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SANITARY SEWER SYSTEM Low PRESSURE AIR TEST
PROJECT Mo/A-.4-ii 6/E, 7/ •
- DATE .:4.21 2_ 603 INSPECTOR /oh:J227 ,3e2L'
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LOCATION • LENGTH •K C TIME RESUL
14 44 Z. . : ).LF• 8 -R C L' b - _ 14
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• • ShortPlat'(SHPL#.
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• REQUEST FOR PROJECT# Prelim-Plat (PP# )
CAG# )
To: :Technical Services Date •a--:I9 Og< WOf : : Green#
From: Plan Review/Project Manager _ J 0 L l Pct•3 A_ :5 jam} j • k -Z
Project Name 1-10(2(,Prta WO e1-_v .
(70 characters sou) -
Description of Project: 4- Lc-i- St ex QL,Aa- vo i-cAA. 1, --e-.-Q3 8 u -•-
i
rtiPR-cr1 OM N11.--
S-T Eft_te€s 4 6TORt-tVWki .. , A1---1 I 111?-.10-1" mato .
Circle Size of Waterline: 8" 10" 12" Circle One: New or Extension •
Circle Size of Sewerline: 01010" 12" Circle One: New or Extension .
Circle Size of Stormline: 12" 15" 18" 24" Circle One: New or Extension
Address or Street Name(s) - - N i✓' y� pL P c 1 - °
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Dvlpr/Contractor/Owner/Cnslt:: PeT -- 4ri CCN.9‹ CIAO 6 / - / /
(10 characters nuz)
(LN'D2O029ti/1U Dl-L)7SD
Check each discipline involved in Project Ltr Drwg #of sheets per discipline
✓ ✓
XTrans-Storm 0 0
(Roadway/Drainage) (Off sue isnprovcmentsXineludc buin name) (include TESC sheets)
. •` Transportation . .(Signsliution,Clunneliution,lighting) • . 0 •0 .
Uol, Wastewater 0 0
Saniury Sewer Main(include buin name)
0- Water (Mains.Valves.Hydrants) 0 0
(include composite&Horizontal C
ul Slice
`�l Suface Water 0 0
Improvements (CLP ONLY)(includc basin name)
I e,D y() 3oo3 R.-3
TS Use Only --g(7 •- — ,moo 3 T-3
wioP - ate — 30D 3 s -. 3
WTIZ,-a-7 - 3 - Do3.
sRP?- a--1 - 3°03 D- 3,00
p .D7 - 3DD3 _, , . . _..