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Home My WebLink About3538; North Batiquitos Interceptor Sewer Inspection Rep; North Batiquitos Interceptor Sewer Inspection Rep; 2005-06-01INSPECTION REPORT ON THE NORTH BATIQUITOS INTERCEPTOR SEWER PARTI ACCESS HOLE INSPECTION REPORT (JUNE 2005) m NORTH BATIQUITOS INTERCEPTOR SEWER INSPECTION REPORT PART 1 ACCESS HOLE INSPECTION REPORT TABLE OF CONTENTS Section 1) Project Summary 2) Table 1-Access Hole Inspection Results 3) Photos 4) Location Map 5) Field Inspection Sheets 6) Enclosed Access Hole Video Inspection DVD with Commentary NORTH BATIQUITOS INTERCEPTOR SEWER ACCESS HOLE INSPECTION REPORT (JUNE 2005) SUMMARY General: The North Batiquitos Interceptor alignment generally follows the north shore of the Batiquitos lagoon, intercepting and conveying wastewater flow from south Carlsbad between El Camino Real and Interstate 5. It then goes northerly to the Encina Water Pollution Control Facility. This inspection included reaches 1 through 4 of the interceptor, or that portion between El Camino Real and the North Batiquitos Lift Station near Gabiano Lane, see location map. The system was constructed in the mid 1970s. This inspection report includes information found in field investigations by both Downstream Services and City staff The City's Engineering and O&M staff initially assessed the condition of the access holes from above grade, in June of 2004. Subsequently Downstream Services was contracted by the City to provide an additional investigation, including the cleaning and CCTV inspection and assessment of each access hole as well as the cleaning and CCTV inspection of the pipeline. Findings: There are several factors, which have impacted the performance and maintenance of the sewer. These include high ground water, high levels of hydrogen sulfide and resultant corrosive acids, restricted access to the pipeline and access holes, and proximity to the lagoon and environmentally sensitive areas. A rating system for the found condition of the access holes is defined on the access hole report sheet. There is a two-page report for each access hole. A summary of conditions including: defects, accessibility, and groundwater infiltration, is provided in Table 1. Thirty-five of the 43 access holes were found have moderate to severe corrosion on their interior concrete surfaces, including the shaft, cone, bench, frame and cover. The majority of the access holes have been foimd to have some level of infiltration from minor seepage to significant. An accessibility scale is also defined and each access hole has been graded accordingly. While several ofthe access holes are accessible to heavy equipment via the coincidental public trail, the majority have limited access due to environmental sensitive surroundings. A portion of the system is with in the Aviara Resort golf course and access to the access holes is limited and should be coordinated with the owner. At the eastern end of the alignment access hurdles include crossing a farmed property as well as an additional environmentally sensitive area. The results of the inspection should be used to help select the most appropriate rehabilitation methods for the access holes. The findings in the pipeline inspection report by Downstream Services, which was done concurrent with the access hole inspection, should also be considered in generating a project description for the rehabilitation of the system. TABLE 1 NORTH BATIQUITOS INTERCEPTOR SEWER ACCESS HOLE INSPECTION REPORT SUMMARY ACCESS HOLE# ACCESSIBILITY 1 -Drive(paved) 2- Drive(unpaved) 3- Drive& Walk<20' 4- Drive & Walk>20' 5- No Maintenance (easy walk) 6- No Maintenance (diff walk) 7- No Maint. Access(easy walk contact property owners) 8- No Maint. Access(diff. walk contact property owners) DEFECTS 1-MILD; 2-MODERATE; 3-SEVERE 1- INFLOW 2- INFILTR. DIMENSIONS ACCESS HOLE# ACCESSIBILITY 1 -Drive(paved) 2- Drive(unpaved) 3- Drive& Walk<20' 4- Drive & Walk>20' 5- No Maintenance (easy walk) 6- No Maintenance (diff walk) 7- No Maint. Access(easy walk contact property owners) 8- No Maint. Access(diff. walk contact property owners) SHAFT & CONE BENCH FRAME & COVER 1- INFLOW 2- INFILTR. Diameter/Depth (Inches) 21 1 1 1 1 60/180 22 2 3 3 3 2 48/83 23 2 3 3 3 2 48/112 24 2 3 3 3 2 48/80 25 2 3 3 3 2 48/76 26 2 3 3 3 2 48/78 27 2 3 3 3 2 48/96 28 2 3 3 3 2 48/92 29 2 3 3 3 2 48/94 30 2 3 3 3 2 48/83 31 2 3 3 3 2 48/79 32 2 3 3 3 2 48/95 33 2 3 3 3 2 48/107 34 3 3 3 3 2 48/103 35 3 3 3 3 2 48/106 36 2 3 3 3 2 48/139 37 2 1 1 1 2 48/223 38 7 3 3 3 2 48/205 39 7 1 1 1 2 48/168 40 2 2 3 2 2 48/170 41 6 3 3 3 2 48/114 42 2 3 3 3 2 48/184 43 2 3 3 3 2 48/131 44 2 2 2 2 2 48/101 45 6 3 3 3 2 48/125 46 6 3 3 3 2 48/91 47 6 2 3 2 2 48/118 48 6 2 3 2 2 48/94 49 6 1 1 1 2 48/99 50 2 1 1 1 2 48/92 51 2 1 1 1 2 48/94 52 2 1 1 I 2 48/124 TABLE I NORTH BATIQUITOS INTERCEPTOR SEWER ACCESS HOLE INSPECTION REPORT SUMMARY ACCESS HOLE# ACCESSIBILITY 1- Drive(paved) 2- Drive( unpaved) 3- Drive&WaIk<20' 4- Drive & Walk>20' 5- No Maintenance (easy walk) 6- No Maintenance (diff walk) 7- No Maint. Access(easy walk contact property owners) 8- No Maint. Access(difF, walk contact property owners) DEFECTS 1-MILD; 2-MODERATE; 3-SEVERE 1- INFLOW 2- INFILTR. DIMENSIONS ACCESS HOLE# ACCESSIBILITY 1- Drive(paved) 2- Drive( unpaved) 3- Drive&WaIk<20' 4- Drive & Walk>20' 5- No Maintenance (easy walk) 6- No Maintenance (diff walk) 7- No Maint. Access(easy walk contact property owners) 8- No Maint. Access(difF, walk contact property owners) SHAFT & CONE BENCH FRAME & COVER 1- INFLOW 2- INFILTR. Diameter/Depth (Inches) 53 2 1 1 1 2 48/84 53a 2 1 1 1 2 48/161 54 7 1 1 1 2 48/70 55 7 2 2 2 2 48/76 56 7 2 2 2 48/120 57 7 2 2 2 2 48/88 58 7 2 2 2 2 48/81 59 7 2 2 2 2 48/76 60 7 2 2 2 2 48/84 61 3 2 2 1 2 48/160 ' 62 1 1 1 1 1 48/109 (JUNE 2005) NORTH BATIQUITOS INTERCEPTOR ACCESS HOLES Interior Photo of AH #42(21) Severe Concrete Corrosion of Shaft and Bench June 2004 : I Surface Photo of AH #42(21) June 2004 NORTH BATIQUITOS INTERCEPTOR ACCESS HOLES Interior Photo of AH #43(22) Severe Corrosion and Ground Water Infiltration June 2004 Surface Photo of AH #43(22) Aviara Resort Golf Course June 2004 NORTH BATIQUITOS INTERCEPTOR ACCESS HOLES Interior Photo of AH #43(22) Severe Concrete Corrosion of Shaft June 2004 Interior Photo of AH #42(21) Severely Corroded Frame June 2004 r^r^.. VI 1. UPSTREAM MANHOLE # U il 1' f 2. DOWNSTREAM MANHOLE # .... I in ( |i bSz—IL 3. INSPECTED MANHOLE :.. I j Ii. II—^ II- 4. Pipe DIRECTION iL 5 " ' " (f _ll. 5. SHAPE OF PIPE I L ' / 6. PIPE DIAMETER^^E1GHT (IN)...| />.. II II /P- IL 7. PIPE MATERIAL 1 ^ II 5 II 2:: IL 8. . PIPE LINER MATERIAL !J ^^^^ 3^'''l~'''^T"~r~"'' 9. ^ RIM TO CROWN (FT) • ) " "- 10. FLOW DEPTH (IN) | !l I IL_!S IL 11. DEPOSITION: INCHES I. . .L TYPE.i J IL _ • i:— 16. FLOW VELOCITY (FPS) \ L II U II 4 IL J ENTER APPROPRIATE NUMBER OR 'SVC' OR 'STUB' J J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOCK POSITION i Jl-ROUND 2-ELUPTICAL 3-80X 4-DOUBLEBOX J S-TRIPLE BOX 6-HORSeSHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-OIP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS _t 1-CIPP2-F0LDAF0RM 3-SLIPLINED 4-SPIRAL WOUND J INCLUDES DEPOSITION A^^ PIPE MOUTH 1-SLUOGE 2-MUO 3-ROCKS 4-DEBRI$ ESTIMATED OR MEASURED (CIRCLE) PIPEff FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 PIPES FCXJTGE LOC. DEF RATNG INFLT(gpm)| COMMENTS 1 1 1 • ^ 1 ! 1 1 1 1 1 1 1 1 17. POSSIBLE PIPE EXPOSURE I 18, PIPE CHECKED FOR EXPOSURE I 1-YES 2-NO :| 1-YES 2-NO COMMENTS; PIPE SKETCH Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 OS Manhole 2 Crack-Hofizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe S Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Right 6 Offset 9 Lower Right 9 Gapped Join! 10 Lower Left 10 Rools 11 Upper Left -14 J^ebris^ -42 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scaling 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 Infiltralion 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below ground teve!) 23 Exposed Cut-off v/all (>2 feet of wall enposed) GEN. LOCATION: (INDICATES IF STREET fW OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE -IfvlSPECTlON,TYpfe. STRUCTURETYPE. LOCATION .| ^ I I-INTERNAL 2-SURFACE S-NOT INSPECTED 4-eUfilED &-NOT FOUND STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-HOCK TRAP 6-FllLED IN 7-TEE 8 JUNCT10N SURFACE TYPE. \ I I t-STREET 2-ALLEY J-SOWIX 4-OflWn'VPKWY 6-YAfip 7-STRM WTCH 8-CfiK BED J-POSSCPXCEO 10OPE.S SPACE 11.CALTRANS fVW J l-ASPHALT 2-CONCfiETE 3-GRAVEL 4-EaOOEO SOIL AT RAISED MH '.TREE 6-ERCCEOSCIL ANOTflE? 7-OlRT«3RA5S / COVER A.'TYPE / ^ I i-PiCK 2-CpNCEALEDPlCK S-VfeWTED 4-STOaM • \ - - , J i-GOOO 2-TlGKT 3-LOOdE 4-flOCKlNG 5-BOLTS MISSING E-GASKET BAD/GONE 7-GOOOO-RING B. FIT I / C. SEAL I / I l-NONE 2-GASKET 3-SILlCONE D SECURING I / I 1-NONE S-STRAPPING BAR 3-ANGLE IRONS 4- SB'ALLEN EOCT £-3/4: ALLEN BOLT 6- 5 POINT BOLT 7- ALF;! ' • BOLT a- 6POtNT80LT 9-BURIED 10-ASPHALT CAP ii-CONCRETE CAP i_Z r E. # OF HOLES. FRAME LintrTvpe: 1- CemendDous 2- Cvt in PUcs 3- Cuctij in :lace poxy flat & F. PONDING DEPTH (IN)I_rlJ!! G. POINDING TYPE \ I 1-SHEET FLOW 2-LOVV POINT "H. SIZ£(D1A.IN)„... I I 1-24- 2-36" 3-48- 4<3THERS . r. INFLOW DISH I —. I 1-NO 2-YES A. OFFSET (IN).. I ~^ I . B. RISER HEIGHT (IN)....LJirZU ^ eQ^ei^<^< GRADE ADJ. A.TYPE j ^ | i-NONE 2-PaECAST 3-ERICK 4-BLOCK £-POURED LINEO:[>ES0NO B. DEPTH (IN), I 1/ I C. MIN. DIA (IN) I I CONE/TOP A. TYPE .\ ' I 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORO e-BRK4C0N 7-CLAY S-PVC LINEDOYE^NO B_ SHAPE ' I I i.rnMr.Pr/TRic 7.cr.cFNTPic a-RATTpa I WALL A. MATERIAL | | 1-NONE 2-PRECST 3-BRK 4-ELK S-PORD e-ERKSCON 7-CUY E-FVC LINEDnYESjZNO B LINING TYpc i l-C£MENTlTiOUS S CAST-IN-FLi-CE o-CUF.ED-IN-FLACE 4-£.=0)Cr' C. DIAAENGTH (IN) I (STO J D. DIAAV'DTH (IN) I i 1 ::=.NCHTYPE 1 5" I l-.NONE S FF.ECAST 3-5.R1CK 4-5LOCK ;-.=CUREO LWHOiDvES^lNO TROUGH TYPE I ^ I 1-NONE 2-PSECAST 3-POURHO 4-VCP 5 =VC 6-=.=:C:< '^PE SEAL TYPE I I l-NONS 2-.V0RrAR 3-GASKET r-=P5 A. TYPE I V \ 1-NONE 2-5.^?. 3-CAST IRON 4-.t=LAST;C B. CONDITION I / 1 1-GOOO 2 CORF.ODE0 2-.V.:S.AL!GN'E0 4-5=C-;EN :-.V;SS:NG E Ur,SA.=E •-••^NHOLE DEPTH (FTJ I %' i \ EVIDENCE OF SURCHARGE (FT) | i •ERECTS FLOW OBS. CODE TGPM) BROKEN CORnOSiON ROOTS \i\ •- -^U.^;5ER0= SO S D S D COPE HOLES C.=ACKS JOiNTS COVER I !L FRAME I !|_ F.=AME SEAL \ !I_ GRADE ADJUSTMENT..L JL CO\'= 1 IL V.'.ALL L JL EIEMCH L Jl TROUGH I ll O.V CODE SEVERITY CODE JL J L J L I 1 pm L J I ! I I L DENSITY CODE I/I CODE - LIGHT - \'.ODERATE . - HEAVY J-STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2-10%-25% 3 - 25% • 50% 4 - >50% 1 - INFLOW 2 • IN.=^iLTRATION ;CESS. / I 1-0HIVE(PAV=0) 2-CniV£(UNPAV=0| 3 CaiVE i V,'ALK*JO' < OR.VS A WAlK>;o $-NOMAl.VT ACCESSiEASYWAiK) 6-NO KUNT. ACCESS (Oi??ICULT WALK] 7-NO ACCESSitASYWALK CCVTACT FSOPEflTY CW\E3J e • NO MMHT. ACCESS (DIFFICULT WALK CCNTA:r PfiOFEflTY 0V/\:^1 \'ORTAR DETERIORATION U^_| i NO 2YES r ~ = CIPiTATlON !_ _! INCHES IN PAST 3 DAYS t ':'.\- NORTH BATIQUITOS INTERCEPTOR SEWER ACCESS HOLE E^SPECTION REPORT ACCESS HOLE# DEFECTS 1-MILD; 2-MODERATE; 3-SEVERE DIMENSIONS ACCESS HOLE# SHAFT & CONE BENCH FRAME & COVER rNFIL.-2. INFLOW-1 Diameter/Depth (Inches) 58 2 2 2 2 59 2 2 2 2 60 2 2 2 2 61 2 2 1 2 62 1 1 1 1 (JUNE 20 05) E m Ii I I I I I I I NORTH BATIQUITOS INTERCEPTOR SEWER ACCESS HOLE INSPECTION REPORT ACCESS DEFECTS HOLE# 1-MILD; 2-MODERATE; 3-SEVERE DIMENSIONS SHAFT & BENCH FRAME & INFIL.-2. INFLOW-1 Diameter/Depth (Inches) CONE COVER 21 1 1 1 60/180 22 3 3 3 2 48/83 23 3 3 3 2 48/112 24 3 3 3 2 48/80 25 3 3 3 2 48/76 26 3 3 3 2 48/78 27 3 3 3 2 48/96 28 3 3 3 2 48/92 29 3 3 3 2 48/94 30 3 3 3 2 48/83 31 3 3 3 2 48/79 32 3 3 3 2 48/95 33 3 3 3 2 48/107 34 3 3 3 2 48/103 35 3 3 3 2 48/106 36 3 3 3 2 48/139 37 1 1 1 2 48/223 38 3 3 3 2 48/205 39 1 1 1 2 48/168 40 2 3 2 2 48/170 41 3 3 3 2 48/114 42 3 3 3 2 48/184 43 3 3 3 2 48/131 44 2 2 2 2 48/101 45 3 3 3 2 48/125 46 3 3 3 2 48/91 47 2 3 2 2 48/118 48 2 3 2 2 48/94 49 1 1 1 2 48/99 50 1 1 1 2 48/92 51 1 1 1 2 48/94 52 1 1 1 2 48/124 53 1 1 1 2 48/84 53a 1 1 1 2 48/161 54 1 1 1 2 48/120 55 2 2 2 2 48/160 56 2 2 2 48/109 57 2 2 2 2 ii PI u 1. UPSTREAM MANHOLE » U 2. DOWNSTREAM MANHOLE # , 3. INSPECTED MANHOLE 4. PipE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN) 7. PIPE MATERIAL 1 1 1 II (o{ Ii 1 1 I / II ^ II I 1 , 1 It 1 i / II -II 1 . 1 II / II 1 I 1 1 I tP. II /XlL 1 1 • I- 1 p II -3 II II 1 ENTER APPROPRIATE NUMBER OR 'SVC OR "STUB" 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOC'K POSITION i 5-TRIPLE BOX 6-HORSESHC 8. PIPE LINER MATERIAL. 8-TILE 9-SRICK 10-TRUSS .11-CIPP2-F0L0&F0RM S-SLIPLINEO 4-SPIRALWOUND I I I 9. ^ RIM TO CROWN (FT). .•• f_lAl^3_J\ •3j|_ 10. FLOW DEPTH (IN) I ^ II ^ Ii- ii. DEPOSITION: INCHES |. ' iL C TYPE.i I ^ IL ^— iL_ 16. FLOW VELOCITY (FPS) I ^ II ^ ll„ 17. POSSIBLE PIPE EXPOSURE | _i 1-YES 2-NO 18. PIPE CHECKED FOR EXPOSURE j | 1-YES 2-NO COMiVIENTS: INCLUDES DEPOSITION PIPE MOUTH l-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPEff FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS i PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 • : 1 1 1 1 1 1 1 1 1 1 1 fm Came Oerects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 OS Manhole 2 Crack-Horizontai 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Servkie 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Ta3 8 Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left XX Debfis -12 iCrown— 12 Grease 13 Inverl 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 InDllralion 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cut-off wall (>2 feet of wall exposed) G EN. LOCATION: (INDICATES IF STREET RAV OR CANYON) A^^/ ^^^^^ ADDRESS: OBSERVATION CODE NO. CODE INSPECTION ,TYPt l! | STRUCTURETYPE ..!.....;! J_ LOCATION I /fi_ SURFACE TYPE. 1-INTERNAL 2-SURFACe 3-NOT INSPECTED 4-eURlED S-NOT FOUND l-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP S-RCCK TRAP 6 F1LLED IN 7-TEE fl JUNCTION l-STREET 2-Al.lEY 3-SOWlX *-0nW/Y5-PKWY frYAflp 7-STBMCITCH B-CRKBEO 9-FOSSCPX8ED II CALTRANS RAW l-ASPHALT 2-CCNCficTE J-GflAVEL 4-EfiOOEOSOlLArRAl$cO MH J-THES S-EKCCED SOIL ANO TflEH 7-OlflT/GPA5S COVER A. 'TYPE .........J.::...-. L B. FIT L r C. SEAL I L D. SECURING I L l-PICK 2-CpNCeALEDPICK 3-VfeNTED 4-STOflM • f • ' , t-COOD 2-TIGKT 3-LOOSfe 4-ROCKiNG 5-BOLTS MISSING 6-GASKFT BAtVOONE 7-GOOO 0-RING 1-NONE 2-GASKET 3-SILICONE J 1 -NONE 2-STHAPPING BAR 3-ANGLE IRONS 4- SB* ALLEN EOLT £-3/4: ALLEN EOLT 6- 5 POINT BOLT 7- ALF.^ * BOLT 8-6 POINT BOLT 9-BURIEO 10-ASPHALT CAP Ii-CONCRETE CAP E. # OF HOLES I / I FRAME F. PONDING DEPTH (IN}L G. PONDING TYPE. L "a SIZE (DIA. IN) L I. INFLOV/DISH L A. OFFSET (IN). 2 1-SHEET FLOW 2-LOV/POI^fT 1-24" 2-36' 3-48' 4-OTHERS J 1-NO 2-YES LintrType: 1- Ccmenddous 2- Cast in Ploc: 3- Cufcd in Place ' 4- Epox)' t\. i^rroct 1 f /I B. RISER HEIGHT (IN)....L-i5lj''^~><^'^ ^ GRADE ADJ. A. TYPE..... | X I 1-NONE 2-PRECAST S-ERICK 4.BL0CK 5-POUREO LINEOiDcESg] NO 8. DEPTH (IN) I I C. MIN. DIA (IN) I I CONE/TOP A. TYPE. :| • | i-NONE 2-PflEGST 3-BRK 4-ELK 5-PORD e-5HK&C0N 7-CUY 8-PVC LINEDOYES0NO R RHAPF ' I ^1 1.CnNr.FrfTRir. ?.FCCFNTPtC 3-'^l ATT0^ V;ALL A. MATERIAL | 'jZ. | l-NONE 2-Pn£CST 3-BRK 4-ELK 5-PORD e-ERKSCON 7-CLAY E-FVC LI.S-EODYEE^SO NGTYPt^ : , 1-CEW^JTlTiOUS 2-CAST-IN-FUCE 3-CU=ED-IM-FLi.CE 4-E.=0XY ^0 ^ AENGTH CN) rmx (L^ ^ioi^ ,^ • AV'OTH(iN) I • ^ ^ rJ ''"^ B. LINING C. DIAAENG D. DIAA' 5ENCHTYPE T=OUGH TYPE :=:?£ SEAL TYPE r-£PS A. TYPE B. CONDITION '.•A.^-HOLE DEPTH (FT) I {J>'^\ EVIDENCE OF SURCHARGE (FT) I • 1-NONE 2-FF.ECAST 3-ER:CK 4-5LOCK S-PCU-RED L!.\=0:DYES l-.SONE 2 PHECAST 3-POUREO 4-VCP 5-FVC e-==:C:< ^ 1 1-NONE 2-^.'0RTAR 3-GASKET J 1-NONE 3-CASTIRO.N 4-FL.AST:C I 1-GOOO 2CORF.O0ED S.-.LIGNEO •;-==:<=>. :-.V;S=:NG e-U:.SAF£ 'EFECTS FLOW OBS. BROKEN S D COHnOSlOM ROOTS I/I — -NU.V=£HO.= S D S 0 COD£ HOLES CRACKS JOINTS . COVER 1 II 1 1 II 1 1 II 1 FRAME 1 1! 1 FRAME SEAL 1 II 1 1 II 1 1. II .1 1 II 1 . GRADE ADJUSTM ENT.-l II I 1 i; 1 1 1! 1 1 II 1 1 1 CONiE I II 1 1 II 1 1 _J! 1 1 II 1 I I VVAI 1 1 II 1 1 11 1 1 II 1 1 II 1 I i . tHNCH 1 II 1 1 |l 1 1. F -f -1 T T . TROUGH 1 il f i II 1 1 II 1 1 II 1 O.V CODE SEVERITY CODE DENSITY CODE I/l CODE - LIGHT 1 - MILD 1 - <10% 1 - INFLOW - \:ODERATE 2-MODERATE 2- 10%-25% 2 • IN.'^ILTRATION I I L I I L . - HEAVY ) - STRUCTUFWL 3-SEVERE 3 - 25% - 50% 4 ->50% L [ -L r L ACCESS I I I 1-DRIV£(PAV£0) 2-CniVE(UNPAV=D| 3 CaiVS4WALK«:0' 4 Ofi.VS4WALK>:0 S-NO.\WI.>fT ACCESSiEASrWALK) 6-NO MA;NT. ACCESS (OlPrlCULT WAIK) 7 .\0 M*.?/T. ACC£SS;£ASf W^LK CONTACT F.qQPEaTlf C\VN=R) e - NO .".tAlNT. ACCESS (DIFFICULT WALK CCMTA:r PROFEai Y OWN;?] V'ORTAR DETERIORATION ]_/_| 1-NO 2YES i'.-EClPlTATlON I_ _| ir-JCHES IN PAST 3 DAYS r 11 t 1. UPSTREAM MANHOLE # 2. DOWNSTREAM MANHOLE » ..„ 3. INSPECTED MANHOLE 4. PipE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN)... 7. PIPE MATERIAL V 'J L .. S3. If "X" i-L ^L 8. PIPE LINER MATERIAL. 9. "^RIM TO CROWN (FT) 10. FLOW DEPTH (IN) — I' I 7.<^ II 11. DEPOSITION; INCHES | iL TYPE i r^L _ 16. FLOW VELOCITY (FPS) I <^ II 1.0 A- ENTER APPROPRIATE NUMBER OR -SVC OR "STUB* J 1-UPSTREAM 2-DOV^NSTREAM J 1-12 CLOCK POSITION i Jl-ROUND 2-ELLIPTiCAL 3-BOX 4-DOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC _| l-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRlCK 10-TRUSS .11-CIPP2-F0LDaF0RM 3-SLtPLINEO 4-SPIRAL WOUND -i; INCLUDES DEPOSITION AT PIPE MOUTH I-SLUDGE 2-MUD 3-ROCKS 4-OEBRlS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 17. POSSIBLE FIFE EXPOSURE I S I 1-YES 2-NO IB. PIPE CHECKED FOR EXPOSURE I t I 1-YES 2-NO CO.MMENTS. PIPES FOOTGE LOC. DEF RATNG !NFLT(gpm} • COMMENTS 1 1 1 1 1 1 1 1 1 1 1 1 1 1 lllll 1 Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pice 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tan 6 Upper Rioht 8 Offset g Lower Right g Gaoped Joint 10 Lower Left 10 Roots 11 Upper Left 11 Debris 12 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerced 14 Scalina IS Camera Emerged 15 Sag 16 Pipe Exterior 16 Inriltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below around level) 23 Exposed Cut-off wall (>2 feet of wall exposed) GEN. LOCATION; (INDICATES IF STREET RA*/OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE fc ' J • — INSPECTION J^pk I / j I l-INTERNAL 2-SURFACE 3-NOT INSPECTED 4-eURlED 5-NOT FOUND STRUCTURE TYPE --l__/_ LOCATION I lo SURFACE TYPE I ^ COVER A. TYPE r V B. FIT I ^ C- SEAL I L D. SECURING I I. E. # OF HOLES I L FRAME F. PONDING DEPTH (IN)t G. PONDING TYPE H. SIZE (DIA. IN).... I. INFLOW DISH A. OFFSET (IN) n B. RISER HEIGHT (IN) GRADE ADJ. A. TYPE I ^ B. DEPTH (IN) I / i C. MIN. DIA (IN) I COME/TOP A. TYPE L_l^- P 6HAPF '. ' ^ SVALL A. MATERIAL. B. LINING TYPE \ C. DIATLENGTH (IN) I 3t ^ D. DIAAV:DTH (IN) I tjQ 2=>;CHTYPE L ^ -ROUGH TYPE 1 3 - :P= SEAL TYPE I ^ ""EPS A. TYPE 1 / B. CONDITION I \ •-•-..NHOLE DEPTH (FT) EVIDENCE OF SURCHARGE (FT) 1 -STNO 2-CLN OLH 3-lN DROP 4-OUT DROP 5-RCCK TRAP 6-FiLLEO IN 7-TEE B JUNCTION 1-STREET 2-ALLEY 3-SuWlX i-DRV/rt" 5-PXWY 6-YAnp 7-STBM CI7CH 8-CfiX BSD 9-rOSS CrX BED IC-OF 11 .CALTRANS FVW l-ASPKALT 2-C0NCR=TE iGRAVEL 4-ERODED SOIL AT RAJScD MH £-Ta=£ 6-ESCC60 SOIL A.SC TSE= 7-0lRT/GP-i£S 1-PlCK 2-CpNCEALEOPlCK 3-VfeNTEO 4-STORW . ( . . 1-GOOO 2-TIGKT 3-LOOSE l-ROCKING S-BOLTS MISSING eCASKCT BAD/GONE 7-GOOOO-RING 1-NONE 2-GASKET S-SILICONE 1-NONE 2-STRAPPlNG BAR 3-ANGLE IRONS 4-£V ALLEN EaT £-3'4: ALLEN EOLT 6-SPOlNTeOLT 7-ALFA • BOLT fl- 6 POINT BOLT 9-BURlEO 10-ASPHALT CAP 11-CONCRETE CAP 1-SHEET FLOW 2-LOV/POIt^ 1-24" 2-36" 3-48" 4-OTHERS 1-NO 2-YES LintrTvpe: 1- Cetncniidous 2- C3S( in Pbc: 3- Cure(J in 1-NONE 2-PRECA5T 3-EHICK 4-BLOCK 5-POURED LINEDOESDNO 1-NONE 2-PRECST 3-BRK 4-ELK 5-PORO e-oRKiCON 7-CLAY B-PVC Lir;ED:0YESn: l-rnMCFNTRir. ^-FCCFNTRIC 3-CLAT TQ= NO 1-NONE 2-PRECST'3-BRK 4-ELK 5-PORO 6-=RKaC0N 7-CLAY E-FVC UNEQDYESDNO l-CEM£NTlTiOUS 2-CAST-i:J-FLfi.Cc 3-CL'.=.E>IN-FLtCE 4.EF0X-^ 1-NONH 2-FBECAST 2-ERlCK 4-5L0CK S-FCU=.EO UNEDitJ^ESD .'iO 1-NONE 2-P.=.£CAST 3-POURED 4-VCP 5-rVC e-E=:CK 1-NONE 2-VORTAR 3-GASKET 1-NONE 2-5AR 3-CASTI.RO.N -I-FL^STIC 1-GOOO 2-CORF.OOED c-V.:S.-.JGr;=D 4.= =.:<E\ :-V;S=;.*--G e-U:.SA=H ERECTS FLOW OBS. CODE (GPM) BROKEN S D COR.=iOSiON ROOTS 1/1 -- -NU>.:5cn OF S D SO CODE HOLES CRACKS JOINTS COVER FRAME...- F.=^A.ME SEAL I !L GRADE ADJUSTMENT..L JL CO^JE I IL WALL I IL EENCH L Jl TROUGH 1 II O.V CODE SEVERITY CODE /n DENSITY CODE CODE - LIGHT - '.'ODERATE . - hiEAVY ) - STRUCTURAL 1-MILD 2 - MODERATE 3-SEVERE 1 -<ior« 2-10%-25% 3 - 25% - SO^i 4 ->50% 1 • INFLOW 2 - INFILTRATION ca>i crt it ^ ;CESS. I "3 I 1-DR1VH(PAV=D) 2-CfllVE{UNPAV=D) 3-CfliV= i V.ALK.30 4 OSiV= 4 WALK>;0 S-NO WL-^T ACCESSjEASY'.Vi^K) ' ~' 6-NOfcU.NT.ACCESS(0lFflCULrWALK) T NO^^A.^. ACCESSiEASrWALK CCsTACI F.^lOPEaiY CvVS^a) a . NO .W:.NT. ACCESS (OlFrlCULT WAIK CCNTACr PRCFSaT Y QwSE?) '-•ORTAR DETERIORATION |_ 1-NO 2-YES r.-.HClPlTATION IJ^-I I'-CHES IN PAST 3 CAYS [ I I I I 1. UPSTREAM MANHOLE ff 2. DOWNSTREAM MANHOLE # .... 3. INSPECTED MANHOLE :.. 4. PlpE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETERmEIGHT (IN)... 7. PIPE MATERIAL V) < ^'^1 ^"^^ L ,£i:d_.i_^:^=ijL—i^II 93 I. S3/}i 51?-/?II ENTER APPROPRIATE NUMBER OR "SVC" OR "STUB* ^ II I II ^ 1 U\—L /^\ ^ II 7^ ^ii_A .ii_Z 8. PIPE LINER MATERIAL. I I jlJ. J 1-UPSTREAM 2-D0V\/NSTREAM J1-12CL0CkPOSITION i Jl-ROUND 2-ELLIPTICAL 3-BOX 4-OOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM e-TILE 9-BRICK 10-TRUSS j1.CIPP2-F0L0aF0RM 3-SUPLINEO 4-SPIRAL WOUND 9. "*" RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE. , I ^ II » £1_ 16. FLOW VELOCITY (FPS) \ J, O II II ^ PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS , 1 ! 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO 1 1-YES 2-NO INCLUDES DEPOSITION AT PIPE MOUTH I-SLUDGE 2-MUD 3-ROCKS 4-OEBRlS ESTIMATED OR MEASURED (CIRCLE) PIPES FOOTGE IOC. DEF RATNG INFLT(gpm) COMMEnfS 1 • 1 • . 1 ! 1 1 1 1 1 1 1 1 I COMMENTS: FIRE SKETCH N Defects Location 0 NU 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-HoFizonlal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left U Detyjs - - -4-2 CMWO — 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Mantiole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below qround level) 23 Exposed Cut-off wall ( >2 feet of wall exposed) GEK LOCATION: (INDICATES IF STREET RAV OR CANYON) Pr^^^^Jy.'^ ^ JC.U^..4r.c OBSERVATION CODE NO. CODE -INSPECTlON,TYpt }\ I { I 1-imERNAL 2-SURFACE STRLJCTURE TYPE \ :l / LOCATION ! /a S-NOT INSPECTED 4-eURlEO 5-NOT FOUND SURFACE TYPE \ "7 COVEH 'TYPE FIT , SEAL , SECURING. E. F. G. "H. I. FRAME A. B. GRADE ADJ. A. B. C. CONE/TOP A. .1 #0F HOLES I PONDING DEPTH (IN)t PONDING TYPE, 1 SIZE (DIA. IN)..... INFLOW DISH I OFFSET (IN).. I RISER HEIGHT m\„,.\ "7 TYPE i i_ DEPTH (IN) I — MIN. DIA (IN) I TYPE :UAiJ B. SHAPE V;ALL A. MATERIAL B. LINING TYPE. C. DIAAENGTH (l.N) \ iCQ D. DIAAV-OTH (IN).. 2ENCHTYPE TROUGH TYPE ^;?= SEAL TYPE r-£P5 A. TYPE B. CONDITION •.••;>:HOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT). DEFECTS FLOW OBS. CODE (GPM) COVER I !l FRA.ME I |! F.RAME SEAL | \\ 3 "X" l-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FILLED IN 7-TEE e-JUNCTlON 1-STR6ET S-ALLEY 5-SuWlX 4-0flV//Y 5-PKWY 6-VASp 7-STR.M PITCH B-CfiX6cO 9-rOSSCPjCeSDlO-OFE.V£?ACp, It-CALTRANS BAV 1-ASPHALT a-CCNCRcTE J-GRAVEL 4-EROOEO SOIL A7 RAiSED MH *-Tfl£= 6-ERCCEO SOIL WO TflEE T-DlRT/GPA^S l-PlCK 2-CpNCEALEOPICK 3-Vfe^^•ED 4-STOaM . j , t-GOOO 2-TIGKT 3-LOO* 4-ROCKING 5-BOLTS MISSING 6-GASKET BA0«JONE 7-GOOO i-RING 1-NONE 2-GASKET 3-SlLICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-S'S'ALLEN EOlT 5-3/4: ALLEN EOLT 6-5POINTBOLT 7-ALfA " BOLT a- 6 POINT BOLT 9-BURIEO 10-ASPHALT CAP 1 i-CONCRET£ CAP 1-SHEET FLOW 2-LOW PaNT 1-24' 2-36" 3-48" 4-OTHERS 1-NO 2-YES 1-NONE 2-PRECAST 3-ERICK 4-BLOCK 5-POURED UNE LintrTrpt: 1- Cemendaous 2- Casl in Pbc: 3- Cund in Place • 4- Epoxy IE&DYES^NO 1-NONE 2-PREGST 3-8RK 4-6LK 5-PORO 6-BRKiCON 7-CUY B-PVC LINEDOYESIANO l.r.riNrFNTRIC 9-FCCFNTPIC 3-RATTOO _^ m f- Mi 1-NONE 2-PnECST 3-BfiK 4.ELK E-PORO EcRKSCON 7.CLAY E-FVC UNEOnYESlZjNO 1-CEMENTITiOUS 2-CAST-IN-FUCE 3-CU=.