � I g' Main will lie " Ft.±6"below existin rade ,�o � � Pipe Req'd. -� ,� '� . EX�S/, 3��''f �'.C-G lS�� Total Pipe _ _ ,,, �" �g ��X � �� Foreign Struclures Permits Required f/ " T�'f Tif'"y/B �/-fI/}�� Water '� Co.Rd. Sewer � St.Hwy. � / Cable N �' R.R. Telephone '� City of Electric � Other pv�,�/{ 'S a By Da e Designa�iLJ�I/s�J�/��:lJcs�� 88 Design APProved ��— �//8 g RELEASE FOR CONSTR. o N��' P �9 Form 299M