NSF 61 & Material: NSF 372 (specify ASTM standard, dimension ratio-DR, Listed? AWWA Standard, and Yes No pressure class) PIPES Size: (Min 3” water main. Min 6” water main for fire protection. Water mains proposed with less than 3” diameter require justification with hydraulic analysis and future water use considerations provided and will only be allowed in special circumstances) JOINTS & MATERIALS: Valve Spacing: Yes No Means of Flushing Dead Ends? Number of Surface Water LAYOUT Crossings/Encounters? Maintain 18” Minimum Vertical Clearance @ Yes No Location with Crossings? Respect to Sewers: Maintain 6’ Minimum Horizontal Clearance? Yes No Normal Operating Pressure: Minimum System Pressure: DISINFECTION METHOD (include chlorine dosage and Retention time): and Operated By: (include name and address) NAME OF CERTIFIED OPERATOR: ADDITIONAL COMMENTS: DISINFECTION Project: Engineer: Date: General Scope of Project:
PIPES Material: (specify ASTM standard, dimension ratio-DR, AWWA Standard, and pressure class) NSF 61 & NSF 372 Listed? Yes No Size: (Min 3” water main. Min 6” water main for fire protection. Water mains proposed with less than 3” diameter require justification with hydraulic analysis and future water use considerations provided and will only be allowed in special circumstances) JOINTS & MATERIALS: LAYOUT Valve Spacing: Means of Flushing Dead Ends? Yes No Number of Surface Water Crossings/Encounters? Location with Respect to Sewers: Maintain 18” Minimum Vertical Clearance @ Crossings? Yes No Maintain 6’ Minimum Horizontal Clearance? Yes No Normal Operating Pressure: Minimum System Pressure: DISINFECTION METHOD (include chlorine dosage and Retention time): and Operated By: (include name and address) NAME OF CERTIFIED OPERATOR: ADDITIONAL COMMENTS: DISINFECTION Project: Engineer: Date: General Scope of Project:
EngineeringServicesPermitApplication.docx