= ?-IN-FLtCE 4-EFOX'i' u l-.NONE 2-FRECAST 3-EnlCK -J-ELOCK 1-NONE 2-PRECAST 3-F0U=E0 4.VCP 1-NONE 2-MORTAR 3-GASKET 1-NONE 2-5AR 3-CAST InO,^' 4-FLAST:C 1-GOOD 2 COnRO0E0 3-?.::SALlGN'E0 4 rFC<E\ :- £-FCU=.ED U.\ED:nY=Sp.';0 S-FVC 6- ==;C:< Li A 7 I :=:NG e-u:.s-;=£ BROKEN COfl.ROSiON ROOTS U — -N'U.Msci^OF S D SO S D COD= HOLES CRACKS JOiNTS \ • J 1. J L J L J L . CO\'E 1 tl 1 1 II 1 1 Ii 1 1 II " 1 1 1 1 , V/.ALL 1 II t 1 11 1 1 . II 1 1 II 1 1 1 L . e£:NCH 1 II 1 1 II 1 1. II 1 r II 1 TROUGH 1 II 1 1 II 1 L. II 1 1 II 1 O-.V CODE SEVERITY CODE DENSITY CODE I/l CODE - LIGHT 1 - MILD 1 -<10% 1 - INFLOW - S'ODERATE 2 - MODERATE 2- 10%-25% 2 • INRLTRATION . - 1-iEAVY 3-SEVERE 3 - 25% - 501; 1 - STRUCTURAL 4•>S0% ACCESS. VORTAR DETERIORATION |_ ; r,-~£CiPlTATlO«N I ^ 1-DRIV£(PAVED) 2-CfllVE(UNPAV=0) 3-CaiVE S VVALK*:0' « OBiVE i WALK>;0 S-NQ .VMI.VT. ACCESSitASV.V^lK) 6-NO MA;.NT. ACCESS tOi??lCULT WALK) 7-NO >.(A..vr. ACCESSJEASY WALK CCSTACT FR0P£3IY CW\£3) fl . NO WA:NT. ACCESS (OIFFICUI-T WAUK CCVTACf PROFSaiY Ov/NjS) 1-NO 2-YES INCHES IN PAST 3 DAYS 1. 2. 3. 4. 5. 6. 7. PIPbff UPSTREAM MANHOLE* DOWNSTREAM MANHOLE #.... INSPECTED MANHOLE PipE DIRECTION SHAPE OF PIPE PIPE DIAMETERfflEIGHT (IN)... PIPE MATERIAL V) sM. ' 9 II I // I 1£ 8. PIPE LINER MATERIAL. 9. "*" RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES TYPE.I 16. FLOW VELOCITY (FPS)... T=TW ENTER APPROPRIATE NUMBER OR "SVC" OR "STUB" 1-UPSTREAM 2-DOWNSTREAM 1-12CL0C'KP0SITI0N j I- ROUNO 2-ELLIPTICAL 3-BOX 4-OOUBLEBOX 5-TRIPLEBOX 6-HORSESHC II- VCP 2-PVC 3-cdNCRETE 4-RCP 5-DIP 6<;!P 7-CM 8-TILE 9-BRICK 10-TRUSS 1-CIPP 2-F0LD&F0RM 3-SLIPLlNED 4-SPIRAL WOUND -IL _ 17. POSSIBLE PIPE EXPOSURE. 18. PIPE CHECKED FOR EXPOSURE |. J 1-YES 2-NO J 1-YES 2-NO COMMENTS: FIFE SKETCH INCLUDES DEPOSITION AT PIPE MOUTH l-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 PIPES FOOTGE LOC. DEF RATNG !NFLT(gpm) COMMENTS 1 1 1 1 ! 1 1 1 1 Defects Location 0 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left .44-Debris —, Crown—— 12 Grease 13 Inverl 13 Corrosion 14 Camera Submerged 14 Scaling 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below cround level] 23 Exposed Cul-off v/all (>2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET Fm OR CANYON) /ggy^^ //t" ^ /-^i-fC^ OBSERVATION ODE NO. CODE INSPECTION TYPt I: I / I 1-lNTEHNAL 2-SURFACE 3-NOT INSPECTED i-eURlED 5-NOT FOUND STRUCTURE TYPE. ;1 / j VSTNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCKTRAP 6 F1LLE0 IN 7-TEE 8-JUNCTIO LOCATION Lia SURFACE TYPE j Z_ J l-STREET 2-ALLEY 3-SCWLK 4-0flV//Y 5-PKWY 6-YARP 7-STfiMClTCH 8-CfiX8E0 »-?0SS CRX EeNj&.OFEN; 11.CALTRA,WSfVW ^) />rxV«Sl,f(? f^^iffjOeA^/tf • \ l-ASPKALT 2-CONCficTE 3-GflAVEL i-EaOOEOSOlLATRA/ScO MH i-TREE 6-ERCCEOSOILA.'iOTRE= 7-0inT/GPA£S COVER A.-TYFE ....„...j.;....v :| / B. BT I t_ C. SEAL I ( I D. SECURING I / I l-PICK 2-CpNCEALED PICK 3-VfeNTED 4-STOR.y . j . 1-GOOO 2-TIGrfT 3-LOOdE 4-ROCKING S-BOLTS MISSING 6-GASKET BAD/GONE /-GOOoi-RING ' 1-NONE 2-GASKET 3-SlLICONE 1-NONE 2-STflAPPING BAR 3-ANGLE IRONS 4-M* ALLEN EOLT £-3f4: ALLEN EOLT 6-SPOINTBOLT 7-ALF.i * BOLT 8- 6POINTB0LT 9-BURIED 10-ASPHALT CAP Il-CONCRETECAP FRAME E. # OF HOLES I / I F. PONDING DEPTH (IN)l_j:^_J] G. PONDING TYPE L 'a SIZE (DIA. IN) L I. INFLOW DISH L A. OFFSET (IN) L B. RISER HEIGHT (IN)....L GRADE ADJ. A. TYPE I L B. DEPTH (IN) L C. MIN. DIA (IN) L' CONE/TOP A. TYPE P SHAPF I J 1-SHEET FLOW 2-LOVV POINT J 1-24" 2-36' 3-48" 4-OTHERS J 1-NO 2-YES I 1-NONE 2-PRECAST 3-EfllCK 4-BLOCK 5-POURED Liner Tvpt! 1- Ccmendoous 2- Cast in Pbc: 3- Cutcd in Ejace • UNEO:^^ 1 I 1- V;ALL A. MATERIAL B. LINING TYPE. -NONE 2-PREGST 3-BRK 4-ELK 5-PORO E-SRKiCON 7-CUY E-PVC LINED: r.nNrFNTRic; ?-Frr.FNTPrc 3-CLAT TQQ YE: 1-NONE 2-Pn£C£T 3-6fiK 4-ELK 5-PORO e-ERKiCON 7-CUY E-FVC L!NED{3YE 1-CEMENTITiOUS 2-CAST-IN.FUCE 3-CUFED-IN-FUCE 'J-EFOX'f C. DIAAE.NGTH (:N) I (P D. DIAAVIDTH (IN) I 2ENCHTYPE I S TROUGH TYPE I 3 SEAL TYPE I Ji r-=PS A. TYPE I L_ B. CONDITION [ '.'^NHOLE DEPTH (FT) I 7t ( EVIDENCE OF SURCHARGE (FT) I K S-PCURED U.\=D:H'^=Sr ncn. 1-NONE 2-FRECAST 3-BRICK 4-SLOC 1-NONE 2-PRECAST 2-POUREO 4-VCP £-FVC e-=.=:CK ' 1-NONE 2-WORTAR 3-GASKET 1-NONE 2-EAR 3-CASTInON 4-FUST;C 1-GOOD 2-CORRODED 3-M:SALlGN=0 4.= =C-:EN :-V.SS:NG E-Ur.SAFE I CEFECTS FLOW OSS. CODE (GPM) BROKEN S D CORROSiON E D - -NU.MSclR OF HOLES CFACK5 JOiNTS COVER FRAME F.RAME SEAL .! II. GRADE ADJUSTMENT..L Jl CONE I ll V.ALL I ![ tSNCH... TROUGH O.V CODE •L SEVERITY CODE -LIGHT -VODERATE .-HEAVY )-STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4•>50% *\CCESS. ' J.'ORTAR DETERIORATION. ' i".-":.£ClPlTATiON l-DHIVE(PAVED) 2 CfllV6(UNPAV=0) 3 CRiVS 4 WALK^JO* 4 QRiVS 4 V/AIK>:0- S-NQ KWl.'TT ACCESSiEASV WJi-K] 6-NO WA.NT. ACCESS (OlFrlCULT WALK) 7-.\0 MA..VT. ACCESSitAST WALK CCVTACT FflOPERTY C^v.SEqj 6 - NO StALNT. ACCESS (DIFFICULT WALK CG^fTACr PSCFEfllY 0V(\:?| U f—\ 1-NO 2YES I 1 IN'CHESIN PAST:-DAYS Kirtjf Li; r w w; 1. UPSTREAM MANHOLE P \JJif^ "^^^ » ^ ^ » ' ^^"^^^ APPROPRIATE NUMBER OR 'SVC OR "STUB'. 2. DOWNSTREAM MANHOLE # .... |. 3 INSPECTED MANHOLE :.. | ^^11^^ IL2= II ! I'^PSTREAM 2-DOWNSTREAM 4. PIPE DIRECTION [2 ±J\ I / ^ Jl 11.12CL0CkP0SITI0N 1 5 SHAPE OF PIPE | f || / » / J II [11-ROUND 2-ELLIPtlCAl 3-BOX 4-DOUBLE BOX 6. PIPE DIAMETER/HEIGHT (IN)... \ II Z luZEZIll— 1 &-TRIPf-E BOX 6-HORSESHC 7. PIPE MATERIAL ] f » ^ II /II ! 1-VCP 2-PVC 3-CONCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS 8. . PIPE LINER MATERIAL .•!J__-^_-k' t ^ I! — 11-CIPP 2-F0LD&F0RM 3.SLIPLINE0 4-SPIRAL WOUND^ 9. * RIM TO CROWN (FT) : I ^i-j_li--J J H 0» ' •! ' [ 10. FLOW DEPTH (IN) \ l\ ^ II II I INCLUDES DEPOSITION AV PIPE MOUTH ). 11. DEPOSITION: INCHES ---| ^ "^Z K ii ' jyp^ l J II "7 r ^ I! I-SLUOGE 2-MUD 3-ROCKS 4-DEBRIS . * 16. FLOW VELOCITY (FPS) I ^ II ^ 11 ^ II I ESTIMATED OR MEASURED (CIRCLE) I I 1 I I 1 1 PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS , 1 1 17. POSSIBLE PIPE EXPOSURE. 18. PIPE CHECKED FOR EXPOSURE |, J 1-YES 2-NO J 1-YES 2-NO COMMENTS: FIFE SKETCH yr PIPE'S FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS • 1 1 1 ! 1 1 1 1 1 1 1 1 Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Hofizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pioe S Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao e Upper Rioht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 4-1-Debris Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltralion 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level} 22 Exposed Encasement (erosion below qround level) 23 Exposed Cut-off wall (>2 leet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAVOR CANYON) 6a ADDRESS: ^ODI OBSERVATION CODE NO. CODE -INSPECTlON^TYpfe J.' | / j 1-lMTERNAL 2-SURFACE 3-NIDT INSPECTED 4-SURlED 5-NOT FOUND STRUCTURETYPE. :l L LOCATION I /A SURFACE TYPE j Z- COVER A:-TYPE :! / B. FIT I t C. SEAL D. SECURING FRAME E. # OF HOLES L F. PONDING DEPTH (IN)L G. PONDING TYPE.. ^ a SIZE (DIA IN) L I. INFLOW DISH L A. OFFSET (IN).. t / 2 B. RISER HEIGHT (IN)....|_23_ G PJ^DE ADJ. A. TYPE I -2- B. DEPTH (IN), I 3? C. MIN. DIA. (IN) 1 CONE/TOP A. TYPE :1 ' I B SHAPF I WALL A. MATERIAL B. LINING TYPE C. DIAVLENGTH (IN).... D. DIAAV:OTH (IN) TYPE TROUGH TYPE '^PE SEAL TYPE r"=PS A. TYPE B. CONDITION.: VAN HOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT) 1 f r 2^ ML3. l-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6-FILLED IN 7-TEE fl-JUNCTIoS l-SrneET 2-ALL£y 3-SCWlX 4-0flW/Y5-PKWY S-yAfip 7-STRMCITCH B-CfiXB£D 9-rOSSC?Xe£D 10^ it.CALTflA,MSfW /j?. ^rfWAr y>c<^^^r4'^. l-ASPHALT 2-CONCRETE J-GflAVEL 4.ER0OE0SOIL ATflAlScD MH J-TRES 6-ERCCEO SOIL ASD TREH T-OlRT/GPASS l-PICK 2-CpNCEALED PICK 3-VfeNTED 4-StOfU.l . j . 1-GOOO 2-TlGHT 3-LOO* 4-ROCKING S-BOLTS MISSING 6-GASKET BAO^SONE 7-GOOO i-RING ' 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STflAPPING BAR 3-ANGLE IRONS 4-SB" ALLEN EOLT 5-3^4: ALLEN EOLT 6-5POINTBOLT T-ALF^ " BOLT 8- ePOINTBOLT 9-BURIED lO-ASPHALTCAP lI-CONCRETcCAP 1 C [ 1-SHEET FLOW 2-LOVV P01^fT 1-24" 2-36' 3-48" 4-OTHERS 1-NO 2-YES Liner Tvpt: 1- Centendcious 2- Cast in Pbc: 3- Curtd in 4/Epoxy 1-NONE 2-PflECAST 3-ERlCK 4-BLOCK 5-POUflEO LINED:[I1YCS[?N0 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD 6-BRKiCON 7-CLAY 8-PVC LINEOQYES0NO 1-CnNGF^fTRIC ?-FCCgNTPiC 3-RATT0=> ^ 1-NONE 2-Pn£CST 3-BfiK 4-ELK 5-PORO e ERKACON 7-CLAY E-FVC L!.NEDQYES0<O 1-CEMENTITiOUS 2-CAST-IN-FLtCE 3-CURED-IN-FLACE 4-E.=0)CI' 1-NONE 2-FRECAST 3-ERlCK 4-510CK £-.=C'J.=.£0 UN = D:n YEsOfo^ 1-NONE 2-PRECAST 3-POUF.ED 4-VCP 5-FVC 6-5=:CK 1-NONE 2-MORTAR 3-GASKET 1-NONE 2-c.-^a 3-CASTIR0,N i-FLASTIC 1-GOOO 2-CORRODED 3S,AUG:.'E0 4.=.=:<=.\ :-.v;S5:.\G E-L-'.SAFE •EFECTS FLOW OBS. CODE "(GPM) BROKEN CORROSION ROOTS M -- -NU.V5ER0F S D S 0 S D CODE HOLES C.=ACKS JOINTS COVER FRA.ME FRAME SEAL •I i!. GRADE ADJUSTMENT..L CONE L V/.ALL L BENCH L Jl TROUGH I II O.V CODE SEVERITY CODE JL J L J I J I J L iUlJ^ IAJ L w I DENSITY CODE I/l CODE -LIGHT -MODERATE .- HEAVY 1 - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 - INFLOW 2 • INFILTRATION ' I) off. ACCESS. * .'-•ORTAR DETERIORATION. ' r--^.= ClPlTATION l-OniV£(PAVEO) 2.CniVE(UNPAV=0| 3-DaiVE 4 WALK<:0 4 OB>VSAV/ALK>;0 5-NO WAi.NT, ACC£SS(EASY WAiK) 6-NO hWJNT. ACCESS pl.-FlCULT WALK} 7.,S0 J.U..NT. ACCESSitASY WALK CCSTACT F.qOPEHTY <:\'lW<\ S • NO MAI.NT. ACCESS (DIFFICULT WALK CCMTACr PROPERTY Qw.S;?] 1-NO 2-YES l.NCHES IN PAST :• DAYS 1. 2. 3. 4. 5. 6. 7. 1 PIPES V) UPSTREAM MANHOLE # L. DOWNSTREAM MANHOLE tt.... I INSPECTED MANHOLE :.. PipE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL iv Ills X L r 7 r 4-1 8. PIPE LINER MATERIAL. .r 1 9. 10. 11. 16. RIM TO CROWN (FT) FLOW DEPTH (IN) I ^ DEPOSITION: INCHES |. TYPE.; i FLOW VELOCITY (FPS) [ 1 _ r- 25 J ENTER APPROPRIATE NUMBER OR 'SVC* OR "STUB* J 1-UPSTREAM 2-OOWNSTREAM J 1-12 CLOCk POSITION j Jl-ROUND 2-ELLIPTICAL 3-BOX 4-OOUBLEBOX J . 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-C6NCRETE 4-RCP 5-DIP 6-CIP 7-CM B-TILE 9-BRICK 10-TRUSS .11-CIPP 2-FOLDAFORM 3-SUPLINEO 4-SPIRAL WOUND INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUDGE 2-MUD 3-ROCKS 4-DEBRlS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE, J 1-YES 2-NO I 1-YES 2-NO PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 • • 1 1 1 1 1 1 I.I 1 1 COMMENTS: FIRE SKETCH Defects Location 0 NW 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 CoHapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upper Riaht e Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left --U Debris •X2 Crown — - 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scalina 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infillration 17 New Manhole 13 Other 31 Pipe Seal 20 E)(posed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below oround level) 23 Exposed Cul-off wall (>2 leet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ^ \^ a Ut f^a OBSERVATION CODE NO CODE INSPECTION ,TYPt l! | { I STRUCTURETYPE ( LOCATION •! SURFACETYPE. 1-INTERNAL 2-SURFACE 3-+J0T INSPECTED 4-BURlED S~NOT FOUND l-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP S-ROCKTRAP 6-FILLEO IN 7-TEE 8-JUNC l-STREET 2-ALLEy a^OWlX 4-OflV//Y 5-PKWY 6-YAnp T-STfiMDTCH 6-CfiXe£0 9-rOSS CRX BEolfr I1-CALTfl^^^sRA//2/prt^/<^^g pr<? Pt^l^ 1-ASPHALT a CCNCfictE 3-GaAVEL 4-EROOEOSOiL A'RAISED MH'j.Tfl== 6-EfiCCEO SOIL ASO TREE 7-OtflT/GPA5S NSPACE COVER A. 