Title Page
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Project Address:
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Customer Name/Address:
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Inspection Date:
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Prepared by
Mains Extension
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Mains Extension Required?
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Installed how?
- Open Cut
- Direction Drill
- Thrust
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Length of Mains Extension (m):
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Photo of Mains Extension Alignment:
Submain
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Is Submain Required?
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Installed how?
- Open Cut
- Directional Drill
- Thrust
- Open Trench
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Length of Submain (m):
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Photo of Submain Alignment:
Service
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Number of Services:
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Installed how?
- Open Cut
- Directional Drill
- Thrust
- Open Trench
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Service Size:
- 15mm
- 15mm Inserted 32mm
- 25mm
- 25mm Inserted in 50
- 32mm
- 50mm
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Service Length (m):
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Meter Position Photo:
Traffic Management
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TM Required:
- All Works Inside Boundary
- Footpath Diversion
- Footpath Closure
- Shoulder Closure
- Contra Flow
- Stop Go
Additional Information
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Reinstatement Required?
- None
- Temporary Cold Mix
- Asphalt Footpath
- Asphalt Road
- Concrete Footpath
- Concrete Vehicle Crossing/ROW
- Concrete Road
- Kerb & Channel
- Cobblestone
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Enter Size Required (m2)
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Digger Required?
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Boundary Kit/Backing Board?
Notes:
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Notes/Obstacles:
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Further Investigation/Plans Required?
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Is an RO required?
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Is an NRO required?
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GIS Screenshot:
