Water and Sewer Connection Inspection Form
Conduct an inspection of the water and sewer connection - Document water and sewer system dimensions, materials, the method of connection, and more.
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iPhone, iPad
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Android
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Web, Desktop
Mobile Data Collection for
About the App
When a water and sewer connection is made or repaired, it is important to conduct a thorough inspection from the start of the connection or repair to the completion of backfilling. Use this Water and Sewer Connection Inspection mobile form to document all information necessary such as the diameter and material of the sewer, depth to connection invert, and gather GPS coordinates of the water and sewer connections. Customize this form to accommodate your specific inspection requirements. This mobile form works in both on and offline environments.
General
Date
Applicant/Owner
Date of miss utility notification
Work order #
Address
Date by which work must be completed
Address/parcel ID#
Description of parcel
Sewer Connection
Location of connection
Is location consistent with that specified in initial site visit?
Upstream to downstream manhole numbers of section receiving connection
Diameter of sewer
Material of sewer
Diameter of lateral
Material of lateral
Depth to connection invert
Was a riser used?
Method of Connection
Bedding material
Backfill material
Is texture of bedding and backfill material acceptable
Was trench over-excavated?
Is compaction required?
If yes, what density?
Water Connection
Location of connection
Is location consistent with that specified in initial site visit?
Diameter of water main
Material of water main
Diameter of service line
Material of service line
Is wet-tap NSF/AWWA approved?
Is corporation stop of acceptable quality and installed at 45 degree angle?
Location of meter box
Is location consistent with that specified in initial site visit?
How many taps within box?
Was double check valve(s) used?
Was box installed on appropriate bedding?
Is box clean and free of debris?
Signature
Fulcrum Powers All Phases of Your Mobile Data Lifecycle
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Multiple Platforms
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Monitor Productivity
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Offline Data Collection
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Data Events
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Team Roles
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Custom Form Builder
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Real-Time Tracking
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Export Options
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API Integration
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Rich Media Collection
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Import Tools
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Secure Storage
Faster Decision Making
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