'TYPE ..V .1 /, B. FIT I L C. SEAL I L D. SECURING I L l-PlCK 2-CpNCEALEOPICK 3-VtWTEO 4-STOaV . j 1-COOD 2-TIGKT S-LOO* 4-ROCKING 5-BOL7S MISSING 6-CASKET BAOASONE 7-GOOO A-RING 1-NONE 2-GASKET 3-SlL»C0NE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-S-S" ALLEN EOLT 5-3/4: ALLEN EOLT 6-5POINTBOLT 7.ALr^ ' BOLT 8- 6P0INTB0LT 9-BURIED 10-ASPHALT CAP 11-CONCRETE CAP I - n 3Z E. # OF HOLES I L F. PONDING DEPTH (1N)L G. PONDING TYPE L H. SIZE (DIA IN) L I. INFLOW DISH L FRAME A. OFFSET (IN). L B. RISER HEIGHT (IN) ....L GRADE ADJ. A. TYPE |. B. DEPTH (IN) L 1-SHEET FLOW 2-LOV/POINT 1-24" 2-36' 3-48" 4-OTHERS 1-NO 2-YES LintrTvpt: 1- Cemenddous 2- CasiuiPlac: 3- Cured in Place ' 4- Epoxy 1-NONE 2-PRECAST 3-ERlCK 4-BLOCK 5-POURED LINED:[>ES0fJO C. MIN. DIA (IN) I "S^ B. SHAPF i.rnNr.Ft^Rir. ^-PCCFNTPIC .^-RATTOP CONE/TOP A. TYPE ' ^ 1 l-NONE 2-PREGST 3-BRK 4-ELK 5-PORD e-oRKiCON 7-CLAY S-PVC LINJ^ YES0NO V.ALL A. MATERIAL B. LINING TYPE. C. DIAAENGTH (IN). D. DIAJW'DTH (IN) 0- : a 3ENCHTYPE TROUGH TYPE I ^ 'KPE SEAL TYPE I. r-=PS A. TYPE 1. B. CONDITION '-•A^HOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT). i 33; 1-NONE 2-Pn£CST 3-6RK 4-6LK 5-PORO £ =RKaCON 7-CLAY E-FVC UNEDDYESJZNO I-CEME.NTITIOUS S-CASMN-FL^CE 3-CU==D-IN-FLACE 4.EF0X'i' 1-NONE 2-PRECAST 3-ERICK 4-HLOCK E-FC'JREO U.\ED:DYE^0^;O 1-NONE 2-PRECAST 2-POUREO 4-VCP 5-FVC 6-==:CK l-NONE 2-iVORTAR 3-GASKET 1-NONE 2-c.Aa 3-CAST IRO.N 4-FLAST:C 1-GOOO 2-CORRODED 3-.V.:SALIG:;£0 i l~Z<~.y. :-V;S=:NG e-L-r.SAFE HP •ai I EFECTS FLOW CODE OBS. (GPM) BROKEN COfl.nOSiO.N ROOTS I/l -.NUM=ERO.= S D SO S D CODE HOLES CRACKS JOINTS c -I !!. COVER FRAME F.RAME SEAL I !|, GRADE ADJUSTMENT..L _Jl CONE I ll ^VALL L Jl EE^JCH TROUGH I i! I O.V CODE SEVERITY CODE J I- J L J l-Z- J \J-J I I I I DENSITY CODE I/l CODE -LIGHT - ^.•ODERATE .- HEAVY »- STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25';i, 3 - 25% - 50% 4 ->50% 1 - INFLOV/ 2 - INFILTRATION ACCESS. V'ORTAR DETERIORATION. r.-~.= ClPlTATION l-OfllVE(PAVEO) 2-CfllV£(UNPAV=0| 3-0317= 4 V;ALK<:0' * Ofi.VS 4 WALK.30 S-NO\Wt.WT ACCESSiEASYtVALK] 6-NO fcUNT. ACCESS (Ol.^rlCULT WALK) 7.N0 MA..VT. ACCESSicASY WALK CCsTACT F.^OPEHTY C\V.N£ai e - NO VvVlNT, ACCESS (OIFFICULT WALK CC^rTA;r P.WEaiY Ov/N^Sj 1-NO 2-YES I'VCMES IN PAST 3 DAYS PIPE » I I I I I I I I I 1 1. 2. 3. 4. 5. 6. 7. UPSTREAM MANHOLE U DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE :.. PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETERA^EIGHT (IN)... PIPE MATERIAL 8. PIPE LINER MATERIAL, i-9. ' RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE.!.... 16. FLOW VELOCITY (FPS). V) > 1 JO „ II 1 II i"^:? II sv ll ^ •. '—f— 1 / II ^ II 3-11 :2- t' ^ II 1 /a II ( II H 1 } <• / II If II / 1 1 /'^ Ii f II H 11 1 ' 1 II ^ n (n II / t ! Jl .-ll-J' II fe? *f> II <:.. j^ II L.^ . 1 ^ tl II II ^ 1 i'-tt J " l> J) 1 /^s-11 11 /',r 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO J 1-YES 2-NO COMMENTS: PIPE SKETCH J ENTER APPROPRIATE NUMBER OR "SVC" OR 'STUB* 1-UPSTREAM 2-DOWNSTREAM 1-12CL0CkP0SITI0N i J 1-ROUND 2-ELUPTlCAL 3-BOX 4-DOUBLEBOX J 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE &-BRICK 10-TRUSS J 1.CIPP2-F0LD&F0RM 3-SUPLINED 4-SPIRAL WOUND I INCLUDES DEPOSITION A^" PIPE MOUTH I I I-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS I ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS * • • 1 1 1 1 1 i t 1 1 1 6?/ / ^^C Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 OS Manhole 2 Crack-Honzonlal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upper Riaht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44-Oebr-is 4-2 Crowri 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scaling IS Camera Emeraed 15 Sag 16 Pipe Exterior 16 Infillration 17 New Mantiole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below around level) 23 Exposed Cut-ofI wall (>2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ADDRESS: 7 n P P [ [ OBSERVATION CODE NO. CODE INSPECTION ,TYpt. l; I [ I STRUCTURETYPE 7 I LOCATION ^p.„\ /O I :z:z::::. / i l-iriTERNAL 2-SURFACE 3-+J0T INSPECTED 4-eUfllED 5-NOT FOUND 1 -STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-Fn.LEO IN 7-TEE 8-JUN^ 1-STfieCT II-CALTRANS SURFACE TYPE. 2-ALLEY 3-SSWU( W)flV//Y5-PKWY 6-YAnp 7-STfiMClTCH B-CfiXBEO S-POSSCPXBED lOOFE-NSPACE l-ASPHALT 2-CCNCfiETE 3-GRAVEL 4-EROOeDSOiLAr aiJSEO MH «-TR== 6-ESCCEO SOIL ANO TREE 7-DinT/GPji£S COVER A,'-TYPE,...'.....x:;...u :1 / , [ B. FIT I ' / 1 C. SEAL I / I D. SECURING I / I I / I 1-PlCK 2-CpNCEALEOPICK 3-VfeNTEO 4-STORW . j ^ 1-GOOO 2-TIGHT 3-LOOSIE 4-ROCKING 5-BOLTS MISSING 6-GASKET EA0«30NE 7-GOOoi.RlNG ' t-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-SB-ALLEN EaT £-3^4: ALLEN BOLT 6-SPOINTBOLT 7-ALF; • BOLT 8- 6P0INTB0LT 9-BURlED 10-ASPHALT CAP 11-CONCflETcCAP E. # OF HOLES I F. PONDING DEPTH flNU — 1 G. PONDING TYPE.. ' I H. SIZE (DIA IN)„ I J?y I I. INFLOW DISH I —. I FRAME A. OFFSET (IN).. I ^ I B. RISER HEIGHT flNL...! .2^ I GR-AOE ADJ. A. TYPE I ^ I B. DEPTH (IN) I /y I C. MIN. DIA (IN) l-iy I CONE/TOP A. TYPE :| ' ^ I B SHAPF L 1-SHEET FLOW 2-LOV/POINT 1-24' '2-36" 3-48' 4-OTHERS 1-NO 2-YES Liner Tvpt: 1- Cemenddous 2- C:ast in Pbc: 3- Cured in ^cc • 1-NONE 2-PaECAST 3-ERICK 4-BLOCK E-POURED LINEOiEjYci 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORO e-BRKiCON 7-CLAY 8-PVC I l-mNCFNTRir. f-FCCFNTPlC 3-t^LAT TQQ LINEDi^fYES' V.ALL A. MATERIAL B. LINING TYPE C. DIAAENGTH {'N). D. DtAJVV:DTH (IN)... uENCHTYPE TROUGH TYPE vlPE SEAL TYPE ; "EPS A. TYPE B. CONDITION.: '.'ANHOLE DEPTH (FT) EVIDENCE OF SURCHARGE (FT).. .1 3.?^' 1-NONE 2-PnECST 3-BRK 4-ELK 5-PORD 6-ERK4C0N 7-CUY E-FVC LINEDYE' 1-CEME.NTITlOUS 2-CAST-!N-FLtCE 3-CUFE3-IN-FLACE 4-EFOX't' l-.\ONE 2-FRECAST 3-E.S:CK 4-ElOCK 5-FCLJRED U.NEOiL^jYE: 1-NONE 2-PRECAST 3-POUF.EO 4-VCP £ FVC 6-E-=:CK 1-NONE 2-V.ORTAR 3-GASKET l-NONE 2-5AR 3-CASTlnO.N 4-FLAST;C 1-GOOO 2C0RF.0DED c-.V.:S,-.UGr;EO i-l-.Z<z>. :-V;S=;.\G E-U.'.SAFE [ EFECTS FLOV/ OBS. CODE (GPM) BROKEN COflnOSiON ROOTS \!\ S D S D SO CODE - -NUV5ER 0= HOLES CFACK5 JOINTS COVER L_ FRA.ME L F.RAME SEAL I GRADE ADJUSTMENT..L CONE L WALL L tHNCH L Jl TROUGH I II 0\V CODE SEVERITY CODE 11 J 1. E J L J! ! I_/LJI^ J 1. J l_ZJI-^ L .1 L/Jli^ L 1^1 i \ I I DENSITY CODE 1/1 CODE ~ LIGHT - MODERATE . - HEAVY » - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 - INFLOW 2 - INRLTRATION E ACCESS. Ij*-=_| l-OniVE(PAVEO) 2-CniVE(UNPAV=0) 3-CaiVE i WALK<:0 * Ofi.V= 4 V/ALK,;o S-NO.MA!.*fr ACCESSIEASYWAI-K) 6-NO MKHT. ACCESS [Dl.cf ICULT WALK) 7 NO MA.NT. ACCESS;tASt WALK CONTACT FflOPERTt C\y.\£ai e • NO MA:.N7, ACCESS (OIFFICULT WALK ccrrA^r pfiCPE?irT ov/s^^i >.'ORTAR DETERIORATION |_ f_! 1-NO 2-YES r.-7HClPlTATION 1_ _1 INCHES IN PAST 3 DAYS • I r.- '. .\^•-• ' PIPE ff 1. UPSTREAM MANHOLE # 2. DOWNSTREAM MANHOLE It.... 3. INSPECTED MANHOLE 4. PlpE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN)... 7. PIPE MATERIAL 8. PIPE LINER MATERIAL. J ENTER APPROPRIATE NUMBER OR •SVC" OR "STUB' i . J 1-UPSTREAM 2-DOWNSTREAM J1-12 CLOC'K POSITION i j 1-ROUND 2-ELLIPTICAL 3-BOX 4-OOUBLEBOX J 5-TRIPLE BOX. 6-HORSESHC J 1-VCP 2-PVC 3-CONCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS 11-CIPP 2-FOLDfiFORM 3-SLIPLINEO 4-SPIRAL WOUND 9. "*" RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE.;.... 16. FLOW VELOCITY (FPS), JL _ INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS ESTIMATED OR MEASURED (CIRCLE) I I 1 I I I PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS .- 1 1 17. POSSIBLE PIPE EXPOSURE. 18. PIPE CHECKED FOR EXPOSURE i. J 1-YES 2-NO ) 1-YES 2-NO COMMENTS: PIPE SKETCH N NOT PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 • • 1 1 1 1 1 I I 1 1 MoT fouK)P Defects Location 0 NV^ 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 CoKapsed Pioe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Eidended Tap 7 Extended Taa 8 Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 J3ebfis 1? Crown —— 12 Grease 13 Invert 13 Caroston 14 Camera Submeraed 14 Scalina 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below around level) 23 Exposed Cul-ofI wall ( ^ >2 leet of wall exposed) GEN. LOCATION: (INDICATES IF STREET R/W OR CANYON) OBSERVATION -INSPECTlON.TYpfe. l! | ^ I 1-! STRUCTURE TYPE LOCATION SURFACE TYPE. COVER A. TYPE B. RT C. SEAL D. SECURING. E. # OF HOLES. F. PONDING DEPTH (IN)l. G. PONDING TYPE. ; H. SIZE (DIA IN) I I. INFLOW DISH I FRAME A. OFFSET (IN). I B. RISER HEIGHT (IN) ....I GRADE ADJ. A. TYPE..... I B. DEPTH (IN) I C. MIN. DIA. (IN) [ CONE/TOP A. TYPE B SHAPF V,ALL A. MATERIAL L B. LINING TYPE L C. DIAAENGTH (:N) 1. D. DIAAV:DTH (IN) L uEN'CHTYPE L TROUGH TYPE L ''-.PE SEAL TYPE L r"=PS A. TYPE L B. CONDITION 1. '-•AN'HOLE DEPTH (FT) L EVIDENCE OF SURCHA.RGE (FT) |. INTERNAL Z-SURFACE 3-IJOT INSPECTED 4-eURIEO 5-N07 FOUND 1 -STND Z-CLN OUT 3-IN DROP 4-OUT DROP 5-HOCK TRAP 6-FILLEO IN 7-TeE fl-JUNCTlON i-STnerr 2-ALLEY 3-SOWLK i-ORwrvs-PKWY MASP T-STRMCUCH B-CRKBEO »-?osscpjceEo I&-OPE.S SPACE 11-CALTRANS fVW l-ASPHALT 2-CCNCficTe 3-GRAVEL 4-EaOOeO SOIL AT RWStD MH S-TREE 6-ERCCED SCtL A,SO THEE 7-OIRT/GP>SS l-PICK 2-CpNCeALEO PICK 3-VfeNTED 4-STOay • f 1-GOOD 2-TIGKT 3-LOOdfe 4-ROCKlNG 5-BOLTS MISSING 6-GASKET EAD«30NE 7-GOOO i-RING 1-NONE 2-GASKET 3-SILICONE l-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-ALLEN EOLT S-S'i: ALLEN EOLT 6-5 POINT BOLT 7.ALF; * BOLT 8- 6 POINT BOLT 9-BURIEO 10-ASPHALT CAP ll-CONCRETE CAP 1-SHEET FLOW 2-LO//PONT 1-24" 2-36' 3-48' 4-OTHERS 1-NO 2-YES LintrTvpe: 1- Ccmencidaus 2- Cast in Pbcs 3- Ctiicd in Place • 4- Epoxy E 1-NONE 2-PRECAST 3-ERICK 4-BLOCK 5-POURED UNED:[>cSnNO 1-NONE 2-PREGST 3-BflK 4-ELK 5-PORO E-oRKiCON 7-CLAY E-PVC LINEOOYESDNO i.r.nNCFr>fTRir. 9-crrPNTPic .I-CIATTO^ 1-NONE 2-PnEC3T 3-BRK 4-6LK 5-PORD E-=RKiC0N 7-CLAY E-FVC LLSEDDYESDNO 1-CEMENTlTiOUS 2-CAST-IN-PL^.CE 3-CUF.ED-IM-FLACE 4-EFOrf l-NONE 2-FRECAST 3-E.RICK 4-510CK £-FCU.=.=D U.NHOIDYESD.^O 1-NONE 2-PRECAST 3-P0U=.ED 4-VCP 5 FVC 6-E.=:CK 1-NONE 2-^/0RTAR 3-GASKET 1-NONE 2 E.^R 3-CASTinO.N 4 FL.AST:C 1-GOOO 2-COR.ROOED 3-.'.:;SALlGNED i-z=Z<z\ :-,V:S=:.'.-G e-'j:;SAF= m 'I GEFECTS FLOW OSS. CODE (GPM) BROKEN CORnOSiOiN ROOTS I/l —- -NU.VEEROF S D SO S D COCE HOLES C=ACKS JOINTS . COVER 1 II 1 I 11 1 1 II 1 FRAME 1 1! 1 1 II 1 1 II 1 1 il 1 F.RAME SEAL 1 II 1 1 tl 1 1 II 1 1 II 1 . GRADE ADJUSTMENT..I II 1 1 Ii 1 1 . II ,...1 1 II ! 1 . COiME I II 1 1 II 11. tl 1 1 II 1 1 , V.'.ALL f II 1 1 II 1 1 II 1 1 II 1 1 . EEMCH 1 11 1 1 Ii 1 1. It 1 1 II 1 TROUGH 1 11 1 1 Ii 1 1 II 1 1 II 1 O.V CODE SEVERITY CODE DENSITY CODE I/l CODE / - LIGHT 1 - MILD 1 -<10% 1 • INFLOW L - VODERATE 2 - MODERATE 2- 10%-25% 2 - INFILTRATION I I . - J-iEAVY I - STRUCTUFIAL 3-SEVERE 3 - 25% - 50",; 4•>50% I •. ACCESS I_ ' V'ORTAR DETERIORATION |_ ' r-.ECiPlTATION I I-ORIVE(PAVED) 2-CfllVE(UNPAV=0) 3 DaiVS S V;ALK<:0 4 DfiiVE 4 \VALK>;o S-NO •VUI.'^, ACCESSjEASY WALKI 6-NO klA;NT. ACCESS (Dl.^f ICULT WALK) 7-NO MA..V7. ACCESSitAST WALK CCSTACT PROPERTY CWM;?) 8 - NO .^(A:NT. ACCESS (OlFrlCULT WALK COfTTArr PROf £31Y OV/.SE?) 1-NO 2-YES INCHES IN PAST 3 DAYS I I 1. 2. 3. 4. 5. 6. 7. PIPE # UPSTREAM MANHOLES DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE PipE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL A ^a. II !— -(- 8. PIPE LINER MATERIAL I I 9. ^ RIM TO CROWN (FT) f G'Y H-—^-L^ J ENTER APPROPRIATE NUMBER OR 'SVC* OR -STUB' J J 1-UPSTREAM 2-DOWNSTREAM J M2 CLOCK POSITION j J 1-ROUND 2-ELUPTICAL 3-BOX 4-DOUBLEBOX J 5-TRIPLEBOX 6-HORSESHC J l-VCP 2-PVC ^CONCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS J 1-CIPP 2-FOL0&FORM 3-SLIPUNED 4-SPIRAL WOUND 10. 11. Si FLOW DEPTH (IN) DEPOSITION: INCHES..... TYPE.i 16. FLOW VELOCITY (FPS) U f ^ -S i 1 A I II _ INCLUDES DEPOSITION AT PIPE MOUTH l-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 t 17. POSSIBLE PIPE EXPOSURE. 