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SANITARY SEWER SYSTEM
OWNERICONTACT: dOtiB hIiCHA£I. Gil)L1AidO
SERVICE ADDRESS/LOCATION:
438 DWiNOCK ST
N° 012621
Boxelder Sanitation District
3201 E Mulberry St., Unit 0
PO Box 1518
Fort Collins, CO 80522
(970) 498-0604 fax (970) 498-0701
bsdacctg@boxeldemanitation.org
PHONE: 566-0156
LOCATE SERVICE CALL WORK ORDER
REASON:
Warning to Excavators to Exercise Caution Lateral sewer lines
Boxelder Sanitation District does not customarily locate lateral sewer lines (service lines) or their connections to
the District's sewer mains because in most cases it cannot precisely do so. Please be aware that any attempt by
the District to do so is hampered by the fact that such lines and connections are not installed, maintained, operated
or owned by the District. The District has often not been provided with plans, maps, or other documentation giving
locations] information on lateral sewer lines by their owners. Therefore, excavators must understand that any
attempts by the District to locate lateral sewer lines or their connections are necessarily based on deduction rather
than hard information and that at best such attempts will indicate a lateral's ESTIMATED location rather than Its
certain one. In light of this, excavators should exercise all due caution and care to protect themselves, other
persons, and all property when excavating near lateral sewer lines that Boxelder has attempted to locate.
Reasonable effort has been made to accurately locate the center of Boxelder Sanitation District sewer main 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 server main (accurate to within 18 inches in either direction). Depth, is estimated to be . Always use caution when
excavating near any utility, and exposed pipes so that pipes are not damaged and pipe bedding disturbance is minimized.
Ves_ No District estimated the location of the laloral connection to the Dla nd s main.
_Yes' No District estimated the location of the lateral beyond the connection N the District's main.
yv NEW SERVICE LATERAL INSTALLATION INSPECTION
i. Connection to sanitary sever collection system cannot be made until a Wastewater Discharge Right is purchased from the District
2. District saddle set charge includes labor, equipment, and tap eadale connector to drill fire collector line and fasten the saddle connector to the collector line.
Permitted may NOT, under any circumstances, attempt to penetrate main collector lines or manholes without the consent of the Dishict.
3. Locator wire is required for burial along the service fine for future locating of the line;
4. Permb es shall provide all excavation, shoring, tlewatering, service line materials and labor for installation of service line to main connection, and
backflll as required by the Dourtct. Federal and State requirements, and applicable Building and Plumbing Codes. No excavation, shoring,
dewalering, or backfill work will be done by the District. and the Manager or his agent will require any additional excavation, sharing, or dewatering of the
excavated space that In his judgment alone is necessary before adequate Inspection may be safely accomplished and approval of the service line
istallahon is granted;
S. The District requires that all service lines be installed such that future use of the service line will not contribute inflow or Infiltrator. of groundwater to the
collection system due to improper connections, grades, bedding materials. placement, or pipe material. The District will require correction of any improper
eonnactlon through it. enforcement autllonly;
6. PcmiUcc, shall notify the District of least 48 hours prior to when the scrvire line is expected to be installed antl ready for inspection and connection:
7. The Distrirt 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 pennitlee 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 prready or any portion thereof caused by or resulting from any such connection to the waetowater collection and tromment
system;
B. The District requires payment of a construction inspection charge for this inspection.
Type of Pipe: .�(l0 Z.S' <d" Pipe Bedding Material:
Installation Satisfactory? Disconnect Valve Satisfactory? r Pipe Slope Adequate visual)? •_,?1
Pipe Bedding Satisfactory? Locator Wire Properly Placed? ,-,.)\
r
Inspected By! li)L". Date: li;�r S
For eaxe:der 5a1aalicr District
O.K. TO BACKFILL Date: J ii z District Initial A471
x'=O.K. TO ISSUE CERTIFICATE OF OCCUPANCY Date: _ District Initial: Ai O
By signing, I acknowledge having read and understood the forgoing and acknowledge receipt of 6 copy of this form.
Received by: I Date: