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HomeMy WebLinkAboutWWP2703320Bravo Environmental BRAVO Kenmore, Wa 98028 TO 425A24-9000, Fax: 425A24-9002 Inspection report Date: P.O.#: Weather: Surveyed By: section number: PSR: 06/21/2007 1 Dry Tim 1 Total Pipe Length Survey Customer: System Owner: Clean Date: Pre -Cleaned: Map Grid11 #: J Jetting Street: NE 26th Flow Control: Start MH: MH-5 City: Renton Year Renewed End MH: MH-6 Location Code: B Main Highway - Suburban/Rural Tape/Media #: FRO-01 Total length surveyed: 394.76 ft Purpose: E Pre -Acceptance Dia/Height: C Circular 8' /8" Use: SS Sanitary Material: PVC Polyvinyl Chloride Pipe Joint length: Lining: Drain. Area: Category: eg ry: Comment: Location details: 1:975 position code observation MPEG photo grade MHS 0.00 AMH Manhole 00:00:07 7.78 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:59 79.79 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:04:09 124.57 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:06:01 — 1 151.00 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 000726 245.15 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:10:52 295.32 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:13:00 324.75 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:14:23 f� 349.58 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:15:38 — I 367.33 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:16:33 1 387.58 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00,17:40 394.76 AMH Manhole, Finish survey 00,18,41 MH$ QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 100th & Duvall.mdb // page: 1 BRAY Bravo Environmental j Kenmore, Wa 98028 env ronmen� Tel 425-424-9000, Fax 425 424-9002 Inspection report Date P.O.#: Weather: Surveyed By: section number: PSR 06/21/2007 1 Dry Tim 2 Total Pipe Length Survey Customer: System Owner: Clean Date: Pre -Cleaned: Map Grid # J Jetting Street: NE 26th Flow Control: Start MH: MH-4 City: Renton Year Renewed End MH: MH-5 Location Code. B Main Highway - Suburban/Rural Tape/Media #: FRO-01 Total length surveyed: 134.94 ft Purpose: E Pre -Acceptance Dia/Height: C Circular 8' /8" Use: SS Sanitary Material: PVC Polyvinyl Chloride Pipe Joint length: Lining: Drain. Area: Category: eg ry: Comment: Location details: 1:350 position code observation MPEG photo grade MH-0� 0.00 AMH Manhole 000005 62.34 TFA Tap Factory Made Active, at 09 o"clock, 6", within 8 inch: YES 000244 68.52 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:03:13 134.94 AMH Manhole, Finish survey 000606 (MH-5 QSR OMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 100th & Duvall.mdb // page: 2 Bravo Environmental BRAV41w Kenmore, Wa 98028 envi ronlmintal Tel. 425-424-9000, Fax: 425424-9002 Inspection report Date: P.O.#: Weather: Surveyed By: section number: PSR: 0612112007 1 Dry Tim 3 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: Map Grid #: J Jetting Street: NE 26th Flow Control: Start MH: MH-1A City: Renton Year Renewed End MH: MHA Location Code: B Main Highway - Suburban/Rural Tape/Media #: FRO-01 Total length surveyed: 173.24 ft Purpose: E Pre -Acceptance Dia/Height: C Circular 8"18" Use: SS Sanitary Material: PVC Polyvinyl Chloride Pipe Joint length: Lining: Drain. Area: Category: 9 ry Comment: Location details: 1:425 position code observation MPEG photo grade MH-1A 0.00 AMH Manhole 00:00:04 137.44 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:05:32 173.24 AMH Manhole, Finish survey 00:07:10 MH-1 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 1 0000 0 0 0 0 0 0 100th & Duvall.mdb // page: 3 Bravo Environmental BRAVO Kenmore, Wa 98028 envilmrimental Tel 425-424-9000, Fax: 425-424-9002 Inspection report Date: P.O.#: Weather: Surveyed By: section number: PSR: 06/2112007 1 Dry Tim 4 Total Pipe length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: Map Grid M J Jetting Street: NE 26th Flow Control: Start MH: Existing City: Renton Year Renewed End MH: MH-1A Location Code: B Main Highway - Suburban/Rural Tape/Media #: FRO-01 Total length surveyed: 61.54 ft Purpose: E Pre -Acceptance Dia/Height: C Circular 8' /8" Use: SS Sanitary Material: PVC Polyvinyl Chloride Pipe Joint length: Lining: Drain. Area: Category: eg ry: Comment: Location details: 1:175 position code observation MPEG photo grade ng 0.00 AMH Manhole 00:00:06 8.58 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:46 39.50 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:01:59 55.15 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:02:46 61.54 AMH Manhole, Finish survey 00:03:16 MH-1A QSR QMR 0000 SPR MPR JOPR 0 SPRI MPRI OPRI 0000 0 0 0 0 0 100th & Duvall.mdb // page: 4 Bravo Environmental BRAVO Kenmore, Wa 98028 Tel 425 424-9000, Fax 425 424-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05109/2007 1 Dry Tim 13 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: Existing City: Renton Year Renewed End MH: MHAA Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 67.1 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8' 18" Use of Sewer: SS Sanitary Material: PVC Polyvinyl Chloride Pipe Length: Lining Method: Drain, Area: Category: Remark:: 1:150 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 12.60 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 h •. ate 43.40 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 59.80 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 67.10 AMH Manhole, Finish survey 00:00:00 OSR OMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.mdb l/ page: 1 BRAVA Bravo Environmental Kenmore, Wa 98028 Tel: 