18. PIPE CHECKED FOR EXPOSURE 1, J 1-YES 2-NO I 1-YES 2-NO COMMENTS: PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS * 1 •1 • • 1 1 1 1 1 1 1 1 1 Defects Location 0 NW 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pice 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tas 8 Upper Rioht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 Debrjs 1? Crown— 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Ei^osed Encasement (at qround level) 22 Exposed Encasement {erosion below around level) 23 Exposed Cul-off wall (>2 feet of wall exposed) G EN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE — INSPECTION ,TYPk .'.! | ( | l-IfiTERNAL 2-SURFACE 3-NOT INSPECTED 4-eURIED 5-NOT FOUND STRUCTURE TYPE. LOCATION SURFACE TYPE | 2- COVER A. -TYPE .........i:....'. .1 / B. FIT I t C. SEAL I ; D. SECURING I Z. E. # OF HOLES I / F. PONDING DEPTH (IN)L G. PONDING TYPE ' FRAME H. SIZE (DIA. IN) U »/• I. INFLOV/DtSH I —: A. OFFSET (IN). I B. RISER HEIGHT (IN) ....LJZ. GRADE ADJ. A. TYPE ! /_ B. DEPTH (IN) I C. MIN. DIA. (IN) I CONE/TOP A. TYPE B SHAPF V;ALL A. MATERIAL I B. LINING TYPE. C. DIA7LE.NGTH ('N). D. DIAJVV:DTH (IN) L £;ENCHTYPE L TROUGH TYPE L rKPE SEAL TYPE I r~EP3 A. TYPE I f B. CONDITION.: I •• •-•AN'HOLE DEPTH (FT) I EVIDENCE OF SURCHARGE (FT) | j 1-STND 2-CLN OUT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6-FlLLEO IN 7-TEE 8 JUNCTI0N 1-STHEET 2-ALLEY 3-SOWLX 4-0flV//Y S-PKWY 6-YARp 7-STRMCtTCH fl-CRKBEO S-FOSSCRXSED It-CALTRA-NSfl/W l-ASPHALT Z-CONCRETE 3-GRAVEL 4-EROOEO SOIL A7 RAISED MH J-TR=£ 6-ERCCEQ SOIL A.SO TREE 7-OinT/GPJi£S l-PICK 2-CpNCeALEO PICK 3-VfeNTED 4-STORW . ( 1-GOOO 2-TlGKT 3-L00* 4-ROCKING 5-BOLTS MISSING e-GASKET eADrt30NE 7-GOOO 4-RING ' 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-£,'6*AtL£N COLT £-3/4: ALLEN EOLT 6-5POINTBOLT 7-ALF' ' BOLT 8- 6P0INTB0LT 9-BURIED lO-ASPHALTCA? II-CONCRETcCAP I 1-SHEET FLOW 2-LOV/POINT 1-24" 2-36' 3-48" 4-OTHERS 1-NO 2-YES Lintr TYM; 1- Ccmenddous 2- Cui in PUc: 3- Cured In place ' 1-NONE 2-PRECAST 3-ERICK 4-BLOCK 5-POURED LINED'.Qf'ESDNO (^'O^zJ^yiz^ l-NONE 2-PRECST 3-BRK 4-ELK 5-PORO 6-5RKiCON 7-CLAY E-PVC LINEDQYESDNO i.r.nNr.Fi^Rif^ ^-FCCFNTPIC 3-C:LATTO=' l-NONE 2-Pn£CST 3-BfiK 4-ELK 5-PORD e-5RK4CON 7-CLAY E-PVC L!N=;>QYESDNO 1-CEMENTITIOUS 2-CAST-IN-FLi-CE 3-CU=.E3-IN-PLACE 4-EF0)Ci' l-.\ONE 2 FRECAST 3-ERICK 4-ELOCK E-FCURED UNEDJJZ'VESD NO 1-NONE 2-PHECAST 3-POURED 4-VCP 5-FVC e-==:CK 1-NONE 2-f.'0RTAR 3-GASKET 1-NONE 2-5.AR 3-CAST IRON ^-FL^STiC 1-GOOO 2-CORROOED 3-?.;:SALIGN=0 i-z~Z<E\ :-.V:S=:NG E-U.'.SAFE DEFECTS FLOV/ OBS. BROKEN CORnOSiON ROOTS I/l -- -NUMBER OF CODE "(GPM) S D S D S D COC-E HOLES CRACKS JOINTS COVER FRAME FRAME SEAL •I !!. GRADE ADJUSTMENT..L CONE L V.'ALL L EHNCH L Jl I TROUGH I II I O.V CODE SEVERITY CODE J I. J L J 1. J L JL LnJ L 4 J L J I. I I I I I I I \ I I i-lTT DENSITY CODE CODE - LIGHT - \'ODERATE -hiEAVY f - STRUCTURAL 1- MILD 2- MODERATE 3- SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 • INFLOV/ 2 - INFILTRATION L r ACCESS. I ^ I I-DRIVEtPAVEO) 2.CRIV£IUNPAV=D) 3 CRlV= S WALKOO 4 OR.VE A V/ALK>;0 S-NO .WI.VT, ACCESSiEASY WALK) 6-KO kUJ.NT. ACCESS (DI.'^rlCULT WALS) 7..\0 WA..NT. ACCESSiEASr WALK CCVTACT FROPERTY CWN=5) e • NO f.W:.NT. ACCESS (DIFFICULT WAIK CCNTA:r PRCPEaiY Ovis.-^\ \'ORTAR DETERIORATION [_ | „l 1-NO 2-YES l".-.HClPlTATiON I_"~J INCHES IN PAST 3 DAYS - ._. r : I : <: .\qv - \-r. 1. 2. 3. 4. 5. 6. 7. PIPE tt UPSTREAM MANHOLES DOWNSTREAM MANHOLE tt.... INSPECTED MANHOLE PipE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL (1) (^J ( 8. PIPE LINER MATERIAL. I 1 I ENTER APPROPRIATE NUMBER OR 'SVC OR 'STUB' t 11-UPSTREAM 2-DOWNSTREAM 11-12 CLOCK POSITION j 11-ROUND 2-ELLIPtlCAL 3-BOX -t-DOUBLEBOX i _ 5-TRIPLEBOX 6-HORSESHC i 1-VCP 2-PVC ^-CONCRETE 4.RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS 1-CIPP 2-FOLOaFORM 3-SUPLINED 4-SPIRAL WOUND •f-9. ' RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES |. TYPE.;: I 16. FLOW VELOCITY (FPS) L 1 L J INCLUDES DEPOSITION AT PIPE MOUTH l-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS ESTIMATED OR MEASURED (CIRCLE) I PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 1 17. POSSIBLE PIPE EXPOSURE. 18. PIPE CHECKED FOR EXPOSURE 1, J 1-YES 2-NO J 1-YES 2-NO PIPE'S FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS • 1 1 1 1 1 1 1 1 1 COMMENTS: Defects Location 0 NVV 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pioe S Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended TaD 6 Upper Riaht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left XX 0«b«s -12, Cwwn — 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below around level] 23 Exposed Cut-off wall {>2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ADDRESS: ~~ OBSERVATION CODE NO. CODE JJU.^ a — INSP^(i;TlON.TYpfe }1 1 I j 1-INTERNAL 2-SURFACE 3-HOT INSPECTED 4-fiUfllED 5-NOT FOUND STRUCTURETYPE L LOCATION I /(P. SURFACE TYPE. il COVER A.'TYPE ........j.:....^ .\ I B. FIT 1_Z. C. SEAL I L D. SECURING I L E. # OF HOLES. -I L FRAME F. PONDING DEPTH (IN)L G. PONDING TYPE a SIZE (DIA IN) „ L I. INFLOW DISH L A. OFFSET (IN). B. RISER HEIGHT flNL...I /& GRADE ADJ. A. TYPE I B. DEPTH (IN) I C. MIN. DIA (IN) I Q \j CON,E/TOP A. TYPE :| ' I B SHAPE ' I WALL A. MATERIAL I ^ a. LINING TYPE. C. DIATLENGTH (:N). D. DIAJ\V:DTH (IN) 1. •EENCHTYPE L TROUGH TYPE I ^ '••:?= SEAL TYPE I 2. f-EPS A. TYPE 1 / B. CONDITION I ^ •-'A.V:HOLE DEPTH (FT) i EVIDENCE OF SURCHARGE (FT) | 1 -STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6-Fn.LEO IN 7-TEE B-JUNCTKJN 1-STR6ET 2-ALLEY 3-SOWLK *-ORV//Y 5-PKWY 6-YAfp 7-STfiMCl7CH 8-CR<e£0 9-F0SSC?JtEE0 IO-OFBTIPACE tl-CALTRANS R/W l-ASPHALT 2-CONCficTE 3-GRAVEL 4.EROOeO SOiLATRAJSES MM J-TRES 6-ERCCEO SCIL ANO TREE 7-OrRr/GPASS l-PICK 2-CpNCEALEO PICK 3-VfeNTED 4-STORM . ( , 1-GOOO 2-TIGrfT 3-LOOdE 4-ROCKING 5-BOLTS MISSING E-GASKET BA0«3ONE 7-GOOO i-RING 1-NONE 2-GASKET 3-SILCONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-5'S-ALLEN SaT 5-3f4: ALLEN EOLT 6-5POINTBOLT 7-ALr^ ' BOLT 8- 6P0INTB0LT S-BURIED 10-ASPHALT CAP 1 i-CONCRETE CAP 1-SHEET FLOW 2-LOV/POINT 1-24" 2-36' 3-48' 4-OTHERS 1-NO 2-YES 1-NONE 2-PRECAST 3-ERlCK 4-BLOCK 5-POUREO UNED LintrTvpe: 1- Cemenddous 2- Casi in Place 3- C«fed in }ce ' poxy ESDNO 1-NONE 2-PREGST 3-eRK 4-ELK 5-PORD 6-onKiCaN 7-CLAY fi-PVC LINEDiQ^sDNO yrnNrFr/TRif; 9.ccrFNTPir 3-CLATTO=^ ^ y J.NEDQYESnNO if feii l-NONE 2-PRECST 3-BRK 4.ELK 5-PORD e-=flK4C0N 7-CLAY E-FVC LI.N: 1-CEM£NTITiOUS 2-CAST-IN-FLt.CE O-CURED-IN-FLACE 4-EFOX'^ 1-NONE 2-PRECAST 3-5.RICK 4-5LOCK 5-.=CUR=0 U-NED^YESDNQ 1-NONE 2-PRECAST 3-POU.RED 4-VCP 5-FVC 6-=F:CK 1-NONE 2-MORTAR 3-GASKET 1-NONE 2-5.AR 3-CAST InO.N 4-FLAST;C 1-GOOO 2-CORF.ODED 2-.'.;:SALIGNED i :=.Z<=\ :-V:SS:NG e-Ur.SAFE I CEFECTS FLOW OBS. CODE (GPM) BROKEN S D CORnOSiON ROOTS I/l — -NU.V5ER OF S D SO CODE HOLES CRACKS JOINTS COVER I _II FRAME ! IS FRAME SEAL I !| GRADE ADJUSTMENT..L _J[ . COiME 1 11 V.'.ALL 1 11 . EcNCH 1 II TROUGH 1 ll O .V CODE SEVERITY CODE -LIGHT 1 - MILD - .VODERATE 2-MODERATE -HEAVY 3-SEVERE - STRUCTURAL J L J L J L .1 L AJ\JL AiiI?J J L ! I L iJ^I I I I ! DENSITY CODE I I 11 I J^itprx^ ^i-f ^^r/^ CODE ^ 1 -<ior. 2- 10%-25% 3 - 25% - 50r, 4•>50% 1 • INFLOW 2 - INFILTRATION :cESS. 7 J I I m VORTAR DETERIORATION. r,-lHCIPlTATION ^ \ l-DniVE(PAVED) 2-CfllV€[UNPAVS0) a CRiVE i WAU-JO' 4 OR.VE 4 V/ALK*;0 S-NO .\WI.NT, ACCESSiEASY WALK) 6-NO hlAiNT. ACCESS (Pl.t^rlCULT WALK) 7.\0 MA..NT. ACCESSitASr W^LK CCVTACT F.ROPERTY Cw.\e3( a - NO J.tA:NT. ACCESS (DIFFICULT WALK COmACr P.ROPEaiY OV/N£5J 1-NO 2 YES "^1 INCHES IN PAST J DAYS 1. UPSTREAM MANHOLE# 2. DOWNSTREAM MANHOLE # .... 3. INSPECTED MANHOLE :.. 4. PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL i 2. ^ II ! Ii IL 1 X a. PIPE LINER MATERIAL ..-!J____l' rlj--^—J! 9. ' RIM TO CROWN (FT) : f g/^|| p <^ \L±^Lj{ 10 FLOW DEPTH (IN) | ^ \£lZ. ll L ll 11. DEPOSITION: INCHES j. TYPE.i J. 16. FLOW VELOCITY (FPS) |. i; 7 • i; J ENTER APPROPRIATE NUMBER OR 'SVC- OR 'STUB' J J 1-UPSTREAM 2-DOWNSTREAM J1-12CL0C"KP0SITI0N j Jl-ROUND 2-ELLIPTlCAL 3-BOX +-DOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM e-TILE 9-BRICK 10-TRUSS J 1-CIPP 2-FOLDaFORM 3-SLIPUNED 4-SPIRAL WOUND I INCLUDES DEPOSITION A^^ PIPE MOUTH I , 1-SLUDGE 2-MUO 3-ROCKS 4-DE8RIS I ESTIMATED OR MEASURED (CIRCLE) I I I I I I I PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS t 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO J 1-YES 2-NO COMMENTS: FIFE SKETCH 1 I PIPES FOOTGE LOC. DEF RATNG INFLT(gpin) COMMENTS • • : 1 1 1 i i 1 1 1 1 Defects Location 0 NW 1 US Manhole 1 CracK-Radial 2 DS Manhole 2 Crack-Hofizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pice 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Taa 8 Upper Ripht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44 Oetifis -12 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scalina 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below around level] 23 Exposed Cut-off wall (>2 (eet of wall exposed) ADDRESS: OBSERVATION CODE NO. rrr iC. u.(-J I-'NTE^^^^^ TYHt — ^ r, , ^ ,.»v.n'5j"iwi ^;;;^^;^^7;;UlSPECTED -BURIED ^NOT FOUND -SUHI-Ai-c ^ fi.Ri LED IN 7-1 TEE 8JUNCT10N , ,^ DROP 4-OUT DROP S-ROCK TRAP 6-FlLLED ' .^PKWY .YA.P 7.STRMC.TCH B-C«KBEO ^POSSCP^eEOIC^PE - INSPECTION .TYf't. : r I.STND2-CLNOUT3 STRUCTURE TYPE |~UZJ ^-STREET 2-ALLEY 3-SOWU( 4-^flV/rr LOCATION......— 'Z^IZ^^^ S-ERCCE0SCIL.S0TREE7^.Rr/GPA,. SURFACE TYPE. 1—2 CONNER A. 'TYPE B. FIT C. SEAL D. SECURING. J VASPHALT 2 T 7T^i^^^^^^°'":' 1BO°TT»SS,NG S.GASKETBAD«ONE r^oooi-RiMG j ';;;nD2A,GHT3.LOO*«OCKlNG5.l S e'c^SlNfeOLT S-BUHIED .0-, , /_J VNONE 2-GASKET 3-SlllCONE .^.^LENEOLT S-V^^ALlENEaT e-S POINT BOIT 7. ALFA E. # OF HOLES. FRAME F. PONDING DEPTH (1N)1 /-Tl ^^^^^ ^^^^^ ^-LOV/ POlKT G. PONDINGT^PE- 2-36' 3-48- 4-OTHERS . •a SIZE (DIA IN) Ua^J ;Q2.YHS INFLOW DISH —-j ; t;^.;BLsT 3.B«CK ..B.OCK .POUBEC UN..Q^.SDN0 1. INFLOW DISH A. OFFSET (IN) B GPJ^DEADJ.A.TYP£ B. DEPTH (IN) C. MIN. DIA (IN) Liner Type: 1- CemendDOus 2- Cast in PUc= 3- CuTtd in 'lace ' =poxy V.ALL A. MATERIAL I—g-J ,^g^,_,„ITiOUS S-CAST-IN FUC^ S-CL-.cD-I.I F- ... ^ r- [ Ml B. LINING TYPE C. DIAAENGTH (IN) D. D1AJV/;0TH (IN).. EENCHTYPE TROUGH TYPE - • = E SEAL TYPE .--=PS A. TYF B. CONDITION '•^.NnOLE DEPTH (FT) ^w,r^cMrF OF SURCHARGE (FT) 1--^ - . c^Eir-^T ''•^^^iCK 4-5L0CK 5-?C'JP.^C U^< = ^ '-^ - ^-^^"^^ G CONE V.'.ALL . BENCH TROUGH O.V CODE CEFECTS COVER FRAME FPAME SEAL ,RADE ADJUSTMcNT..L Jl • L J -LIGHT - >.'ODERATE , - t-iEAVY ) - STRUCTURAL -L J -U J ccvFRlTY CODE 1 - MILD 2- MODERATE 3- SEVERE \JL.\ I ! 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 - INFLOSV 2 - INRLTRATION L IP ;cESS. . VORTABOETEB,OBAT,0. ,J^1 ^^^^^ V .n .nR-»w»'.K,:0 5-N0VWW.ACC£SSiEAS'r-,v«.K) DAYS r.:^, = ClPlTATlON UPSTREAM MANHOLES | ^ 2. DOWNSTREAM MANHOLE # .... 3. INSPECTED MANHOLE 4. PipE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN)... 7. PIPE MATERIAL 1 n It IL L 8. PIPE LINER MATERIAL. •f-9. ' RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE.!..., 16. FLOW VELOCITY (FPS), \ ^ II y^T J ENTER APPROPRIATE NUf^BER OR 'SVC" OR "STUB" J ' J 1-UPSTREAM 2-DOWNSTREAM Jl-12CLDCkPOSITION j J 1-ROUNO 2-ELLIPTICAL ^-BOX 4-OOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC J 1-VCP 2-PVC S-CO'NCRETE 4-RCP 5-DIP 6-CIP 7-CM e-TILE 9-BRICK 10-TRUSS .11-CIPP 2-F0LD&F0RM 3-SLIPLINED 4-SPIRAL WOUND I ^11 % 4-1 INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUDGE 2-MUD 3-ROCKS 4-OEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 • 1 1 1 III i 1 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO J 1-YES 2-NO COMMENTS: PIPE SKETCH Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Hofizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Taa 8 Upper Riaht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 lOebfis .42 Crown — 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at^round level) 22 Exposed Encasement (erosion below qround level) 23 Exposed Cut-off wall ( >2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREETRM/OR CANYON) r'j^S Z^'^^^^c^ .^'^ ^ Y ADDRESS: OBSERVATION CODE NO. CODE INSPECTlON.TYPt. STRUCTURETYPE. hi 3^T INSPEi LOCATION 1 ((^ SURFACE TYPE 1 7 CON/ER Ai 'TYPE .1 / B. FIT I i C. SEAL I / D. SECURING / E. # OF HOLES L F. PONDING DEPTH (1N)L G. PONDING TYPE ' FRAME a SIZE (DIA IN) i I. INFLOW DISH I A. OFFSET (IN). B. RISER HEIGhfT flNL...! d? Y GPJ^DE ADJ. A. TYPE I ^ B. DEPTH (IN) I C. MIN. DIA (IN) I CONE/TOP A. TYPE :l ! B. SHAPE ' I ^ V;ALL A, MATERIAL j J_ B. LINING TYPE \ ^ C. DIAAENGTH (-N) I ^ D. DIAAV:DTH (IN) I £: = NCHTYPE I £_ TROUGH TYPE I i ;^?E SEAL TYPE t ^ A. TYPE B. CONDITION.. 'EPS '.•ANHOLE DEPTH (FT) l/^f ?s EVIDENCE OF SURCHA.SGE (FT) I l-IfiTERNAL 2-SURFACE 3^0T INSPECTED 4-eURlED 5-NOT FOUND 1-STND 2-CLN OUT 3-IN DROP 4-OUT DROP S-ROCK TRAP 6-FILLED IN 7.TEE e-JUNCTIO^ 1-STRECT 2-ALLEY 3-SCWLK i-ORWrV5-PKWY 6-YASp 7-STRMCiTCH B-CRKBEO 9-?0SSCPXBED lOOFE.VSPACE 11-CALTRANS flAV l-ASPHALT 2-CONCfiETE S-GRAVEL 4-EROOEOSOIL AT RAISED MH J-TflEE 6-ERCCEO SOIL ANO TflEE 70lflT/GPviSS 1-PICK 2-CpNCEALEO PICK 3•Vfe^fTED 4-STORM • ( 1-GOOO 2-TIGHT 3-LOO* 4-ROCKlNG 5-BOLTS MISSING 6-GASKET BAD/GONE 7-GOOO A-RING 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING 8AR 3-ANGLE IRONS 4-S'B'ALLEN EaT 5-3^4: ALLEN EaT 6-SPOINTBOLT 7.ALr.i * BOLT a- 6POINTB0LT 9-BURIEO 10-ASPHALT CAP 11-CONCRETE CAP 1-SHEET FLOW 2-LOV/POirfT 1-24" 2-36' 3-48" 4-OTHERS 1-NO 2-YES /4 Liner Tvpt: 1- Ccmenddous 2- Cast in Placs 3- Curtd in Place 1-NONE 2-PRECAST 3-ERlCK 4-BLOCK 5-POURED LINEq^ESQNO 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD 6-5RKiCON 7-CUY E-PVC LINE 1-CnNrFNTRlC 9.FrCFNTPlC 3-R AT TQS W IP YESQNO l-NONE 2-Pn£CST 3-BF,K 4-ELK 5-PORD 1-CEMEMTlTiOUS 2-CA$T-lN-FLt.CE 3-CU; e-E^KaCON 7-CLAY E-FVC LI.NEOOYEEDNO =.=D-1M-FLACE 4 E?0X'i' . CC?A£ HXr 1-N'ONE 2-Fn£CAST 3-5.RICK 4-BLOCK e l-NONE 2-PRECAST 3-POUREO 4-VCP £ 1-NONE 2•^.^0RTAR 3-GASKET l-N'ONE 2-E,^R 3-CASTIRO.N ^-FLASTiC 1-GOOD 2-coRRODEO 3-.'.::S.-,LIG:;ED •=CU.=.ED LWEO:0Y=£D.SO rVC 6 =.~;CK = ':-;=>. :-V:S5:NG 6-Uf.SAFE CEFECTS FLOW OBS. CODE "(GPM) BROKEN S O COVER I !L FRA.ME..,-. I !!_ FPAME SEAL I !| iRAOE ADJUSTMENT..L J I COR.SOSiON S D 1x37 ROOTS \A "- -NU>.!=£n OF—• S D COCE HOLES C.=ACKS JOINTS^ . CONE I II 1 I ll I 1 , V.ALL 1 ll I I ll ! L . EENCH 1 ll I 1 ll I 1. , TROUGH I ll 1 I ll I I O.V CODE SEVERITY CODE DENSITY CODE - LIGHT 1 - MILD 1 -<10% -r.'ODERATE 2 - MODERATE 2-10%-25% - HEAVY 3-SEVERE 3 - 25% - SO-/. - STRUCTURAL 4 ->50% J I I 1 ! r""T CODE 1 • INFLOW 2 - INRLTRATION -I I . ^1 \ , : \——_*l W :cESS. ^.'ORTAR DETERIORATION, r ~£ClPlTATION 1-DRIVE(PAV£D) a CfllVE(UNPAV=D) a CRiVE 1 V/ALK*:o- 4 OB.VE 4 WALK>:0 S-NO VUl.NT. ACCESSiEASlf WALK) $-N0 MA;NT. ACCESS (Ol.^f ICULT WALK) 7-.V0 ".lANT. ACCESSiEASY WALK CCSTACI PflOPERTY C\1\i^] e - KO SWJNT. ACCESS {OlFrlCULT WAlK CC^f^Zf PRCFSfllY Ov/.s;?i 1-NO 2-YES INCHES IN PAST 3 DAYS I I I I I I I 1. UPSTREAM MANHOLE # DOWNSTREAM MANHOLE #.... INSPECTED MANHOLE :.. PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL U/ II f/f '/3 II 1/1/ II II / II ^ II " ENTER APPROPRIATE NUMBER OR 'SVC- OR 'STUB' / 8. PIPE LINER MATERIAL. J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOC'K POSITION i Jl-ROUND 2-ELLIPTICAL 3-BOX 4-DOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-ClP 7-CM 8-TILE 9-BRICK 10-TRUSS .11-CIPP 2-F0LD&F0RM 3-SUPUNEO 4-SPIRAL WOUND 9. * RIM TO CROWN (FT). f 10. FLOW DEPTH (IN) L ^ 11. DEPOSITION: INCHES I. TYPE.i i J2v JL - J INCLUDES DEPOSITION A^^ PIPE MOUTH 16. FLOW VELOCITY (FPS) } . /. ^ W _ ^11 Ll _j 1-SLUDGE 2-MUD 3-ROCKS 4-OEBRIS _J ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J l-YES 2-NO J 1-YES 2-NO COMMENTS: PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 I 1 1 1 • • . 1 1 1 1 1 j 1 Defects Location 0 NW 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-HoFizonlal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Taa 8 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left U 0«t>ris -12 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scarinp 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Inriltration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement {at qround level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cul-off v/all (>2 leet of wall exposed) GEN. LOCATION; (INDICATES IF STREET RAV OR CANYON) ^ c i^ ADDRESS: OBSERVATION CODE NO. CODE " INSPECTION TYpfe l! 1 j/ | 1-lNTERNAL 2-SURFACE 3-WOT INSPECTED 4-BURlED 5-NOT FOUND STRUCTURE TYPE. LOCATION SURFACE TYPE I COVER A''TYPE B. FIT C. SEAL D. SECURING. E. # OF HOLES I L FRAME F. PONDING DEPTH (IN)L G. PONOINCSTYPE *^ H. SIZE (DIA. IN) L I. INFLOW DISH L A. OFf=SET(IN) L B. RISER HEIGHT (IN)....I GRJ^DE ADJ. A. TYPE I B. DEPTH (IN) I / y C. MIN. DIA. (IN) I CONE/TOP A. TYPE :| ' ^ I B. SHAPE ' I A V;ALL A. MATERIAL I ^ B. LINING TYPE ; ^ C. DIATLENGTH (;N) I D. DIAAV:DTH (IN) I 3ENCH TYPE TROUGH TYPE ^;?£ SEALTYPE..^ T'EPS A. TYPE B. CONDITION I. •.•A\HOLE DEPTH (FT) L EVIDENCE OF SURCHARGE (FT) 1. Z2 1 -STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FlLLEO IN 7-TEE 8 JUNCT10N 1-STREET 2-ALLEY 3-SCWLX i-OflW/Y 5-PKWY 6-YASp J-STRMCITCH B-CRXBEO 9-FOSS CPJt 660 11.CALTRANSRW 1-ASPHALT 2-CCNCfiETE 3-GRAVEL H-EROOEDSOIL AT RAISED MH J-TRES 6-EKCCEO SOIL A.SD TREE 7-OlRT/GPJSS l-PICK 2-CpNCeALEO PICK 3-Vfe^fTED 4-STORM . j . , l-GOOD 2-TIGWT 3-LOOdE 4-ROCKING S-BOLTS HISSING 6-GASKET BAO^SONE 7-GOOoi-RlNG 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-S^-ALLEN EaT 5-3/4: ALLEN EOLT 6-5 POINT BOLT 7-ALFA " BOLT 8- 6P01NTB0LT 9-8URIE0 10-ASPHALT CAP ll-CONCRETECAP 1-SHEET FLOW 2-LOVV POINT 1-24- 2-36" 3-48" 4-OTHERS l-NO 2-YES Lintr Tvpt: 1- Ccmenddous 2- Ca«inPlac2 l-Cund in s= • 4-fooxy 1-NONE 2-PRECAST 3.ERICK 4-BLOCK £-POURE0 UN 1-NONE 2-PflEGST 3-BRK 4-ELK 5-PORO e-oRK&CON 7-CLAY 8-PVC LrnNrFNTRif: ?-FnrFNTPic a-CLATTO^ EO^^IESDNO UNEO^YESQNC ) e-=RK4C0N 7-CLAY E FVC LI.SEDQYEEDNO •==D-IN-FLACE 4-E?0)CI' r l-NONE 2-Pn£CST 3-BRK 4-ELK 5-PORD 6-= 1-CEM£NTlTiOUS 2-CA$T-IN-rL<CE 3-CU= 1-NONE 2-FRECAST 3-5.=;iCK 4-ELOCK 5-FCURED LWHOijZJ VESQ .\0 l-NONE 2-PHECAST 3-POU.n=0 4-VCP £-=VC 6 =.=:CK ' l-NONE 2-.*.10RTAR 3-GASKET 1-NONE 2-B.AR 3 CAST IRON -J-.^LASTiC 1-GOOO 2-CORF.ODED 3-V.:S.-.JGNED 4.= =C-;=.\ :-.V:S=:NG 6-'J:.SAFE [ I CEFECTS FLOW OBS. CODE TGPM) BROKEN S D CORROSiON ROOTS M — -NU.V5ER0.= S D S D COCE HOLES CRACKS JOiNTS COVER 1 FRAME L F.='AMESEAL L GRADE ADJUSTMcNT..L CONE L V/.ALL L . EENCH L JL TROUGH i 11 O .V CODE SEVERITY CODE J 1. J L II I bi. L2J J L L il J 1. J L \ I J L DENSITY CODE I/l CODE -LIGHT • - S'OOEFIATE . - HEAVY )-STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% - sor, 4 ->50% 1 • INFLOW 2 - INFILTRATION ACCESS I { 1 1-DRIVE(PAV£0) 2-CRIVE(UNPAV=0| 3 CRiVE 4 V.'ALK<M- < OfiiV=4V/ALK>:0 S-NO .MAI.VT. ACCESSjEASr WALK) C-NO MA:NT. ACCESS (OI.'='f ICULT WALK) I NO ^^A..NT. ACCESSJEASr WALK CCSTACT P.=»OP£aiV CW.S£;?) 0 - NO MA;.NT. ACCESS (DIFFICULT WA:.K CCMTACI PROFERIY 0VA=5] * V'ORTAR DETERIORATION I_ jLl 1-NO 2-YES • r.REClPlTATION I_ _| INCHES IN PAST 3 DAYS m 3 1. UPSTREAM MANHOLE # U Y.3 il fe_Z_ !L 2. DOWNSTREAM MANHOLE # .... L 3. INSPECTED MANHOLE :.. I / II 2. IL 4. PlpE DIRECTION I' ^. II! y JL 5. SHAPE OF PIPE 1 '. L_fl 1 lU 6. PIPE DIAMETERMEIGHT (IN)... | ^ I ll ^1 IL 7. PIPE MATERIAL I /—II / !L 8. \ PIPE LINER MATERIAL ! ' L' iL 9. ^ RIM TO CROWN (FT) • j j' ^ II Y'^^^l 10. FLOW DEPTH (IN) \ ^ II S_—IL 11. DEPOSITION: INCHES L ^ jL Ti'PE.; J__y_.IL -K-^'- 16. FLOW VELOCITY (FPS) I A S II —IL I ENTER APPROPRIATE NUMBER OR 'SVC* OR "STUB' J J 1-UPSTREAM 2-DOWNSTREAM J M2 CLOCK POSITION j Jl-ROUND 2-ELLIPTICAL 3-BOX 4^UBLE BOX i S-TRIPLE BOX 6-HORSESHC _l 1-VCP 2-PVC 3-cdNCRETE 4-RCP 5-DlP 6-ClP 7-CM &-TILE 9-BRICK 10-TRUSS 11-CIPP 2-FOLDaPORM 3-SUPLlNED 4-SPIRAL WOUND INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUDGE 2-MUD 3-RDCKS 4-DEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 t PIPES FOOTGE LOC. DEF RATNG INFLT(gpni) • COMMENTS • • 1 1 1 1 1 1 1 1 1 1 1 1 1 17. POSSIBLE PIPE EXPOSURE I I 1-YES 2-NO 18. PIPE CHECKED FOR EXPOSURE 1 | 1-YES 2-NO COMMENTS: Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Hofizonlal 3 Camera Blocited 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Right 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left | U Dettfis -12 Crown——— 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scaling 15 Camera Emerged IS Sag 16 Pipe Exterior 16 InriHration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cut-off wall (>2 leet of wait exposed) GEN. LOCATION: fWO/CAr£S/FSrff££rmvOR CAA/YOA/J ^^f^ui/^S '^^^ " ADDRESS: ' yy^^.TTj^ OBSERVATION CODE NO. CODE -INSPECTION TYpt. STRUCTURETYPE. _z LOCATION I /O SURFACE TYPE L 7 CONNER A.'TYPE ....„...i: ...L. B. FIT I / C. SEAL D. SECURING I L T E. # OF HOLES. / F. PONDING DEPTH (IN)[ }_ FRAME G. PONDING TYPE. ; "a SIZE (DIA IN) I 2^' I. INFLOW DISH I A. OFFSET (IN). I — B. RISER HEIGHT (IN)....L GPJ^DE ADJ. A. TYPE..... L B. DEPTH (IN) I ^ V C. MIN. DIA (IN) I CONEA-OP A. TYPE :| ' g- I - B SHAPF \ I V;ALL A. MATERIAL | B. LINING TYPE ! ^ C. DIAAENGTH (IN) L D. DIAAV:DTH (IN) Li^ UENCH TYPE TROUGH TYPE •^;P£ SEAL TYPE fEPS A. TYPE B. CONDITION •••ANHOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT). T -2 1-imERNAL 2-SURFACE 3-NOT INSPECTED 4-SURIED 5-NOT FOUND 1 -STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FILLEO IN 7-TEE 8-JUNCTli 1-STREET 2-ALLEY 3-SCWLK t-ORV//Y 5-PKWY 6-YAnp 7-STfi.M PITCH B-CRKBEO 9-WSS CfiX BE? 11-CALTRANS RAV l-ASPHALT 2-CCNCfiETE 3-GRAVEL 4-EROOEO SOIL AT RAISED MH £-Tfl£= 6-ERCCEO SCIL ASO TflEE 7-OinT/GfiASS I -PICK 2-CpNCEALEO PICK 3-VfeMTEO 4.ST0ay 1-GOOO 2-TlGKT 3-L00* 4-ROCKING 5-BOLTS MISSING 6-GASKcT EAO^ONE 7-GOOO 5-RING 1-NONE 2-GASKET 3-SlLICONE 1-NONE 2-STRAPPING 8AR 3-ANGLE IRONS 4-S'8*ALLEN EaT 5-3/4: ALLEN EOLT 6-SPOINTBOLT 7.ALr; * BOLT 8- 6P0INTB0LT 9-8URIED (O-ASPHALT CAP 11-CONCRETE CAP 1-SHEET FLOW 2-LO//P0^^^• 1-24" 2-36' 3-48' 4-OTHERS 1-NO 2-YES LintrTvpe: 1- Cemenddous 2- CastinFbc! 3- Curcd in Place • 4- Epoxy -NONE 2-PRECAST 3-ERlCK 4-BLOCK E-POURED LINEDIDYCS^NO 1-NONE 2-PflEGST 3-BRK 4-ELK 5-PORD 6-SRKiCON 7-CLAY e-PVC LINEDOYESDNO 1-r.nNGFNTRir ?-FCr.FNTPlC 3-ClATTOO 1-NONE 2-Pn£CST 3-BRK 4-ELK 5-PORO e-=RKiCON 7-CLAY E-FVC UNEOnYESD.SO 1-CEMENTITlOUS 2-CAST-IN-FLACE 3-CU=.ED-IN FLACE 4-EF0)CI' 1-NONE 2-FRECAST 3-5R1CK 4-5LOCK £ =CU=ED U.NEDOYESDNO l-NONE 2 PRECAST 3-P0U.=ED 4-VCP 5-=VC 6-~.=:CK 1-NONE 2-MORTAR 3-GASKET 1-NONE 2-EAR 3-CAST InO.N -i-FLASTlC 1-GOOO 2-CORRODED 3-\::SALIG:;ED •;-=-:<=>; :-V:S=:NG E-U:;SA== I I EFECTS FLOW OBS. CODE (GPM) BROKEN COR.ROSiON ROOTS 1/1 — -NU.V=cRO= S D SO S D CODE HOLES C=ACKS JOINTS COVER I IL FRA.ME...- I 11. FPAME SEAL | |L GRADE ADJUSTMENT..L CONE L W.ALL L J 1. J L J I. J L e^NCH L Jl TROUGH I 11 O.V CODE SEVERITY CODE J L II f t J~""l L^lli^! J I I I I v^.•^-^..;yv^ I i [ \ DENSITY CODE CODE -LIGHT - \!ODERATE . - l-iEAVY ) - STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2-10%-25% 3 - 25% • 50% 4 ->50% 1 - INFLOW 2 - INFILTRATION ACCESS .<^/^£^.<r:f/T.'!^l (_\ 1.0fllVE{PAVED) 2-CRIVE{UNPAV=0f 3-0ai'/E 1 V;ALK<:0- * Ofi.VEAWALK>:[) S-hOMAI.NT. ACCESSiEASYWAiK] e-KO WA.NT. ACCESS (OlFrlCULT WALK) 7.,\0 .>.IA.N7. ACCESSitAST WAI.^ CCVTACT PflOPERTY CW\£a) 1(01 6 - HO MJll.NT. ACCESS (DIFFICULT WALK COfTTArr PSCFERIY OV;S:=l V'ORTAR DETERIORATION I_/_l 1-NO 2-YES r.-'^=ClPlTATION _| INCHES IN PAST DAYS • • : I y • .\^.-- " v'u 1. 2. 3. 4. 5. 6. 7. 9. PIPE tt UPSTREAM MANHOLE # DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE :.. PipE DIRECTION SHAPE OF PIPE PIPE DIAMETERmElGHT (IN)... PIPE MATERIAL 8. PIPE LINER MATERIAL. I I V) / II 2 7 w \ il , " ^ :2JL ^ _l! ENTER APPROPRIATE NUMBER OR -SVC" OR 'STUB* RIM TO CROWN (FT) I nr ll yjp ll 11. DEPOSITION: INCHES I ^ l!