TRENCH PERMIT RIDER Pursuant t G.L. cs. 81, 21 and 82A 1, 720 CMR 13.00 and 520 CMR 7.00 et seq THIS PERMIT MUST BE FULLY COMPLETED PRIOR TO CONSIDERATION Name f Applicant Street Address Phne Cell City/Twn MA ZIP Name f Excavatr (if different frm applicant) Street Address Phne Cell City/Twn MA ZIP Name f Owner(s) f Prperty Street Address Phne Cell City/Twn MA ZIP Other Cntact Permit Fee Received N ( ) Yes ( ) Descriptin, lcatin and purpse f prpsed trench: Please describe the exact lcatin f the prpsed trench and its purpse (include a descriptin f what is (r is intended) t be laid in prpsed trench (eg; pipes/cable lines etc..) Please use reverse side if additinal space is needed. Insurance Certificate #: Name and Cntact Infrmatin f Insurer: Plicy Expiratin Date: Dig Safe #: Name f Cmpetent Persn (as defined by 520 CMR 7.02):
Massachusetts Histing License # License Grade: Expiratin Date: BY SIGNING THIS FORM, THE APPLICANTAND EXCAVATOR 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 APPLICANT AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO REIMBURSE THE COMMONWEALTH FOR ANY AND ALL COSTS AND EXPENSES INCURRED BY THE COMMONWEALTH 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 COMMONWEALTH TO PROTECT THE PUBLIC WHERE THE APPLICANT OR EXCAVATOR HAS FAILED TO COMPLY THEREWITH INCLUDING POLICE DETAILS AND OTHER REMEDIAL MEASURES DEEMED NECESSARY BY THE COMMONWEALTH. THE UNDERSIGNED APPLICANT AND EXCAVATOR AGREE JOINTLY AND SEVERALLY TO DEFEND, INDEMNIFY, AND HOLD HARMLESS THE COMMONWEALTH 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. APPLICANT SIGNATURE DATE EXCAVATOR SIGNATURE (IF DIFFERENT) DATE PERMIT APPROVED BY PERMITTING AUTHORITY CONDITIONS OF APPROVAL Fr Department use -- D nt write in this sectin $ Applicatin Fee Date CONDITIONS AND REQUIREMENTS PURSUANT TO G.L.C.82A AND 520 CMR 7.00 et seq. (as amended)
By signing the applicatin, the applicant understands and agrees t cmply with the fllwing: i. N trench may be excavated unless the requirements f sectins 40 thrugh 40D f chapter 82, and any accmpanying regulatins, have been met and this permit is invalid unless and until said requirements have been cmplied with by the excavatr applying fr the permit including, but nt limited t, the establishment f a valid excavatin number with the undergrund plant damage preventin system as said system is defined in sectin 76D f chapter 164 (DIG SAFE); ii. Trenches may pse a significant health and safety hazard. Pursuant t Sectin 1 f Chapter 82 f the General Laws, an excavatr shall nt leave any pen trench unattended withut first making every reasnable effrt t eliminate any recgnized safety hazard that may exist as a result f leaving said pen trench unattended. Excavatrs shuld cnsult regulatins prmulgated by the Department f Public Safety in rder t familiarize themselves with the recgnized safety hazards assciated with excavatins and pen trenches and the prcedures required r recmmended by said department in rder t make every reasnable effrt t eliminate said safety hazards which may include cvering, barricading r therwise prtecting pen trenches frm accidental entry. iii. Persns engaging in any in any trenching peratin shall familiarize themselves with the federal safety standards prmulgated by the Occupatinal Safety and Health Administratin n excavatins: 29 CFR 1926.650 et.seq., entitled Subpart P Excavatins. iv. Excavatrs engaging in any trenching peratin wh utilize histing r ther mechanical equipment subject t chapter 146 shall nly emply individuals licensed t perate said equipment by the Department f Public Safety pursuant t said chapter and this permit must be presented t said licensed peratr befre any excavatin is cmmenced; v. By applying fr, accepting and signing this permit, the applicant hereby attests t the fllwing: (1) that they have read and understands the regulatins prmulgated by the Department f Public Safety with regard t cnstructin related excavatins and trench safety; (2) that he has read and understands the federal safety standards prmulgated by the Occupatinal Safety and Health Administratin n excavatins: 29 CMR 1926.650 et.seq., entitled Subpart P Excavatins as well as any ther excavatin requirements established by this municipality; and (3) that he is aware f and has, with regard t the prpsed trench excavatin n private prperty r prpsed excavatin f a city r twn public way that frms the basis f the permit applicatin, cmplied with the requirements f sectins 40-40D f chapter 82A. vi. This permit shall be psted in plain view n the site f the trench. Fr additinal infrmatin please visit the Department f Public Safety s website at www.mass.gv/dps
Summary f Excavatin and Trench Safety Regulatin (520 CMR 14.00 et seq.) This summary was prepared by the Massachusetts Department f Public Safety pursuant t G.L.c.82A and des nt include all requirements f the 520 CMR 14.00. T view the full regulatin and G.L.c.82A, g t www/mass.gv/dps Pursuant t M.G.L. c. 82, 1, the Department f Public Safety, jintly with the Divisin f Occupatinal Safety, drafted regulatins relative t trench safety. The regulatin is cdified in sectin 14.00 f title 520 f the Cde f Massachusetts Regulatins. The regulatin requires all excavatrs t btain a permit prir t the excavatin f a trench made fr a cnstructin-related purpse n public r private land r rights-f-way. All municipalities must establish a lcal permitting authrity fr the purpse f issuing permits fr trenches within their municipality. Trenches n land wned r cntrlled by a public (state) agency requires a permit t be issued by that public agency unless therwise designated. In additin t the permitting requirements mandated by statute, the trench safety regulatins require that all excavatrs, whether public r private, take specific precautins t prtect the general public and prevent unauthrized access t unattended trenches. Accrdingly, unattended trenches must be cvered, barricaded r backfilled. Cvers must be rad plates at least ¾ thick r equivalent; barricades must be fences at least 6 high with n penings greater than 4 between vertical supprts; backfilling must be sufficient t eliminate the trench. Alternatively, excavatrs may chse t attend trenches at all times, fr instance by hiring a plice detail, security guard r ther attendant wh will be present during times when the trench will be unattended by the excavatr. The regulatins further prvide that lcal permitting authrities, the Department f Public Safety, r the Divisin f Occupatinal Safety may rder an immediate shutdwn f a trench in the event f a death r serius injury; the failure t btain a permit; r the failure t implement r effectively use adequate prtectins fr the general public. The trench shall remain shutdwn until re-inspected and authrized t re-pen prvided, hwever, that excavatrs shall have the right t appeal an immediate shutdwn. Permitting authrities are further authrized t suspend r revke a permit fllwing a hearing. Excavatrs may als be subject t administrative fines issued by the Department f Public Safety fr identified vilatins.