425-424-9000, Fax: 425-424-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR. 20070507 1 Dry Tim 1 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: Fields Ave N Flow Control: N Not Controlled Start MH: MH4 7 City: Renton Year Renewed End MH: MHAX J Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 149.9 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8" /8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark:: 1:350 position code observation counter photo grade i T 0.00 AMH Manhole 00:00:00 �j n �r 149.90 AMH Manhole, Finish survey 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 t 0 10 0 0 0 0 Langley mugummu 11 you— 1 Bravo Environmental BRAVO Kenmore, Wa 98028 Tel: 425 424-9000, Fax 425 424-9002 envuronmenta Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 2 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: Fields Ave N Flow Control: N Not Controlled Start MH: MH-7 City: Renton Year Renewed End MH: PE Location Code: B Main Highway - Suburban/Rural Tape/Media M LAN-01 pipe length: 21.3 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8" /8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark:: 1:50 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 y 21.30 ACOM Cleanout Mainline, Remark: Pipe End 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.mdb // page: 2 Bravo Environmental BRAV Kenmore, Wa 98028 Tel: 425-424-9000, Fax: 425424-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 3 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-6 City: Renton Year Renewed End MH: MH-7 Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 400.6 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8'Y8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark:: 1:900 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 4. 10.20 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 81.60 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 88.10 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 152.80 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 172.30 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 236.20 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 252.00 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 305.10 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 348.20 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 377.40 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 400.60 AMH Manhole, Finish survey 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.man 11 page: s Bravo Environmental BRAV o Kenmore, Wa 98028 Tel: 425A24-9000, Fax: 425A24-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 4 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-5 City: Renton Year Renewed End MH: MH-6 Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 395.4 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8'78" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark:: 1:900 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 6.00 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 79.10 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 123.80 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 j149.30 T TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 243.30 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 293.70 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 323.00 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 349.00 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 366.10 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 387.40 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 395.40 AMH Manhole, Finish survey 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.man // page: 4 Bravo Environmental BRAV Kenmore, Wa 98028 Tel:425A24-9000,Fax:425-424-9002 environmentall Inspection report Date: P.O.# Weather: Surveyed By section number: PSR: 05/07/2007 1 Dry Tim 5 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-4 City: Renton Year Renewed End MH: MH-5 Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 135.4 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8" /8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark:: 1:325 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 :y T 62.50 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 67.90 I I'll TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 106.10 D Deformed, 1 %, Remark: Bulge 00:00:00 S 4 135.40 AMH Manhole, Finish survey 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 4100 0000 4 0 4 4 0 4 Langley rzlage.maD If page: a Bravo Environmental BRAW Kenmore, Wa 98028 Tel: 425-424-9000, Fax: 425-424-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 6 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-4 City: Renton Year Renewed End MH: MH-9 Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 123.2 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8" /8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain, Area: Category: Remark:: 1:275 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 T 123.20 AMH Manhole, Finish survey 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.mde 11 page: b Bravo Environmental BRAV Kenmore, Wa 98028 Tel:425-424-9000,Fax:425-424-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 06/07/2007 1 Dry Tim 7 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: City: Renton Year Renewed Location Code: B Main Highway - Suburban/Rural Tape/Media #: Reason for inspection: E Pre -Acceptance Use of Sewer: SS Sanitary Drain. Area: Remark 1:25 position code observation AMH Manhole N Not Controlled Start