Please fill out the excavation notification form below, prepare it for printing, and submit it to the Navy for approval. The notification number and sign-offs will be conducted by the Navy.

Institutional Control Excavation Map
Please check this map to see the areas where excavations are restricted on Adak Island.
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NAVY INSTITUTIONAL CONTROL EXCAVATION NOTIFICATION NUMBER __________________________
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NAME:

(By placing your name here you are signing the permit as the originator)
PHONE:

(No dashes)


LOCATION OF EXCAVATION:
Location should be marked by stakes and/or paint. (Coordinates will be transferred from the excavation notification map page.)
Northing:    
Easting:      
Cross Streets:
COMPANY: DATE:    
CITY
STATE
_______________________________________________________________________________________
PURPOSE OF THE EXCAVATION:

** Describe the purpose of the excavation
** Please attach the excavation map.
To make an excavation map, select a site map and follow instructions.
_____________________________________________________________________________
EXCAVATION TO BEGIN:
(DATE)
(TIME)
ESTIMATED COMPLETION DATE: METHOD OF EXCAVATION: DEPTH OF EXCAVATION:
_________________________________________________________________________________________________
Requester must notify the Navy 3 working days prior to excavation:
Naval Facilities Engineering Command Northwest
Code EV3 1101 Tautog Circle
Silverdale, WA 98315-1101
Telephone: 1-866-239-1219
Fax: (360) 396-0857


If suspected munitions is encountered, stop work, call 911 and identify this as a Munitions related call.
 
_________________________________________________________________________________________________
Excavation will not proceed until the following personnel review and comment on the IC environmental excavation notification application.
I HAVE READ AND UNDERSTAND THE NAVY'S REQUIREMENTS FOR INSTITUTIONAL CONTROL EXCAVATIONS AND AGREE TO ABIDE BY THEM.


SIGNATURE (REQUESTER):_________________________________     DATE: __________________________
Have you received ordnance awareness training briefing? Yes or No  
     
COMMENTS:




The requester is responsible for ensuring that all IC excavation workers have completed ordnance awareness training prior to beginning the excavation. Work shall immediately stop if suspected ordnance items are encountered during excavation. The workers must immediately evacuate the area and call 911 and identify this as a munitions related call. An initial exclusion zone of a 300-foot radius around the site will be maintained and all non-essential personnel will be denied access until Navy personnel direct otherwise. In no case will excavation be allowed to resume at the site until the Navy has completed necessary response actions to render an area safe.
Excavation Notification is valid for 120 days from signed approval date.


Permit expires on this date:_______________________________. Please call 1 (866) 239-1219 for waiver.


   APPROVED    DISAPPROVED __________________________
Approver Signature
______________
Date
____________________________________________________________________________
EXTENSION GRANTED:  30 days

 90 days

 60 days

 Other _____

__________________________
Approver Signature
______________
Date
Please remember to attach the excavation notification map file (select site map at top of this page), prepare site map for printing, and submit it to the Navy for approval. The notification number and sign-offs will be conducted by the Navy.

The purpose of the institutional control excavation notification is to notify the Navy of intrusive projects that will be performed on institutional control sites. After the Navy reviews the request, the original request will be returned to the requester, approved or disapproved, as appropriate. The Navy will retain a copy. An approved IC Excavation notification must be in the possession of personnel on site during excavation or work will be stopped. The IC Excavation Notification will expire after 120 days. If an IC Excavation notification extension is necessary, the requester shall contact the Navy at 1-866-239-1219 one-week before the current IC Excavation notification expires to request an extension.

Last Updated: June 11, 2013