Notification And Request For Inspection (Nri) Form Page 2
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21.
APPLICABILITY: This form may be used in lieu of a standard Watershed Management Permit form only if the works consist of:
A. A development area less than 0.5acres, or the new impervious area created for a Right-of-Way (ROW) project is less than 0.5acres.
B.
Sewer reconstruction, relining, rehabilitation.
Sewer reconstruction, replacement, repair (including spot repairs involving excavation) on public right-of-way or utility easement,
including appurtenances, using the same alignment (same trench); or,
Reconstruction of an existing building sewer service, including the addition of an inspection or maintenance manhole, with no change in
alignment. Reconstructed sewers must be of the same diameter as that being replaced; and/or,
C.
Minor New construction
The addition of a grease trap/separator, triple basin, or maintenance inspection manhole or mud basin with less than 25 linear feet of new
sewer service construction with no new connection to an existing sewer main, in conjunction with building alteration, and/or change in
ownership or use. Plans are required for new construction.
This form shall not be used if the alignment is changed more than 5 feet horizontally, if new service areas are added, if new sewer work would
require stormwater management facilities, if work includes new or reconstructed outfalls to a waterway or new or reconstructed lift stations, or
if reconstructed/replaced sewers will be larger in diameter than the existing sewer (including via pipe bursting). For these cases, a standard
Watershed Management Permit is required.
2.
INSTRUCTIONS FOR FILING FORMS: Submit two (2) original signed NRI forms; complete all information or indicate non-applicability;
do not leave any blank spaces; use “X” for checking applicable information. Submit two (2) copies of location map and plans. Address all
correspondence to Local Sewer Systems Section; for any inquiries or assistance, call (312) 751-3260.
Make written submittal sufficiently in advance. Give advance notice of at least two (2) working days before any work is started (telephone
(708) 588-4055). For emergency repairs, give advance notice and obtain permission to start before any work is started, and proceed with written
submittal. Failure to give advance notice and make written submittal as required constitutes a violation of the Watershed Management
Ordinance.
3.
EXPIRATION: This NRI will expire if construction has not started within one (1) year from the date of issuance. Construction under an expired
NRI is deemed construction without a permit. Construction must be completed within one (1) year after start of construction.
4.
REVOCATION: In issuing this NRI, the MWRD has relied upon the statements and representations made by the Applicant or his/her agent.
Any incorrect statements or misrepresentations will be cause for revocation of this NRI, and all rights of the Applicant hereunder will
immediately become null and void.
5.
PERMIT FEES: The permit fee to be presented with the NRI applications is $250.00 plus $5.00 per linear foot of sewer. (There is no fee for
government public works projects.) The Fee Payment Voucher form is to be completed and submitted as instructed on that form. This NRI
application will not be processed unless the fee, where applicable, is paid in full.
---------------------------------------------INSPECTION REPORT: (FOR MWRD USE ONLY) ---------------------------------------------------------------
1.
TIME SCHEDULE: (a) Verbal telephone notice received ___________
(b) Work started ___________ Work completed ___________
(c) First inspection made ____________ Total number of inspection made ___________.
SUPERVISION: (a) Construction supervision provided: Yes ☐ No ☐. If yes, supervision by Municipal employee ☐ by Consultant ☐
2.
(b) Name of inspector ________________________________________.
MANHOLES: (a) With respect to the ground immediately adjacent, existing rims are below ☐; at or above ☐ immediate surroundings.
3.
(b) Existing /new manholes are located in a low area and are subject to entry of surface runoff: Yes ☐ No ☐.
If yes, watertight manhole covers are provided: Yes ☐ No ☐
(c) Condition of walls, bench, and frame of existing manholes: Subject to infiltration ☐; Satisfactory ☐.
MATERIALS: (a) Existing pipe ☐ Existing bedding ☐; Existing joint ☐.
(b) New pipe ☐; New bedding ☐; New joint ☐.
4.
TESTING AND APPROVAL: (a) Visual inspection only ☐; Other tests (specify) ____________________________________________.
5.
(b) Test or inspection performed by: Municipal employee ☐; Consultant ☐; MWRD ☐.
(c) Names of persons performing or witnessing test or inspection: _________________________________________________________.
_______________________________________________________________________________________________________________
Comments: _____________________________________________________________________________________________________
_______________________________________________________________________________________________________________.
-----------------------------------------APPROVAL BY METROPOLITAN WATER RECLAMATON DISTRICT-----------------------------------------
The project has been inspected and is hereby approved. (Test method _______________________________.)
This approval does not constitute a release from other obligations under the Watershed Management Ordinance.
Date: _________________________
_____________________________________ ___________________________________________
MWRD Area Inspector
MWRD Area Engineer/Field Supervisor
8/16
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