MH: MH-9 End MH: PE LAN-01 pipe length: 6.9 It Dia/Height: C Circular 8" /8" Material: PVC Polyvinyl Chloride Pipe Length: Lining Method: ACOM Cleanout Mainline, Remark: Pipe End counter photo grade 00:00:00 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 1 0 0 0 0 Langley raage.moo a page: r Bravo Environmental BRAVOaEo Kenmore, Wa 98028 Tel: 425A24-9000, Fax: 425A24-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 8 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-3 City: Renton Year Renewed End MH: MH-4 Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 272.9 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8"18" Use of Sewer: SS Sanitary Material: PVC Polyvinyl Chloride Pipe Length: Lining Method: Drain. Area: Category: Remark 1:625 position code observation AMH Manhole counter photo grade 00:00:00 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 AMH Manhole, Finish survey QSR QMR I SPR I MPR OPR 0000 0000 0 I 0 0 Langley Ridge.mdb // page: 8 00:00:00 SPRI MPRI OPRI 0 0 0 Bravo Environmental BRAVA Kenmore, Wa 98028 Tel 425-424-9000,Fax: 425-424-9002 environmenta Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 9 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-3 City: Renton Year Renewed End MH: CO-1 Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 125.8 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8" /8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark:: 1:300 position code observation counter photo grade lViti�3= 0.00 AMH Manhole 00:00:00 l:? 125.80 ACOM Cleanout Mainline, Remark: Pipe End 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.mao 11 page: u BRA I Bravo Environmental Kenmore, Wa 98028 Tel:425-424-9000,Fax:425-424-9002 envi ronmenta Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 10 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: J Jetting rate: Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-2 City: Renton Year Renewed End MH: MH-3 Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 106.3 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8"/8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: I Category: Remark:: 1:250 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 T i 63.60 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 I i 86.10 TFA Tap Factory Made Active, at 09 o'clock, 6", within 8 inch: YES 00:00:00 106.30 AMH Manhole, Finish survey 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley rtlage.mon n page: iu Bravo Environmental BRAV Kenmore, Wa 98028 Tel:425-424-9000,Fax:425-424-9002 environments Inspection report Date: P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 11 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate: J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-2 City: Renton Year Renewed End MH: MHA Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 176.1 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8" /8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark:: 1:400 position code observation counter photo grade 0.00 AMH Manhole 00:00:00 Ik 176.10 AMH Manhole, Finish survey 00:00:00 OSR OMR SPR MPR OPR SPRI4_ MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.man i/ page: ii Bravo Environmental BRAVO Kenmore, Wa 98028 Tel 425-424-9000. Fax 425-424-9002 _ environments Inspection report Date P.O.# Weather: Surveyed By: section number: PSR: 05/07/2007 1 Dry Tim 12 Total Pipe Length: Survey Customer: System Owner: Clean Date: Pre -Cleaned: rate J Jetting Street: NE 26th St Flow Control: N Not Controlled Start MH: MH-1 A City: Renton Year Renewed End MH: MHA Location Code: B Main Highway - Suburban/Rural Tape/Media #: LAN-01 pipe length: 177.7 ft Reason for inspection: E Pre -Acceptance Dia/Height: C Circular 8"/8" Material: PVC Polyvinyl Chloride Pipe Length: Use of Sewer: SS Sanitary Lining Method: Drain. Area: Category: Remark 1:400 position code observation counter photo grade 0.00 AMH 1' i1 iI Lj �j I:; J Manhole 00:00:00 T, rr is='I J lca -i i 140.10 TFA Tap Factory Made Active, at 03 o'clock, 6", within 8 inch: YES 00:00:00 >1 177.70 AMH Manhole, Finish survey 00:00:00 QSR QMR SPR MPR OPR SPRI MPRI OPRI 0000 0000 0 0 0 0 0 0 Langley Ridge.mdb It page: iz SANITARY SEWER SYSTEM PROJECT - �;4, DATE LOW PRESSURE AIR TEST INPF7 T P /its, �N LOCATION LENGTH K C M� RESULT S S i4l ly or 7bSal A ILI 77 6q L, �5 m R ti I' -ll _ I - PROJECT REQUEST FORM PLANNINGBUILDING/PUBLIC WORKS DATE: t_ CONTACT: EXT. FILE STATUS NEW OR ❑ EXISTING: FILE CODE (Plu-xx-xxxx): LOCATION `B My Work Space: 0 File Bay Shelf #: 0 Other: PROJECT NAME/ FILE TITLE: characters DESCRIPTION OF PROJECT: UTILITY PERMIT # (���� LUA# o S' -of 3 WO# ADDRESS / STREET NAME(S): ,�_ JV ,= Vic iiv/ tz DEV: - VTR :OWN: 5- ZMA ; CNSLT/ENG. C% OTHER ALIASES: Circle Size of Waterline: 10" 12" Circle One: New / Replace / Extension Circle Size of Sewerline: 10" 12" Circle One: New / Replace / Extension Circle Size of Stormline: 12" 18" 24" Circle One New / Replace / Extension CHECK EACH DISCIPLINE INVOLVED IN PROJECT Ltr Drwg # of sheets TED )9 13 (off site improvements) (include TESC) TRO $9 ❑ (Signalization, Channelization, Lighting) � WWP (sanitary sewer main, include basin name) Wm � El(Mains, Valves, Hydrants) (inc. composite & HorizontalCtrl) S WP 0 (CIP onlyxinclude basin name) I PLR (For Developer Files Only) O (letter only) PLEASE CIRCLE TBE DISCIPLINES WHICH NEED TO SIGN MYLARS WATER WASTEWATER SURFACE WATER TRANSPORTATION FIRE FOR WIN MA TWA INANrW rtcc nwn v File Codes File Alias Date Entered and Labels Made ^^ - ottr% ' 33,zv 0- OIL ? -