8201 164Th Ave NE, Suite 200 Redmond, WA 98052 Greenroads.Org

Noise Control PLan

8201 164th Ave NE, Suite 200|Redmond, WA 98052|greenroads.org

General Project Information

Project Name: / Click to enter text. /
Work Site Location / Address: / Click to enter text. /
Project Period: / FROM:MM/DD/YYYY / TO:MM/DD/YYYY
Prepared by: / Click to enter name of personnel preparing this form. /
Distance to Closest Receptor: / #####ft or km
Receptor Type & Zoning Designation: / Click to enter text. /
Ambient Sound Level (dB): / Click to enter text. /
Permitting Authority: / Click to enter text. /
Location of Plan (i.e. Posted on Site): / Click to enter text. /

Project Roles and Responsibilities

This form must be signed by the prime contractor and/or any parties responsible for noise control and noise management issues resulting from construction operations throughout the duration of Your Project.

Signature BY responsible Party

This noise control plan is true and complete to the best of my knowledge. (Digital signatures accepted.)

Signature / Date
Name: / Click to enter text. / Phone: / Click to enter text.
Company: / Click to enter text. / Fax: / Click to enter text.
Title: / Click to enter text. / Email: / Click to enter text.
Name: / Click to enter text. / Phone: / Click to enter text.
Company: / Click to enter text. / Fax: / Click to enter text.
Title: / Click to enter text. / Email: / Click to enter text.

Construction NOisePermits, Standards And Policies

Post weblinks on your Project Page to any applicable noise control codes, standards or other local policies that apply to construction works.

Department Issuing Permit / Permit Number
☐Transportation☐Buildings / Click here to enter permit number.
☐Other:Click to enter another department. / Enter a brief description for the permit
☐Transportation☐Buildings / Click here to enter permit number.
☐Other:Click to enter another department. / Enter a brief description for the permit
☐Transportation☐Buildings / Click here to enter permit number.
☐Other:Click to enter another department. / Enter a brief description for the permit
☐Transportation☐Buildings / Click here to enter permit number.
☐Other:Click to enter another department. / Enter a brief description for the permit

Construction WorkDates and Operating Hours

Attach copies of any variances for construction noise.

Normal Work Hours: / FROM: Enter as army time. / TO:Enter as army time.
Type of Construction Activity / From / To / Applicable Variance?
Demolition Construction Work Dates: / MM/YYYY / MM/YYYY / ☐Yes☐No
Excavation Construction Work Dates: / MM/YYYY / MM/YYYY / ☐Yes☐No
Foundation Construction Work Dates: / MM/YYYY / MM/YYYY / ☒Yes☐No
Superstructure Construction Work Dates: / MM/YYYY / MM/YYYY / ☐Yes☐No
Finishing Construction Work Dates: / MM/YYYY / MM/YYYY / ☐Yes☐No
Other:Click to enter text. / MM/YYYY / MM/YYYY / ☐Yes☐No
Other:Click to enter text. / MM/YYYY / MM/YYYY / ☐Yes☐No

Construction Device Noise Control

Indicate the use of pile drivers, jackhammers, vacuum excavators, dump trucks, cranes, concrete saws, augur drill rigs, generators, compressors, street plates, backup alarms, pumps, blowers, or other equipment and devices that generate noise during construction activities.

Control measures may include adding shrouds, mufflers, or silencers to construction equipment, selecting alternative (quieter) equipment, PPE, or noise reduction devices, etc.Mitigation approaches for the whole site may include barriers such as perimeter or construction fences, temporary barriers, moveable barriers, shifting or regulating hours of operation, building soundproofing, relocating people, compensation, etc.

Work Activity / Operation / List of Equipment Used / Describe Noise Control Devices / Mitigation Approach / Temporary? / Permanent?
Demolition / Click to enter text. / Click to enter text. / ☐Yes☐No / ☐Yes☐No
Excavation / Click to enter text. / Click to enter text. / ☐Yes☐No / ☐Yes☐No
Foundations / Click to enter text. / Click to enter text. / ☐Yes☐No / ☐Yes☐No
Superstructures / Click to enter text. / Click to enter text. / ☐Yes☐No / ☐Yes☐No
Finishing / Click to enter text. / Click to enter text. / ☐Yes☐No / ☐Yes☐No
Other:Click to enter text. / Click to enter text. / Click to enter text. / ☐Yes☐No / ☐Yes☐No
Other:Click to enter text. / Click to enter text. / Click to enter text. / ☐Yes☐No / ☐Yes☐No

Monitoring and Corrective Action

Describe the contractor’s procedures for monitoring noise according to local policies, noise standards and acceptable levels.

Describe the contractor’s procedure for implementing a corrective action due to non-compliant noise levels.

Describe the contractor’s procedure to modify the noise control plan if methods are found ineffective / insufficient or when modifications are necessary.

PR-5[Last Modified: 03/25/15]| 1