Summary f 1926 CFR Subpart P -OSHA Excavatin Standard This is a wrker prtectin standard, and is designed t prtect emplyees wh are wrking inside a trench. This summary was prepared by the Massachusetts Divisin f Occupatinal Safety and nt OSHA fr infrmatinal purpses nly and des nt cnstitute an fficial interpretatin by OSHA f their regulatins, and may nt include all aspects f the standard. Fr further infrmatin r a full cpy f the standard g t www.sha.gv. Trench Definitin per the OSHA standard: An excavatin made belw the surface f the grund, narrw in relatin t its length. In general, the depth is greater than the width, but the width f the trench is nt greater than fifteen feet. Prtective Systems t prevent sil wall cllapse are always required in trenches deeper than 5, and are als required in trenches less than 5 deep when the cmpetent persn determines that a hazard exists. Prtectin ptins include: Shring. Shring must be used in accrdance with the OSHA Excavatin standard appendices, the equipment manufacturer s tabulated data, r designed by a registered prfessinal engineer. Shielding (Trench Bxes). Trench bxes must be used in accrdance with the equipment manufacturer s tabulated data, r a registered prfessinal engineer. Slping r Benching. In Type C sils (what is mst typically encuntered) the excavatin must extend hrizntally 1 ½ feet fr every ft f trench depth n bth sides, 1 ft fr Type B sils, and ¾ ft fr Type A sils. A registered prfessinal engineer must design prtective systems fr all excavatins greater than 20 in depth. Ladders must be used in trenches deeper than 4. Ladders must be inside the trench with wrkers at all times, and lcated within 25 f unbstructed lateral travel fr every wrker in the trench. Ladders must extend 3 abve the tp f the trench s wrkers can safely get nt and ff f the ladder. Inspectins f every trench wrksite are required: Prir t the start f each shift, and again when there is a change in cnditins such as a rainstrm. Inspectins must be cnducted by the cmpetent persn (see belw). Cmpetent Persn(s) is: Capable (i.e., trained and knwledgeable) in identifying existing and predictable hazards in the trench, and ther wrking cnditins which may pse a hazard t wrkers, and Authrized by management t take necessary crrective actin t eliminate the hazards. Emplyees must be remved frm hazardus areas until the hazard has been crrected. Undergrund Utilities must be: Identified prir t pening the excavatin (e.g., cntact Digsafe). Lcated by safe and acceptable means while excavating. Prtected, supprted, r remved nce expsed. Spils must be kept back a minimum f 2 frm the edge f the trench. Surface Encumbrances creating a hazard must be remved r supprted t safeguard emplyees. Keep heavy equipment and heavy material as far back frm the edge f the trench as pssible. Stability f Adjacent Structures: Where the stability f adjacent structures is endangered by creatin f the trench, they must be underpinned, braced, r therwise supprted. Sidewalks, pavements, etc. shall nt be undermined unless a supprt system r ther methd f prtectin is prvided. Prtectin frm water accumulatin hazards: It is nt allwable fr emplyees t wrk in trenches with accumulated water. If water cntrl such as pumping is used t prevent water accumulatin, this must be mnitred by the cmpetent persn. If the trench interrupts natural drainage f surface water, ditches, dikes r ther means must be used t prevent this water frm entering the excavatin. Additinal Requirements: Fr mbile equipment perated near the edge f the trench, a warning system such as barricades r stp lgs must be
used. Emplyees are nt permitted t wrk underneath lads. Operatrs may nt remain in vehicles being laded unless vehicles are equipped with adequate prtectin as per 1926.601(b)(6). Emplyees must wear high-visibility clthing in traffic wrk znes. Air mnitring must be cnducted in trenches deeper than 4 if the ptential fr a hazardus atmsphere exists. If a hazardus atmsphere is fund t exist (e.g., O 2 <19.5% r >23.5%, 20% LEL, specific chemical hazard), adequate prtectins shall be taken such as ventilatin f the space. Walkways are required where emplyees must crss ver the trench. Walkways with guardrails must be prvided fr crssing ver trenches > 6 deep. Emplyees must be prtected frm lse rck r sil thrugh prtectins such as scaling r prtective barricades.