Form 21 - Sewer System Field Acceptance Checklist - San Antonio Water System
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1FN014-4 (Rev. 8/00)
SAN ANTONIO WATER SYSTEM
SEWER SYSTEM FIELD ACCEPTANCE CHECKLIST
Project / Permit No.: __________________________
Title / Location: ________________________________________________________________________________
Contractor: _______________________
Consultant: _______________________________
Inspector: _______________________________________
Type of Project:
Bilateral
Joint
GCP
Trilateral
Permit
Items / Systems to check:
YES
/
NO
/
NA
Remarks
Bedding material approved type, installed correctly.....................................
_______________
Secondary backfill material approved type, installed correctly.....................
_______________
Backfill compaction done correctly, test reports submitted...........................
_______________
Manhole ring & cover approved type, installed correctly..............................
_______________
Manhole rings concrete encased..................................................................
_______________
All inverts correct..........................................................................................
_______________
Pipes flush with inside wall of manhole........................................................
_______________
Sewer lateral drops protrude properly into main...........................................
_______________
System free of debris....................................................................................
_______________
Wiper pulled through all piping.....................................................................
_______________
Throat rings and manholes wiped.................................................................
_______________
Laterals extend to property line....................................................................
_______________
All required pipe tests passed / test reports submitted:
Air test ......................................................................
_______________
Hydrostatic test ........................................................
_______________
Vacuum test .............................................................
_______________
Mandrel pulled through.................................................................................
_______________
Video tape of system submitted and approved.............................................
_______________
Asphalt patchwork acceptable......................................................................
_______________
Site cleaned up and area restored................................................................
_______________
Contractor’s “red-line” drawings complete and ............................................
_______________
cross checked with Inspector’s “mark-up” drawings
All parties sign “red-line” drawings................................................................
_______________
“Red-line” drawings submitted to Consultant................................................
_______________
Punchlist Items: ________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Type of Pipe:
PVC SDR 26
DI
RCP
RFP
Other _____________
PVC SDR 35
C 900
Manufacturer: ___________________________________________________________
Size / Length of Pipe:
8” ______ LF
12” ______ LF
24” ______ LF
Other: _____ Inch ______ LF
Manhole Type: ________________
# Manholes: _________________
Contract Completion Date: ______________
Final Inspection Date: _____________________
Warranty Start Date: ___________________
Warranty Period: ___________________
Date flows can be introduced into system: ____________________
Signatures:
_________________________
_________________________
_________________________
SAWS Inspector
Contractor
Consultant
Form 21
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