^ iw — ii J 1-UPSTREAM 2-DOWNSTREAM J1-12CL0C'KP0S!T10N j Jl-ROUND 2-ELLlPTlCAL 3-BOX 4-DOUBLEBOX J &-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DlP 6CIP 7-CM 8-TILE 9-8RICK 10-TRUSS J 1-CIPP 2-F0LD&F0RM 3-SLIPLINED 4-SPIRAL WOUND 10. FLOW DEPTH (IN) J INCLUDES DEPOSITION AT PIPE MOUTH TYPE.I.... 16. FLOW VELOCITY (FPS), •i L 2_iia 1-SLUDGE 2-MUO 3-ROCKS 4-DEBRlS ESTIMATED OR MEASURED (CIRCLE) I I I I I I I I I I PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE, 1-YES 2-NO 1-YES 2-NO COMMENTS: PIPES FOOTGE IOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 • 1 1 1 • • 1 1 1 1 1 1 1 1 1 1 1 1 Defects Location 0 H\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-HoHzontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pice 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Taa 8 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left -U Oebtis -42 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltralion 17 New Manhole IS Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below cround level) 23 Exposed Cul-off wall (>2 feet of wall exposed) . LOCATION: (INDICATES IF STREET RAV OR CANYON) _s j/^^c^^ ' GEN ADDRESS OBSERVATION CODE NO. CODE INSPECTlON.TYpfe. STRUCTURETYPE \ , LOCATION I Q SURFACE TYPE | 2- COVER A. 'TYPE B. FIT.... •\—L .L__Z. C. SEAL I L D. SECURING I L. .L_Z FRAME E. # OF HOLES. F. PONDING DEPTH flNU / G. PONDING TYPE. H. SIZE (DIA IN) I JfY' I. INFLOV/DISH I • A. OFFSET (IN) I — B. RISER HEIGHT fINL...I '—• GRADE ADJ. A. TYPE I p B. DEPTH (IN) I^y C. MIN. DIA (IN) I o?y CONE/TOP A. TYPE :| ' ^ I B SHAPE \';ALL A. MATERIAL B. LINING TYPE. _ C. DIAAENGTH (IN) I '^'7 D. DIAAV.DTK (IN) 1 Y 2ENCHTYPE „ TROUGH TYPE I 3. 'KP= SEAL TYPE I ^ f-=P3 A. TYPE I / B. CONDITION.: 1 '.•ANHOLE DEPTH (R) /.C/ EVIDENCE OF SURCHA.RGE (FT) I 1-INTERNAL 2-SURFACE 3-NOT INSPECTED *-eURlED 5-NOT FOUND l-STNO 2-CLN OLTT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6-FlLLED IN 7-TEE fl-JUNCTION l-STHEET 2-ALLEY 3-S0WU( 4-DRV//Y 5-PKWY 6-YAflp 7-STRMCrrCH B-CfiiC6E0 »-?OSSCPJ< GEO 10OFE.N SPACE 11-CALTRA-»iSR/W l-ASPHALT 2-CONCRETE 3-GRAVEL 4-EaOOEOSOlL A7RAJSE3 UH J-TREE 6-ERCCEO SOIL AND TREE 7-OlRT/GPASS m in 1-PICK 2-CpNCEALEDPICK 3-Vt^fTED 4.ST0ay " ^ 1-GOOO 2TIGKT 3-LOO* 4-ROCKlNG 5-BOLTS MISSING 6-GASKET BAD/GONE 7-GOOoi-RING ' 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-SB'ALLEN EOLT £-3/4; ALLEN EaT 6-5POINTBOLT 7.ALr; ' BOLT 8- 6P0(NTB0LT 9-BURIEO 10-ASPHALT CAP H-CONCRETECAP 1-SHEET FLOW 2-La//POINT 1-24" 2-36" 3-48" 4-OTHERS 1-NO 2YES Liner Trpt: 1- Cemenddous 2- Cast in Place 3- Curcd In Place - 1-NONE 2-PRECAST 3-ERICK 4-8LOCK 5-POURED LINEt)£}r£SDNO 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD e-BRKiCON 7-CLAY e-PVC LINEO.oi'ESnNO i-r.nrjr.FNTRif^ 9.cr.rFMTPic 3-CLATTOP l-NONE 2-PnECST 3-BRK 4-ELK 5-PORO e =RK4C0N 7-CLAY E-FVC UN=E)0 YESQNO 1-CEMENTlTlOUS S-CAST-IN'-FLACE 3-CU==D-IN-FLACE <-EFO)C/ 1-NONE 2-FRECAST 3-E.=;!CK 4-5LOCK 5-FC'JR=D U.\=DjZ^"^ESD-SO 1-NONE 2-PRECAST 3-POURED 4-VCP £ FVC e-E=:CK 1-NONE 2-MORTAR 3-GASKET 1-NONE 2-5.AR 3-CAST IRON 4-FLnST:C 1-GOOO 2C0RF.0DHD c-.'.;:SALIGN=D 4-=-C<=.\ :-V:SS:NG E-'JNSAFE m \ I DEFECTS FLOV/ OBS. CODE (GPM) BROKEN CORROSiON ROOTS I/l -- -NU.M=£RO= SO ED S D COC£ HOLES C.=ACKS JOINTS r.nv"=R 1 II 1 1 II 1 1 II 1 FRA.ME I Ii I 1 ll 1 1^1 J£\ 1 !! F=JA\,1F SFAI 1 II 1 1 ll I I 11 1 I II . GRADE ADJUSTMENT..! II t 1 i; 1 1-^1 y 1 1 II . CONE I II 1 1 ll 1 1 ^ 1 I li . V.'.ALL I 11 1 1 II 1 1^1 7 1 1 11 . E^NCH 1 11 I 1 11 1 IJL.\ XA 1 II TROUGH 1 li I \ 11 1 1 1 1 1 li O'.V CODE SEVERITY CODE DENSITY CODE l/l CODE -LIGHT - VODERATE . - HEAVY 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% - SO'/o 1 • INFLO^V 2 • INFILTRATION J L j 1 I - STRUCTURAL 4 - >50% ACCESS 1 / 1^ 1 t-DRIV£(PAVED) 2-CfllV£(UNPAV=D) 3-CniVE 4 WALK.:0- 4 OR.VE 4 WALK»;o J-NC-WLVT, ACCESSiEASr IVALU} 6-NO AlAJNT. ACCESS (Dl.ff ICULT WALX) 7..N0 ^^A..VT. ACCESSitASY WALK CC'.TACt F.^lOPtaTY QVi^'l^) e • KO KWNT, ACCESS (DIFFICULT WALK CCNTA^r P.<iCF£RrY 0VISI=.\ .'-•ORTAR DETERIORATION |_ /_! 1*^0 2-YES r,-":,ECiPlTAT10N \__ _\ INCHES IN PAST c DAYS I 1. 1. 2. m 2. 3. m 4. 6. IM 6. 6. 7. m rirc ff UPSTREAM MANHOLES DOWNSTREAM MANHOLE ft.... INSPECTED MANHOLE PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL 2- 1 j£: 11 // IL 8. PIPE LINER MATERIAL. c ^ p|M jn r.pnWM (FT) -. > ll 10. FLOW DEPTH (IN) |_ 11. DEPOSITION: INCHES |. TYPE.I i 16. FLOW VELOCITY (FPS) L ENTER APPROPRIATE NUMBER OR -SVC- OR 'STUB' J 1-UPSTREAM 2-OOWNSTREAM J1-12CLOC"KPOS1T10N i J 1-ROUNO 2-ELUPTlCAL 3-BOX 4-DOUBLE BOX J 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DlP S-CIP 7-CM 8-TILE &-BR1CK 10-TRUSS .11-CIPP 2-F0LD&F0RM 3-SUPLlNEO 4-SPIRAL WOUND ^IL.^ ^I_Z INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUOGE 2-MUD 3.R0CKS 4-OEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO J 1-YES 2-NO COMMENTS: PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) - COMMENTS • : 1 1 1 1 1 1 1 1 1 1 1 1 Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Hofizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Senflce 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended T33 8 Upper Riaht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left M Debris 12 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scalina 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below qround level) 23 Exposed Cut-off wall (>2 feet o( wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ^^^'g^/y^.jr ^^^^^-^-j^ ADDRESS: OBSERVATION CODE NO. CODE -INSPECTlON^TYpfe l' | ( I 1-INTERNAL 2-SURFACe 3-NOT INSPECTED 4-eURIED 5-NOT FOUND STRUCTURE TYPE LOCATION I SURFACE TYPE COVER A. -TYPE B. FIT.... C. SEAL 1 l_ D. SECURING I {_ E. # OF HOLES I )_ FRAME F. PONDING DEPTH (IN)L G. PONDING TYPE L a SIZE (DIA IN) .....L I. INFLOW DISH L A. OFFSET (IN). n B. RISER HEIGHT (IN)....|_2:y. GPJ^DEADJ. A. TYPE B. DEPTH (IN), C. MIN. DIA (IN). CONE/TOP A. TYPE B SHAPF ' I O-^ V.ALL A. MATERIAL B. LINING TYPE. C. DIAAENGTH (:N). D. DIAAV'DTH (IN) L_J^ .1 ^ 2ENCHTYPE TROUGH TYPE ^;RE SEAL TYPE r"=PS A. TYPE B. CONDITION i ^ ' •••ANHOLE DEPTH (FT) \^' ^ EVIDENCE OF SURCHA.RGE (FT) I •1^ 1-STNO 2-CLN OLTT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6-FlLLED IN 7-TEE 8-JUNCTION 1-STREET 2-ALLEY 3-SOWLK 4-0RV//Y5-PKWY frYAnp 7-STBMCfiCH B-CRKBEO 9-rOSSCSXfi60 I0-OPE.'<SPACE II-CALTRANS AM l-ASPHALT 2-CONCRETE 3-GRAVEL ^-EROOEOSOILAT PAJSED MH S-TREE 6-ERCCEO SOIL WO TPEE 70lRT/G?ASS HP w l-PICK 2-CpNCGALED PICK 3-VfeNTED 4-STOfl.y . j , 1-GOOO 2-TlGMT 3-LOO* 4-ROCKING 5-BOLTS MISSING 6-GASKET BAOrtSONE 7-GOOoi-RING ' 1-NONE 2-GASKET 3-SILICONE 1-NONE a-STRAPPING BAR 3.ANGLE IRONS 4-S-S'ALLEN EOLT 5-3^4: ALLEN EOLT 6-5POINTBOLT 7-ALr; ' BOLT 8- 6POINTB0LT 9-BURIED 10-ASPHALT CAP Il-CONCRETECAP 1-SHEET FLOW 2-LOVV POINT 1-24" '2-36' 3-48" 4-OTHERS 1-NO 2-YES Liner TYTK: 1- Cemenddous 2- Cut in PUc£ 3- CurEd in Place • NO 1-NQNE 2-PRECAST 3-ERICK 4-BLOCK £-FOUflED LINEDO'cSD l-NONE 2-PREGST 3-BRK 4-ELK S-PORO e-BRK&CON 7-CLAY fi-PVC LINED^CESDNO l-CQNCFNTRir: ?-FCCENTPlC a-CL ATTO^^ . 1-NONE 2-PnECST 3-6fiK 4-ELK 5-PORD E-=HKiCON 7-CLAY EFVCIJNEO0YESD NO 1-CEMENTiTIOUS 2-CAST-IN-FLACE 3-CU.=.=D-IN-FLACE i.-^?OXi l-.NONE 2-FRECAST 3-ERICK 4-5LOCK 5-.=CUREC UN=D:p^=£D .SO l-NONE 2-PRECAST 3-POUREO 4-VCP E FVC e-=,=:CK l-NONE 2-^!0RTAR 3-GASKET 1-N0N5 2-EAR 3-CAST IRON 4-.PLAST;C 1-GOOO 2-COFlRODEO 3-.V.:5ALlGr;ED i-z-.Z<~.\ :-V:SC:NG e-U.'.SAFE I I DEFECTS FLOW OBS. CODE TGPM) BROKEN S D II COVER I FRAME L _J!. F.3AMESEAL I H GRADE ADJUSTMENT..L Jl CONE I IL V.ALL L JL EENCH L Ji TROUGH I 11 OVV CODE SEVERITY CODE CORROSiON S D ROOTS I/l — -NU.VScR OF S O CODE HOLES CRACKS JOIiNTS Xii y J LjJI_fJ L J L DENSITY CODE CODE - LIGHT -.'.'ODERATE . - HEAVY f-STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 • INFLOW 2 - INRLTRATION ACCESS. VORTAR DETERIORATION. r,-"^.= CIPlTATION t-DRIVE(PAV£0) 2-CftlVE(UNPAVE0) 3-DaiVE i V.'ALK<:0' < Ofi.VE 4 WALK»;0 S-NO.WAI.VT, ACCESSiEAST WALK) 6-NO KU:NT. ACCESS (OlFrlCULT WALK) 7.N0 ».IA..VT. ACCE5S;£ASr WALK CCSTACT PaOPERIV CW\E?1) e - NO f.W:.ST. ACCESS (Olf FICULT WALK CCWTA;r P.tiCFERIV ows-=i 1-NO 2-YES INCHES IN PAST 3 DAYS I PIPE# ^1) ' 1. UPSTREAM MANHOLE fi | ^/jL H 'L 2. DOWNSTREAM MANHOLE # .... | 3^ 1| $^£_JL 3. INSPECTED MANHOLE :..| f 11 ^ IL 4. PipE DIRECTION L , ^ 11 I ^ 'L 5. SHAPE OF PIPE I . L_ll L IL 6. PIPE DIAMETER/HEIGHT (IN)... 1 II_£X IL 7. PIPE MATERIAL I l—W 1 IL 8. PIPE LINER MATERIAL .-! ' ^ ^ I' uL 9. ^ RIM TO CROWN (FT) -. f /'^^f II /^/ il- 10. FLOW DEPTH (IN) I 2_ II Q-—IL 11. DEPOSITION: INCHES |. ^ijl^ ^ h- TYPE.; I y H _ ZL_J"_ 16. FLOW VELOCITY (FPS) U LSL\\—/L^—H- J ENTER APPROPRIATE NUMBER OR "SVC" OR "STUB" J J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOCK POSITION j J 1-ROUNO 2-ELUPTiCAL 3-BOX 4-DOUBLEBOX J 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-cdNCRETE 4-RCP 5-DlP 6-ClP 7-CM e-TILE 9-BRICK 10-TRUSS .11-CIPP 2-FOLDAFORM 3-SLIPLINEO 4-SPIRAL WOUND, INCLUDES DEPOSITION AT PIPE MOUTH I-SLUDGE 2-MUO 3-ROCKS 4-DEBRlS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) • COMMENTS • • 1 1 1 1 I 1 1 1 1 17. POSSIBLE PIPE EXPOSURE, I I I 18. PIPE CHECKED FOR EXPOSURE L J 1-YES 2-NO J 1-YES 2-NO COMMENTS: Defects Location 0 NV\ 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Hoflzonlal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Cdlapsed Pipe 5 Wye Service 5 WYC Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 Oebf4S 1? Crown —— 12 Grease 13 Inverl 13 Corrosion 14 Camera Submeraed 14 Scalinq 15 Camera Emerqed 15 Sati 16 Pipe Exterior 16 Infillration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below oround level) 23 Exposed Cut-off wall | >2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ^:^T^'^U f ADDRESS: OBSERVATION CODE NO. CODE — INSPECTION TYPt L' I X I 1-INTERNAL 2-SURFACE 3-NOT INSPECTED 4-SI;RIED 5-NOT FOUND STRUCTURETYPE. ..:.....:| f_ LOCATION I lO__ SURFACE TYPE. COVER A. 'TYfE .........ll....' .1 /, B. FIT I / C. SEAL I / D. SECURING I L- E. # OF HOLES I L FRAME F. PONDING DEPTH (1N)1 i_ G. PONDING TYPE ! a SIZE (DIA IN). I. INFLOW DISH L A. OFFSET (IN).. L B. RISER HEIGHT (1N)....L GRJiOE ADJ. A. TYPE I B. DEPTH (IN) I n ^ C. MIN. DIA (IN) I CONE/TOP A. TYPE .\ ' ^ '. B. SHAPF \ i ^ WALL A. MATERIAL B. LINING TYPE C. DIAAE.NGTH (:N)... D. DIAJVV'DTH (IN) 2ENCH TYPE TROUGH TYPE ^:?E SEAL TYPE r"EP3 A. TYPE B. CONDITION •••ANHOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT).... l-STNO 2-CLN OUT 3-lN DROP 4-OUT DROP 5-ROCK TRAP 6-FlLLEO IN 7-TEE B-JUNCTION! 1-STREET 2-ALLEY 3-SOWLX 4-0nV//Y 5-PKWY 6-YAnp 7-STfiM&TCH l-CfiKBED *-?0SSCSXeeiJ^5.OPE.NS?AC£ II-CALTRANSRAV l-ASPHALT 2-CONCRETE 3-GflAVEL 4.ERO0EDSO1L AT RAISED MH J-TREE 6-EKCCEO SOIL ASO TREE 7-OlflT/GPJi£S 1-PlCK 2-CpNCEALEDPICK 3-VfeNTEO 4-STOaM . ( . 1-GOOD 2-TIGKT 3-LOOdE 4-ROCKING S-BOLTS MISSING 6-GASKET EADflSONE 7-GOOO i-RING 1-NONE 2-CASKET S-SILCONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-£'6-ALL£N EaT S-3f4: ALLEN BaT 6-SPOINTBOLT 7-ALr' ' BOLT 8- 6P0INTB0LT 9-BURIED 10-ASPHALT CAP 11-CONCRETE CAP 1-SHEET FLOW 2-LOV/POINT 1-24- 2-36' 3-48" 40THERS 1-NO 2-YES 1-NONE 2-Pfl£CAST 3-ERlCK 4-BLOCK 5-POURED UNED LintrTvpe: 1- Cemenddous 2- CaK in Pbc: 3- Cund in Place : GiEpoxy IEO^^ESDNO r l-NONE 2-PREGST 3-BRK 4-ELK 5-PORD €-5RKiC0N 7-CLAY E-PVC LINED^YESDNO 1.^•ONCF^fTRl^• P-FCCFNTPIC S-t^LATTQS ^ 1-NONE 2-PnECST 3-BRK 4-ELK 5-POflD e-ERKiCON 7-CUY E-FVC LINEaflvESnNO 1-CEM£NTITiOUS 2-CAST-i:; FLiCE 3-CL'=.ED-IN-FLACE 4-EF0X*C l-NONE 2-FRECAST 3-5.R:CK 4-5LOCK 5-FC'J.=.ED UNE^^^YESDNO 1-NONE 2-PRECAST 2-POUREO 4-VCP 5-FVC e-==:CK l-NONE 2-iVORTAR 3-GASKET 1-NONE 2-c.AR 3-CAST InO.N ^-FLASTC 1-GOOO 2-CORF.ODED 3-V.:S.-.LIGN'£0 4-5 = :<EN :-V:S=:NG e-L-r.SA=E [ •EFECTS FLOW OBS. BROKEN COR.nOSlON ROOTS I/l — -NUMBER OF CODE (GPM) S D S D S D CODE HOLES CRACKS JOINTS . COVER I II 1 I 1! 1 I Ix! : FRAME 1 1! 1 ( ll I I / Ix! : FPAME SEAL 1 11 1 1 II i 1 , GRADE ADJUSTMENT..! II 1 1 11 11/ lY 1 1 II 1 1 1 . CONE 1 11 1 I ll 11^ 1 9\ L_II_J lllll . W.ALL I ll 1 t II 1 I ^ iJ^ 1 II ! 1^ 1 III , cENCH 1 ll I 1 11 1 \r 11 11 1 ... TROUGH 1 ll 1 1 II 1 1 1 I 1 ll 1 CODE SEVERITY CODE DENSITY CODE I/l CODE - LIGHT 1 - MILD 1 -<10% 1 - INFLOW - \'.ODERATE 2-MODERATE 2- 10%-25% 2 - INFILTRATION . - hiEAVY I - STRUCTURAL 3-SEVERS 3 - 25% - 50% 4 ->50% ACCESS. y^i/^ .'