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City of Blackfoot 157 North Broadway Blackfoot, Idaho 83221 (208)785-8600 X13 Fax: (208) 785-8602 RIGHT-OF-WAY-PERMIT (TRENCHING/BORING) CONTRACTOR: CONTRACT PERSON: TYPE OF WORK: TRENCHING_________ BORING OTHER DESCRIPTION OF WORK & LOCATION: MAP OF AREA OF WORK: SKETCH ON BACK: SEE ATTACHMENT: TYPE OF ROAD SURFACE: PAVEMENT________OIL________GRAVEL________DIRT_______WATER LOAD: PROPERTY OWNER: OWNER’S STREET ADDRESS: APPLICANT AGREES TO RESTORE SAID RIGHT-OF-WAY TO SATISFACTORY CONDITION ACCORDING TO THE CITY SPECIFICATIONS AT APPLICANTS EXPENSE AND TO HOLD THE CITY HARMLESS FROM ANY AND ALL DAMAGES OR EXPENSES CAUSED BY, OR IN ANY WAY CONNECTED WITH, THE USE OF SAID PROPERTY OR RESTORING THE SAME TO ITS ORIGINAL CONDITTION(S) The City reserves the right to require certain backfill material specifications and/or compaction testing. In no case shall the replacement pavement be less than 2’’thick and on major roadways. (See back for requirements of non-shrink back fill). This permit is for the use of the City Right-of-Way only. No survey has been conducted by the City to determine the location of the Right-of-Way in this permit. Verification of Right-of-Way is the responsibility of the contractor. This permit does not alter franchise agreements. Signature: Date: Approval Date: Date: Public Works Dept. Approval: _________Public Works Dept. Final Sign off : Trench cuts within right-of-way that are designated as a 4’ or higher shall be backfilled with 3’ fill slurry. Street Class: (INITIAL) ---PAGE BREAK--- PLEASE SEE BACK OF PERMIT FOR TESTING AND INSPECTION REQUIREMENTS ALL CONSTRUCTION MUST MEET THE ISPWC EDITION (2015) CITY OF BLACKFOOT ENGINEERING STANDARDS AND SPECIFICATIONS. ALL CONSTRUCTION MATERIALS MUST BE FROM A SOURCE APPROVED BY THE CITY OF BLACKFOOT ENGINEERING DEPARTMENT (54-28/ MIX GRAVEL, CONCRETE, ASPHALT, NON-SHRINK BACKFILL, ETC.) THESE REQUIREMENTS INCLUDE THE ASPHALT PATCHBACK IN THE STREET TO THE ADJOINING, CURB AND GUTTER. (Patching the trench with thick ½ hot mix asphalt pavement grade 58-28 and of crushed aggregate base and 12’’ of subbase.) 8-3-10: TIME TO COMPLETE REPAIRS: Permanent asphalt repairs shall be completed by the permittee not later than three days after the excavation has been backfilled, unless otherwise authorized by the public works director or his designated representative. If weather conditions prohibit permanent repairs, the public works director, or his designated representative, may authorize the use and installation of temporary cold patches. Such temporary cold patches shall be replaced by the permittee as soon as weather permits. (2003 Code § 8-06-08) 8-3-9(A): ORDINANCE NO. 2128 This section covers the work of installing non-shrink backfill materials in certain trench cuts located within the City of Blackfoot right-of-ways. The City of Blackfoot maintains an IWORQ’s Pavement Management System that grades all right-of-ways on a scale of 1 to 10, with a 10 being a right-of-way in excellent condition. This section shall apply to all trench cuts within right-of-ways that are designated as a 4 or higher. The designation is available from the City of Blackfoot at the time of obtaining a permit for the trench cut. All requirements for excavation shall meet with the City of Blackfoot specifications when working within the City’s right-of-ways. After the Permittee has excavated and disposed of all material from the trench area and upon completion of the installation and testing of the installed line, the Permittee shall wrap all mechanical fittings with plastic sheeting (minimum four mil.) in a manner which will prevent bonding of the non-shrink material to the fitting. The Permittee shall then place compact gravel to a level of one foot above the installed line or the permittee shall then place non-shrink backfill material in the trench using a method that fills all voids to the top of the existing subgrade elevation. After sufficient time for the non-shrink backfill material to cure in order to carry the traffic loads, the Permittee shall then replace the asphalt plantmix surfacing and aggregate base in accordance with specifications of the City of Blackfoot. The non-shrink backfill material shall be encasement concrete with a minimum cement content of 50 lbs. to the cubic yard, maximum water to cement ratio of .80, a maximum slump of 10, and a 0-10% air content. All backfilling made pursuant to this Section shall be supervised at the time of backfilling and approved by a representative of the Street Department of the City of Blackfoot. The Permittee must schedule in advance with the Street Department for a representative to be present at the time of the backfill.