NYC DEPARTMENT OF BUILDINGS
SEWER SELF CERTIFICATION
HOUSE CONNECTION PROPOSAL FORM
For 1-, 2-, or 3- Family Home Only
HC
VALID FOR TWO (2) YEARS
PROJECT DATA:
Borough of _______________________ Building Dept. No (s) ____________________________________
Tax Block ______________ Lot (s) _________________ Zoning ____________ Map No. ___________
Project Location _________________________________________________________________________
Site Area_____________________(sq. ft.) Attached NYC Water Board Review Fee $_________________
1. PLAN
All House Connections Must Be Gravity Lines Only
2. HOUSE CONNECTIONS REQUESTED:
3. CONNECTION INFO:
Total Developed Site Storm Flow ______ cfs
1.
Connection to exist:
Allow. Storm Flow to the Sewers ______ cfs
Spur
Riser
Curb
Detention
Retention
Connection
Sanitary
Storm
Comb.
Drywells
2.
Proposed New Riser
_ _______ _______ xxxxxxx
No. Requested
_______
3.
Fold Spur in
_______ _______ _______ xxxxxxx
Size
_______ _______ _______ xxxxxxx
Material (s)
4.
Drill in
_______ _______ _______ _______
Total Q (s)
5.
Reuse Plugged Connections
Note:
The property owner is responsible for plugging all inactive pre-existing
sewer connections.
4. SUPPORT DOCUMENTS:
*1.
Site Plan – 6 copies with hydraulic calculations _____________________________________________
*2.
Survey – 3 copies with watercourse note _________________________________________________
*3.
Tentative Lot Number Request Form – Attached __________________ Not Applicable _____________
4.
Department of Buildings Amendment – Attached _________________ Not Applicable _____________
5.
Builders Pavement Plan – Attached ____________________________ Not Applicable _____________
6.
Boring Logs – Attached _____________________________________ Not Applicable _____________
7.
Other (Specify) ____________________________________________ Attached __________________
* Requires PE/RA Stamp and Original Signature (L.S. for Survey)
1
safety service integrity
HC04 (10/06)