HomeMy WebLinkAbout2157 Sunbury Ln - Correspondence/Water and or Sewer - 04/20/20054/ 18/05 Called In
4/20/05 Requested for
D.U.- 9:00 A.M.
OWNER
SERVICE ADDRESS
OWNER ADDRESS
❑ SERVICE CALL
REASON FOR CALL:
LOCATE
N2 007164
Saddle Set
Stub Out Used
SANITARY SEWER SYSTEM
CONTACT TIM/ ASPEN HOMES
PHONE 567-5105
❑ WORK ORDER
(If Locate is for new service line construction, read notes for inspection below)
REASON FOR LOCATE:
Reasonable effort has been made to accurately locate the center of BoxelderSanitation District sewer lines in the vicinity'
of the service address as requested and these have been marked on ground surface with green paint. The sewer location
markings represent approximate horizontal location of the sewer (accurate to within 18 inches in either direction). Depth
is estimated to be . Always use caution when excavating near
any utility, and expose pipes so that pipes are not damaged and pipe bedding disturbance is minimized.
M O.K..TO ISSUE CERTIFICATE OF OCCUPANCY �3�('�j►—�,?,2-�i'
Ey NEW SERVICE INSTALLATION INSPECTION
01 NOTE:
1. Connection to sanitary sewer collection system cannot be made until System Development Charge is paid to the District AND
a Sanitary Sewer System Connection Permit has been issued by the District;
2. The District will provide labor, equipment, and tap saddle connector to drill the collector line and fasten the saddle connector to
the collector line. Permittee may NOT,under any circumstances, attempt to penetrate main collector lines or manholes;
3. The District will provide locator wire which is required for burial along with the service line for future locating of the line;
4. Permittee shall provide all excavation, shoring, dewatering, service line materials and labor for Installation of service
line to main connection, and backfill as required by the District, Federal and State OSHA requirements, and applicable
Building and Plumbing Codes. No excavation, shoring, dewatering, or backfill work will be done by the District, and the
Manager or his agent will require any additional excavation, shoring, or dewatering of the excavated space that in his judgement
alone is necessary before adequate inspection may be accomplished and approval of the service line installation is granted;
5. The District requires that all service lines be installed such that future use of the service line will not contribute inflow or infiltration
of groundwater to the collection system due to improper connections, grades, bedding materials or placement, or pipe material.
The District will require correction of any improper connection through its enforcement authority;
6. Permittee shall notify the District at least 24 hours prior to when the service line is expected to be installed and ready for
inspection and connection;
7. The District shall not be subject to any liability for any deficiency or defect of service line materials or installation which is not
discovered by inspection nor shall owner or permittee be absolved from liability for any deficiency or defect of service line
materials or installation and any resulting damage or from responsibility to correct such deficiency or defect. The District does
not assume any obligation nor acquire any liability for personal injury to any party or damage to the connecting property or any
portion thereof caused by or resulting from any such connection to the wastewater collection and treatment system; 8. The District requires payment of a $50.00 construction inspection charge for this inspection.
r r 1 if
Type of Pipe: �%'?�'+�. Pipe Bedding Material: —
Installation Satisfactory? Clean Outs Satisfactory? Pipe Slope Adequate? VP
Pipe Bedding'Satisfact� ry? Locator Wire Properly Placed? u' Backfill Satisfactory?
Inspected by:
Date_ A e.
for ox ed r Sanitation istnct
By signing, I acknowledge having read and understood the forgoing and acknowledge receipt of a copy of this
form.
Received by: Date
P.O. Box 1518 - 2217 Airway Ave. #3 • Fort Collins, Colorado 80522
Phone (970) 498-0604 • Fax (970) 498-0701