Title Page
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Line Number
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Interflow Reference
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Line Diameter (as per supplied info)
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Line length (as per supplied info)
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Junctions (as per supplied info)
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Conducted on
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Prepared by
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Location
US Manhole
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Manhole Number
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Access location
- Road
- path
- front yard
- backyard
- bush
- Parklands
- other
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Details
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Was the manhole able to be located?
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Is the location and other information on the supplied map accurate?
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What are the inaccuracies?
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Type of Access
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Details
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Type of manhole
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Details
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Is a Dig-up Required?
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Dig-Up Details
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Rehabilitation Required
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Difficulty categories
1/Manhole on road. Kubota can work from the back of the truck.
2/ MH invert less than 20m from truck. Kubota able to work over manhole.
3/ MH invert over 20m from truck. Kubota able to work over manhole.
4/ Winder must be manually handled to a distance (from invert) less than 20m from Kubota -Unable to work over manhole. Assess profile flow and manning requirements.
5/ Winder must be manually handled to a distance (from invert) greater than 20m from Kubota -Unable to work over manhole. Assess profile flow and manning requirements.
6/ Difficult Terrain. Category 5+ environmentally sensitive &/or extra equipment required. eg. cranes, scaffolding, flying foxes, barge. Take Photos, determine manning requirements. -
Profile Handling distance?
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Number of extra people required?
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Extra Equipment required? (eg. Flying Fox, Barge, Crane)
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Works Required?
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Depth to invert?
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Jackout Estimates
0= No jackout ie. easily accessed dropper
1= Under 30 mins. ie, Retic lines with slight to no bends in channel
2= 30-60 mins. ie, Retic lines with large bends or straight through carriers (up to DN450)
3= 60 mins +. ie, Carriers with bends in channel or over DN450 -
Extra equipment recommended? (eg. Air operated demo saw, High pressure water lance, 90 pound Jackhammer)
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Shallow manholes with a width of less than 1m are likely to require the removal of the aspro to complete lining works.
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Is the removal of the aspro recommended to complete lining?
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Photos of Manhole and surrounding area?
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Unable to be located because of
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Were you able to locate by probing?
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Photo with probe over buried manhole
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Photos of the estimated location and surrounding area
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Address
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Property Details
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Property identification photos. Eg. business signs with numbers
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Property type
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Details
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Park Name
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Photos of the area
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Details
DS Manhole
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Manhole Number
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Access location
- Road
- path
- front yard
- backyard
- bush
- Parklands
- other
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Details
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Was the manhole able to be located?
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Is the location and other information on the supplied map accurate?
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What are the inaccuracies?
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Type of Access
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Details
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Type of manhole
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Details
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Is a Dig-up Required?
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Dig-Up Details
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Rehabilitation Required
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Difficulty categories
1/Manhole on road. Kubota can work from the back of the truck.
2/ MH invert less than 20m from truck. Kubota able to work over manhole.
3/ MH invert over 20m from truck. Kubota able to work over manhole.
4/ Winder must be manually handled to a distance (from invert) less than 20m from Kubota -Unable to work over manhole. Assess profile flow and manning requirements.
5/ Winder must be manually handled to a distance (from invert) greater than 20m from Kubota -Unable to work over manhole. Assess profile flow and manning requirements.
6/ Difficult Terrain. Category 5+ environmentally sensitive &/or extra equipment required. eg. cranes, scaffolding, flying foxes, barge. Take Photos, determine manning requirements. -
Profile Handling distance?
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Number of extra people required?
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Extra Equipment required? (eg. Flying Fox, Barge, Crane)
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Works Required?
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Depth to invert?
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Extra equipment recommended? (eg. Air operated demo saw, High pressure water lance, 90 pound Jackhammer)
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Shallow manholes with a width of less than 1m are likely to require the removal of the aspro to complete lining works.
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Is the removal of the aspro recommended to complete lining?
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Jackout Estimates
0= No jackout ie. easily accessed dropper
1= Under 30 mins. ie, Retic lines with slight to no bends in channel
2= 30-60 mins. ie, Retic lines with large bends or straight through carriers (up to DN450)
3= 60 mins +. ie, Carriers with bends in channel or over DN450 -
Photos of Manhole and surrounding area?
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Unable to be located because of
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Were you able to locate by probing?
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Photo with probe over buried manhole
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Photos of the estimated location and surrounding area
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Address
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Property Details
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Property identification photos. Eg. business signs with numbers
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Property type
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Details
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Photos of the area
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Details
Traffic / Access
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Are there any nearby services that may be affected by the works?
- School
- Hospital
- Emergency services
- Bus Stop
- Clearway
- Railway
- Defense / Restricted area
- Roadside Parking
- Other
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Details
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Will any vehicle be located on a roadway for work?
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within 100m of any of the following?
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Road Type?
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Road Authority?
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Road Width?
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Speed Limit?
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Management type?
- Standard
- Contra-flow
- Stop-Go Controller
- Road Closure
- Temporary traffic Lights
- Other
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Will works be affecting any pathways?
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Will a park permit be required to complete the works?
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Name of Park?
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Impact to park?
- Entry with Kubota
- Vehicle entry
- Dig-up
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Other Details
Resident Information
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Number of affected customers? (the number of houses connected to the line, or houses on the street if works will be impacting the traffic conditions)
Add impacted Resident contact information.
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Address
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Customers Name
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Contact Number
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Email address
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Impact to property?
- Entry into yard for lining
- Entry into yard for plugging
- Dig-up on property
- Access through yard
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Property impacts?
- Children on property
- Pets on property
- Pool
- Fences
- Gates (locked)
- Gardens
- Shed
- Driveway
- Paving
- Retaining Wall
- Significant Tree/s
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Details
Risks / Hazards
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Are any of the following environmental risks present?
- Nearby Creeks / River
- Nearby Stormwater Drains
- Other Waterway
- Other environmental risk
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Details
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Are any of the following hazards present?
- Overhead services
- Known underground services
- Pets on property
- Yard in need of maintenance
- Snakes/ants/ticks etc.
- Other health / safety issues
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Details
Flow Control
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Date and Time
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Is the line affected by a pump station?
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Recommended flow control measures?
- Plug and release
- Bypass pumping
- Tankering
- Pump station isolation
Assumptions
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Please note any assumptions that have been made within this form? (ie. Depth of buried manholes, Manholes located on inaccessible properties not buried etc.)
Condition of Area
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Any existing damage to the surrounding area to be taken note of?
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Photos of existing damage
Sketch
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Recommended winding direction?
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Sketch of the area
Completion
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Signature