Form 20 - Water System Field Acceptance Checklist - San Antonio Water System

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FN013-4 (Rev. 8/00)
SAN ANTONIO WATER SYSTEM
WATER 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
Phase I:
Bedding material approved type, installed correctly.....................................
_______________
Secondary backfill material approved type, installed correctly.....................
_______________
Valves open and shut freely and are left in open position............................
_______________
Fire hydrants set, clear of traffic, caps in place............................................
_______________
Mains have been pressure tested and passed.............................................
_______________
Mains have been chlorinated........................................................................
_______________
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................................................
_______________
Phase II:
Meter boxes set to proper grade with top soil and level...............................
_______________
Meter in box set not more than 8” below lid..................................................
_______________
Meter boxes not set in driveways or sidewalks.............................................
_______________
Customer cutoff valve w/ lid installed to proper grade..................................
_______________
Meter templates installed..............................................................................
_______________
Dielectric couplings installed.........................................................................
_______________
Valve box set, extension straight, box 1 ½” above extension.......................
_______________
Valve boxes set to proper grade with top soil and level................................
_______________
Valve boxes subject to traffic have concrete collar.......................................
_______________
2” blow-offs visible and intact........................................................................
_______________
Fire hydrants set to proper grade and painted..............................................
_______________
Fire hydrant valve boxes visible, operable, and open...................................
_______________
Fire hydrants operated under pressure........................................................
_______________
General:
Backfill compaction done correctly, test reports submitted...........................
_______________
Asphalt patchwork acceptable......................................................................
_______________
Site cleaned up and area restored................................................................
_______________
Punchlist Items: ________________________________________________________________________________
______________________________________________________________________________________________
Type of Pipe:
CSC 301
CSC 303
PVC
DI
Poly
Other _________
Manufacturer: ___________________________________________________________
Size / Length of Pipe:
6” _______ LF
8” ______ LF
12” ______ LF
20” ______ LF
24” ______ LF
Other: _____ Inch ______ LF
Contract Completion Date: ______________
Final Inspection Date: _____________________
Warranty Start Date: ___________________
Warranty Period: ___________________
NOTE: Water meters can not be issued until the associated sewer system is approved to accept flows.
Signatures:
_________________________
_________________________
_________________________
SAWS Inspector
Contractor
Consultant
Form 20

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