Notification And Request For Inspection (Nri) Form
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1
2SEWER REPLACEMENT
NOTIFICATION AND REQUEST FOR INSPECTION (NRI)
METROPOLITAN WATER RECLAMATION DISTRICT OF GREATER CHICAGO
111 EAST ERIE STREET, CHICAGO, ILLINOIS 60611
312-751-3260
1.
PROJECT INFORMATION
Name and description of project: _______________________________________________________________________________________
__________________________________________________________________________________________________________________
Location of project (street address or with respect to two major streets): ________________________________________________________
__________________________________________________________________________________________________________________
Municipality (Township, if unincorporated): _____________________________________________________________________________
Related MWRD Sewer Permit and/or Watershed Management Permit Number, if known ________________________________.
2.
PROJECT
Is the project located within the floodplain? ☐ Yes ☐ No
Development Area: __________acres
3.
PROJECT TYPE
Government/Municipal ☐; Commercial ☐; Industrial ☐; Residential ☐; Private Utility ☐; Institutional ☐;
Recreational ☐; Sewer Rehabilitation ☐; Other ________________________________.
4.
SCOPE OF CONSTRUCTION
Work consists of : Sewer main reconstruction ☐; Replacement ☐; Relining ☐; Spot repairs ☐; Building sewer service replacement/relining
☐; Existing manholes to be reconstructed ☐; New manhole(s) ☐; Grease trap (s) ☐;
Oil separator(s) ☐; Mud basin (s) ☐. Other______________
Reason for replacement/repair: Collapse ☐; Deterioration ☐; Suspected breaks ☐; Excessive Infiltration/Inflow ☐;
Building Alterations ☐; Other ________________________________________________.
Bedding must be used for new or replacement sewer work as required by MWRD specifications.
5.
PIPE MATERIAL AND JOINTS
Diameter
Length
Material and
Joint and
No. of Structure (s).
Specification
Specification
EXISTING
PROPOSED
6.
PERMITTEE (MUNICIPALITY)
7. CO-PERMITTEE (OWNER)
I hereby certify that the project described herein will be
We have read and thoroughly understand the conditions
constructed in accordance with all applicable requirements
and requirements of this permit application.
and necessary supervision will be provided.
Company:
Address:
____________________________________________
Address:
__________________________________________
____________________ Zip ____________________
_____________________ Zip __________________
Name:
____________________________________________
Name:
__________________________________________
Title:
____________________________________________
Title:
__________________________________________
Signature: ____________________________________________
Signature: __________________________________________
Date: ___________________ Phone: ______________________
Date: _________________ Phone: _______________________
FOR MWRD USE ONLY…………………………………………………………………………………………………………………
NRI APPROVAL
By: _________________________________________________
Date Issued: ______________________________________
(Local Sewer Systems)
Fee Paid $_______________________
Atlas Sheet _______ Location: Horizontal (hh) _______ Vertical (vv) ________ Service Basin _______ Drainage Basin Code_______
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