Public Manhole Access Application

Name of Applicant Firm or Government Agency: *  

Purpose of the Request (Surveying, CCTV, COVID-19 Sampling, etc.): *  

Specific Performance Time Period.  (Access by the Applicant either before or after the stated time period shall constitute a violation of this Regional Wastewater Reclamation Department Directive).

Permit Activation Date: *          Time: *  9:00 AM - 3:30 PM6:00 PM - 6:00 AM

Permit Termination Date: * 

 Type 1 Access– Visual access of the public sanitary sewer system only.  (Physical entry into the public sanitary sewer system by employee of the applicant is not authorized).

 Type 2 Access– Non-Physical Access of the public sanitary sewer system to allow only the insertion and removal of tools or equipment below the rim of the manhole cover. No human body part may break the plane of the manhole cover rim. The tools or equipment to be inserted in the manhole are identified as follows:

 Type 3 Access–Physical Access and Entry into the public sanitary sewer system. This access involves a human or human body part being inserted beneath the rim of the manhole, which is classified by OSHA as a Permit Required Confined Space Entry (PRCSE) and outlined in OSHA Standard CFR 1910.146. This type of access also requires compliance with all federal, state and local regulations regarding entries into such spaces (i.e. Temporary Traffic Control, Fall Protection). Prior to entry, an established safety plan must be in place that addresses the requirements of this Standard. RWRD hereby notifies the applicant that sewer manholes are hazardous environments and may contain hazards such as low oxygen, explosive vapors and gases, high hydrogen sulfide, falls, pathogens, and hazardous energy. The customer's responsible person on site shall address all potential hazards prior to any entry. RWRD staff is not required to be present.

Street Address: *   City: * 
(Address to the closest or most downstream manhole/structure being accessed. Please refer to the Pima County PimaMaps webpage.)

Closest Major Cross Streets: *  

Right of Way Access:  The Permitee is responsible for the jurisdiction’s Right of Way use permit, all traffic control and safety compliance measures necessary to protect the public and employees, and any other permits required to perform the work.

Certifications

Applicant certifies, by signature below, that when this permit is marked above for “Physical Access and Entry” the employees performing the work (including the physical entry) shall:

1. Be properly equipped with industry-standard confined-space entry safety equipment and atmospheric monitoring equipment suitable for a hazardous sanitary sewer environment.
2. Have been trained in and will employ OSHA confined-space entry safety procedures (29 CFR §1910.146 or successor provisions).

Permit Conditions

1. Upon request, applicant will provide RWRD with a copy of the written confined space entry procedures that will govern the confined space entry and/or the training records of the individuals that will physically perform the confined space entry.
2. The applicant will indemnify, defend, and hold harmless Pima County, its officers, departments, employees, and agents from and against any and all suits, actions, legal or administrative proceedings, claims, demands, or damages of any kind or nature which result from any act or omission of applicant, its agents, employees, or anyone acting under its direction, control, or on its behalf unless due solely to county negligence.
3. The Sanitary Sewer Access Permit shall neither constitute nor replace the Confined Space Entry Permit that the applicant must issue, in accordance with the applicant’s written confined space entry procedures as required for OSHA compliance, at the site of and at the time of the physical confined space entry.

By electronic submission of this permit application, I hereby certify that all of the information I have provided is true and correct, that I am duly authorized to submit this application on behalf of the permit applicant, and that the permit applicant will fully comply with all conditions of the permit.

*By(Name):  * Date: