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HomeMy WebLinkAbout020 TrenchExandVentilationPermit_01072021Rev. 12/18/2020 Trench/Excavation Ventilation Requirements for the Bozeman Solvent Site Area This form is only for trenching and excavation activities in the area at and around the Hasting Shopping Center related to the Bozeman Solvent Site and specifically depicted on the attached Figure 1. For more information, contact the City’s Engineer’s Office. You must submit a copy of this form along with the permit applications for the following: Street Cut Permit Water and/or Sewer Connection Permit Water and/or Sewer Extension Permit Residential Building Permit Commercial Building Permit If none of the above permits apply, submit this form with a description of the purpose of the excavation Forms must be submitted to both the City of Bozeman and the Montana Department of Environmental Quality (MDEQ) at the following addresses: Engineering Department Montana Department of Environmental Quality City of Bozeman Attn: Bozeman Solvent Site P.O. Box 1230 P.O. Box 200901 Bozeman, MT 59718 Helena, MT 59620-0901 406-582-2280 1.Attach a drawing or sketch showing the approximate location and dimensions of the proposed trench and/or excavation. 2. Provide the following information for the trenching and/or excavation activities to be completed in the subject area: Trench/excavation length__________________________ *Length must not be greater than 100 feet without prior approval of the MDEQ. Trench/excavation width___________________________ Trench/excavation depth___________________________ 3.Consult the attached table: Trench Excavation Scenarios Requiring Fresh Air Mechanical Ventilation – Bozeman Solvent Site. 4.Is fresh air mechanical ventilation required? Yes / No I agree that the representations on this form are true and accurate. I agree that if the information provided above is to change for any reason, I will notify the City of Bozeman and the MDEQ, by submittal of an updated Trench/Excavation Ventilation Requirements for Bozeman Solvent Site Form. By providing the signature below, I agree that if any fresh air mechanical ventilation is required as indicated above, I will provide such ventilation at any and all times an individual is in the trench or excavation area. Applicant Name (Please Print):___________________________________ Applicant Address:______________________________________________________________________ Applicant Phone Number:_____________________ APPLICIANT AUTHORIZED SIGNATURE: _____________________________ DATE: ____________ Reviewed By:____________________________________________ Date:_____________________ City Engineer or Designee Trench Ventilation Required? ____Yes _____ No WGMGROUPWWW.WGMGROUP.COMPRELIMINARYPLOTTED:SAVED:5/24/225/23/22 WGMGROUPWWW.WGMGROUP.COMPRELIMINARYPLOTTED:SAVED:5/24/225/18/22