.'ORTAR DETERIORATION. r.--:,= CIPlTATION 3:»_1 l-DRlVEIPAVEO) 2-CRIVe(UNPAV=0| 3-CaiVE i V.'ALK*:0- < OfiiVE 4 IVALK»;0 S-NO .UtAl.VT, ACCESSiEAST WALK) 6-NO KtA;.NT. ACCESS (DI.'^rlCULT WALX) 7 .\0 MX.VT. ACCESSJtASY WALK CCVTACT F.ROPERTY CWN£S) 6 - NO SW;N7. ACCESS {DIFFICULT WALK CGf/TACf PROFEfllY Qv/.sE^i !_/ _| 1-NO 2-YES !_ _| INCHES IN PAST o DAYS I 1. 2. 3. 4. 5. 6. 7. 8. plPh tt UPSTREAM MANHOLE ft DOWNSTREAM MANHOLE #.... INSPECTED MANHOLE PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL t 1 I Z€ M 1 . / II -1 It 3 11 I' 9 11 I / ^ II ^ -1 1 r tl / ll • 1 1 ^ M 11 ^ ll 1 1 / 11 X II r 1 ^ PIPE LINER MATERIAL .•! ' 9. ^ RIM TO CROWN (FT) ( I 6 10. 11. FLOW DEPTH (IN) DEPOSITION: INCHES. TYPE.i.... (D If 3, .i 16. FLOW VELOCITY (FPS) I ^ I i;^— —iw.2i^ ENTER APPROPRIATE NUMBER OR 'SVC" OR "STUB" J 1-UPSTREAM 2-DOWNSTREAM 1-12CL0C'KP0SITI0N 1 1-ROUND 2-ELLIPTICAL 3-BOX 4-DOUBLEBOX 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS 1-CIPP 2-F0LD&FDRM 3-SUPLINED 4-SPIRAL WOUND INCLUDES DEPOSITION A^^ PIPE MOUTH _j I-SLUOGE 2-MUO 3-ROCKS 4-0EBR(S _J ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 t PIPES FOOTGE LOC. DEF RATNG INFLT(gpm} • COMMENTS • 1 • . 1 1 1 1 1 1 1 1 17. POSSIBLE PIPE EXPOSURE 16, PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO 1 1-YES 2-NO COMMENTS: PIPE SKETCH A. I N 7^ Defects Location 0 NW 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pioe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tas e Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44 Debr-is — -12 Cfowft — 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scalinq IS Camera Emerged 15 Saq 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement {at qround level) 22 Exposed Encasement (erosion below around level) 23 Exposed Cut-off wall (>2 feel ol wall exposed) GEN. LOCATION: (INDICATES IF STREET IW OR CANYON) /p^Af ^ r /^S ADDRESS: OBSERVATION CODE NO. CODE INSPECTION ,TYpk. l; | ^ I STRUCTURETYPE. ;i / LOCATION I //7 SURFACE TYPE I "7" COVER A. -TYPE.........i:; B. FIT f C. SEAL I / D. SECURING I J_ E. # OF HOLES I L F. PONDING DEPTH flNU / FRAME G. PONDING TYPE.. \ ^ ' H. SIZE (DIA IN) I ^V ' I. INFLOW DISH I — A. OFFSET (IN).. I B. RISER HEIGHT flNL...I G RJ^DE ADJ. A. TYPE I ^ B. DEPTH (IN) U?~7 C. MIN. DIA (IN) \J^y CONE/TOP A. TYPE B. SHAPF,, , , ' ' ^ V/ALL A. MATERIAL B. LINING TYPE C. DIAAENGTH (IN).... D. DIAAV:DTH (IN) BENCH TYPE TROUGH TYPE ;^;?£ SEAL TYPE f'EPS A. TYPE B. CONDITION •••ANHOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT) EFECTS FLOW OBS. CODE (GPM) COVER FRAME FRAME SEAL GRADE ADJUSTMENT..L CONE L v.-ALL L EENCH L Jl TROUGH I 1! O.V CODE SEVERITY CODE 1-tNTERNAL 2-SURFACe 3-NOT INSPECTED 4-fiURlED 5-NOT FOUND 1-STND 2-CLN OLTT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6-FlLLED IN 7-TEE fl-JUNCTlO 1-STREET 2-ALLEY 3-SOWlX *-OflW/Y S-PKWY S-YAflp 7-STfi.MClTCH B-CfiKBEO 9-?0SSCfiX 6ED I0OFE.1 SPACE 11-CALTRANS RAV <!^f f {^^^rs^ l-ASPHALT 2-COKCRETE J-GRAVEL 4.ER00eDSOlL AT RAJSEO MH J-THEE 6-ERCCEOSCIL A.SDTflE= 7-DrnT/GRA£S 1-PICK a-CpNCEALED PICK 3•Vfe^fTED 4-STOR.M . j . 1-GOOO 2-TlGKT 3-LOO* 4-ROCKING ^BOLTS MISSING 6-GASKET BAD^ONE 7-GOOO i-RtNG l-NONE 2-GASKET 3-SILlCONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-£'6-ALLEN SaT £-3/4: ALLEN EOLT 6-6POiNT BOLT 7-ALF- ' BOLT 8- 6P0INTB0LT 9-BURtED 10-ASPHALT CAP Il-CONCRETECAP 1-SHEET FLOW 2-LOV/POINT 1-24" 2-36' 3-48" 4-OTHERS 1-NO 2-YES 1-NONE 2-PRECAST 3-ERICK 4-BLOCK 5-POURED LIN LintrTvpe: 1- Cemenddous 2- Cait in Place 3- Cured in 4- BMxy EO^ESD NO 1-NONE 2-PREGST 3-6RK 4-BLK 5-PORO €-DRK&CON 7-CUY fi-PVC LINEDyjYESDNO i.rr^NrFNTRin 7-FnrFNTPin •I-CLATTO=' lZ_ 1-NONE 2 PnECST 3-BRK 4-ELK 5-PORO E-EflKACON 7-CLAY £-FVC U-SED^ZYESDNO 1-CEMENTITiOUS 2-CASM:J-FU.CE 3-CU=.ED-IN-FLACE 4-E?0X"^ 1-NONE 2 FRECAST 3-5.R1CK 4-5LOCK 5-FCURED UN=D:^Y==DN0 1-NONE 2-PRECAST 3-POUnED 4-VCP 5 FVC E-=F:CK 1-NONE 2-MORTAR 3-GASKET 1-NONE 2-EAR 3-CAST IRON -i-FLASTiC 1-GOOO 2-CORP.OD5D 2-.V:SALlGN'E0 i. z?Z<z\ : V:S=:NG e-U.'.SA.=£ BROKEN CORROSiON ROOTS M — -NUVEcROF S D SO S D CODE HOLES CRACKS JOINTS 1^1 DENSITY CODE I/l CODE - LIGHT - ^•ODERATE .-HEAVY ) - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% • 50r* 4•>50% 1 - INFLOW 2 • INFILTRATION ;CESS. •L7-I ?.'ORTAR DETERIORATION 1_ /_| r-lHClPlTATION _| l.ORIVE(PAVEO) 2-CRIVE(UNPAV;0) J-DRiVE 4 WALK<:0' < ORiVE 4 WALK>:o S-NO JUAl.VT. ACCESSjEAST WALK) 6-KO fca-NT. ACCESS (Dl.f f ICULT WALS) ^tA..NT. ACCESSJEASV WAL'< CCSTACT F.ROPERTY CW.S£R1 6 - NO M.A:.NT. ACCESS (DIFFICULT WA;K CCfrTACI PROFERIY Om:=| 1-t^O 2-YES INCHES IN PAST :• DAYS ^ 3. ^ 6. Wi 7. I I I I I I I I I I PIPE ff UPSTREAM MANHOLE # DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE PipE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL 3^ 2>y 3' i 'J' T 8. PIPE LINER MATERIAL. .1 I 9. 10. 11. 16. RIM TO CROWN (FT) FLOW DEPTH (IN) DEPOSITION; INCHES. TYPE.;.... FLOW VELOCITY (FPS). JL _ a 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE I. J 1-YES 2-NO 1 1-YES 2-NO COMMENTS: PIPE SKETCH ENTER APPROPRIATE NUMBER OR "SVC- OR "STUB* J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOCK POSITION j Jl-ROUND 2-ELLlPTICAL 3-BOX 4-'DOUBLEBOX J 5-TRlPLEBOX 6-HORSESHC _l 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-ClP 7-CM e-TILE 9-BRICK 10-TRUSS .11.CIPP2-FOLD4FORM 3-SLIPLlNED 4-SPIRAL WOUND INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUOGE 2-MUO 3-ROCKS 4-OEBRlS _J ESTIMATED OR MEASURED (CIRCLE) PIPE* FOOTGE LOC. DEF RATNG INFLT(gprn) COMMENTS 1 1 1 PIPE'S FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 • 1 1 1 1 • • 1 1 1 1 1 1 1 1 1 1 1 Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left U Debris — -12 Crown —— 12 Grease 13 Invert 13 Corrosion 14 Camera Submersed 14 Scaling 15 Camera Emeraed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below qround level) 23 Exposed Cul-off wall ( >2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ADDRESS: 6a ~h'f,c<(h:,^ /jH- 3^ OBSERVATION CODE NO. CODE -INSPECTlON.TYpfe l! | ( I 1-INTERNAL 2-SURFACe 3-UOT INSPECTED *-aURlED 5-NOT FOUND STRUCTURE TYPE LOCATION I to SURFACE TYPE 1 2_ COVER A. 'TYPE B. FIT C. SEAL D. SECURING. •UJ. -L_l E. # OF HOLES I L F, PONDING DEPTH flNU / G. PONDING TYPE 1 P a SIZE (DIA. IN).... I ^7' I. INFLOW DISH I FRAME A. OFFSET (IN) I — B. RISER HEIGHT (1N)....1_—1_ GRADE ADJ. A. TYPE I ^ B. DEPTH (IN) 1^7 C. MIN. DIA (IN) I o) CONE/TOP A. TYPE _ B SHAPF I ^ V;ALL A. MATERIAL B. LINING TYPE C. DIAAENGTH (IN).... D. DIAAV:DTH (IN) 2ENCH TYPE TROUGH TYPE *^;P= SEAL TYPE r-EPS A. TYPE B. CONDITION •-•ANHOLE DEPTH (FT) EVIDENCE OF SURCHARGE (FT) il no. 1-STND 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCKTRAP 6-FlLLED IN 7-TEE 8-JUNCTIOM l-STREET 2-ALLEY i-S5WU( *-OftV//Y S-PKWY frVARp 7-STRM CiTCH «-CRX8£0 J-rOSSCPXCED lO-Op'fes 1I.CALTFW,VSRAV l-ASPHALT 2-CCNCfiETE 3-GRAVEL 4.ERO0E0 SOIL AT RAISED MH J-TREE 6-ERCCEOSCILAS-OTaE: 7-OlflT/GPJiSS l-PICK 2-CpNCEALEO PICK 3-VfeNTEO 4-STOfl.y • { 1-COOD 2-TIGHT 3-LOOdE 4-ROCKING 5-BOLTS MISSING E-GASKET 6AD«J0NE 7-COOO i-RING 1-NONE 2-GASKET S-SILCONE 1-NONE 2-STflAPPING BAR 3-ANGLE IRONS 4-SB'ALLEN EOLT 5-3/4: ALLEN EaT 6-SPOINTBOLT 7-ALF' • BOLT fl- 6P0INTB0LT 9-BURIED lO-ASPHALTCAP Il-CONCflETcCAP Liner Tvpt: I-Cemenddous 1-SHEET FLOW 2-LOVV POINT 2-Cast In Pbcs 1-24" 2-36' 3-48" 4-OTHERS 3-Cured in 1-NO 2-YES Ji" l-NONE 2-PRECAST 3-EHICK 4-BLOCK 5-POURED LINED:0'ESDNO 1-NONE 2-PREGST 3-8RK 4-ELK 5-PORO €-BnK&CON 7-CLAY fi-PVC LINE0Z]YESnNO LmNCFfyfTRir. g-FCCFNTPIQ 3-^1 AT T0=> ^ 1-NONE 2-PnECST 3-BRK 4-ELK 5-PORD E-ERKSCON 7-CLAY E-FVC 1-CEMENTlTIOUS 2 CAST-IN-FL.C.CE 3-CU=.=D-tN-PLACE 4-EFOX'i' l-.NONE 2-FRECAST S-E.nlCK 4-SLOCK E-FC'JRED UN = D:0Y=sD .NO 1-NONE 2-PRECAST 3-POURED 4-VCP 5-rVC 6-=.=;CK 1-NONE 2-.V0RTAR 3-GASKET l-NONE 2-5.AR 3 CAST IRON -J-FLASTIC 1-GOOO 2-C0R.=.0DED 3-.V:S.ALlGN'=0 A z-.Z<z\ :-V;S=:NG E-LV.EAFE CEFECTS FLOV; OBS. BROKEN COR.nOSiON ROOTS CODE "(GPM) S O S D S 0 I/l — -NUMEER CODE HOLES C.=ACKS JOINTS .1 I! COVER FRA.ME F.=AME SEAL I 11 GRADE ADJUSTMENT..L _li '^O^JE 1 11 ^VALL L Jl . BENCH L Jl TROUGH 1 11 O .V CODE SEVERITY CODE J 1. J L^tlJlj L J L Jl I l-JJU^ 1- Jl I l^lJll L_ Jl I VJ-JILA L_ jLlJ L±xfcr~T: Jl I I II I i_ I/l CODE 1 ! DENSITY CODE - LIGHT - VODERATE .- HEAVY f - STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2-10%-251'o 3 - 25% • 50% 4 f >50% 1 • INFLOW 2-INFILTRATION ;cEss. .j y I l-OfllVE(PAVEO) 2-CRlV£(UNPAV;0) 3-CRiV£ 4 WALK<:0- 4 OR.VE 4 WALK»;CJ S-NO .KWI.VT. ACCESSjEAST WALK) 6-NO MA;NT. ACCESS (OlFrlCULT WALK) 7 .\0 ^U..VT. ACCESSitAST WALK CCSTACT FflOPERTY CW\S5) e - NO MJkl.NT. ACCESS (DlFi=lCULT WALK CCNTACr PSOFEaiT OV/.s:=] 1-NO 2-YES VORTAR DETERIORATION 1_ f r .-£CIPiTATlON |_ _! INCHES IN PAST 3 DAYS PIPE tf 'm 1. UPSTREAM MANHOLE « m 2. DOWNSTREAM MANHOLE ft.... m 3. INSPECTED MANHOLE m 4. FipE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETERMEIGHT (IN)... 7. (1) ^7 .ife II 37 L ,M,ii^g, 1 I I 8. PIPE LINER MATERIAL. I I 9. RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE.i.... 16. FLOW VELOCITY (FPS). 2 ENTER APPROPRIATE NUMBER OR 'SVC' OR "STUB' J 1-UPSTREAM 2-DOWNSTREAM J l-12CLOCkPOSITiON j Jl-ROUND 2-ELUPTICAL 3-BOX 4-DOUBLE BOX J 5-TRIPLE B0:( 6-HORSESHC J 1-VCP 2-PVC 3-cdNCRETE 4-RCP 5-DIP 6-ClP 7-CM 8-TlLE 9-BRlCK 10-TRUSS J 1-ClPP 2-FOLDaFORM 3-SLIPLlNED 4-SPIRAL WOUND J J INCLUDES DEPOSITION AT PIPE MOUTH _, 1-SLUOGE 2-MUD 3-ROCKS 4-OEBRIS _j ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm} • COMMENTS 1 1 1 1 1 1 1 1 1 17. POSSIBLE PIPE EXPOSURE, 18. PIPE CHECKED FOR EXPOSURE l_ J 1-YES 2-NO J 1-YES 2-NO COMMENTS; PIPE SKETCH Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Herizonlal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pice 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Lett 10 Roots 11 Upper Left 11 1 Debris •—— 17 Crown 12 Grease 13 Inverl 13 Corrosion 14 Camera Submeraed 14 Scalinq 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Inriltration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below oround level) 23 ExposedCut-oirwall! >2 feet of wall exposed) GEN. LOCATION; (INDICATES IF STREET RAV OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE ™INSPECTlON,TYpfe '.! 1 / I l-IiaERNAL 2-SURFACE 3-NOT INSPECTED 4-SURIED 5-NOT FOUND STRUCTURE TYPE LOCATION i lo SURFACE TYPE I :2_ COVER 'TYPE .........J.: FIT , SEAL , SECURING... E. F. G. 'a I. FRAME A. B. GRADE ADJ. A. B. C. CONE/TOP A. R # OF HOLES „ I L PONDING DEPTH (IN)|. L PONDING TYPE * ??_ SIZE (DIA. IN).... I INFLOV/DISH I — OFf=SET(lN). I RISER HEIGHT flN)....l '— TYPE I DEPTH (IN) I MIN. DIA. (IN) I TYPE :l • SHAPF I ^ V;ALL A. MATERIAL | A. B. LINING TYPE ! C. DIAAENGTH (IN) [J D. DIATVV'DTH (IN) 1 ^ IiENCHTYPE TROUGH TYPE -^?= SEAL TYPE r-=P3 A. TYPE X T B. CONDITION I •••ANHOLE DEPTH (FT) I /"^.^ EVIDENCE OF SURCHARGE (FT) I l-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FlLLED IN 7-TEE 8-JUNCTI0^ 1-STRECT 2-ALLEY J-SOWU< l-ORVZ/V 5-PKWY frYARp 7-STfi.MC(7CH e-CRKBEO 9-FOSS CFX CEO I { 11-CALTRANS RAW l-ASPHALT 2-CONCfiETE J-GRAVEL 4-EROOeO SOIL AT RAISED MH «.TR=£ 6-ERCCEOSCIL ASOTRES 7-0lflT/GRA«S 1-PICK 2-CpNCEALEO PICK 3-VfeNTED 4-STOaM . ^ 1-COOO 2-TIGHT S-LOO^E 4-ROCKING 5-BaTS MISSING 6-GASKET BAO^ONE 7-GOOo5-RING 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPlNG BAR S-ANGLE IRONS 4-£'fi-ALLEN EaT £-3/4: ALLEN EOLT 6-5P0INTB0LT 7-ALFA * BOLT 8- 6P0INTB0LT 9-BURIED 10-ASPHALT CAP li-CONCRETECAP 1-SHEET FLOW 2-LOV/POINT 1-24' 2-36' 3-48" 4-OTHERS 1-NO 2-YES 1i 6^A^ 1-NONE 2-PRECAST 3-EfllCK 4-BLOCK 5-POURED LIN LintrTvpe: 1- Cemenddous 2- Cast in Place 3- Ciired in lace ' Epoxy I I I ED0?cSnNO 1-NONE 2-PflEGST 3-BflK 4-ELK 5-PORD E-BRKiCON 7-CLAY 8-PVC LINE0:^YESDN l-rONCFNTRtC 9.FCCFNTPIC 3-C| AT TQO NO m I* l-NONE 2-Pn£CST 3-BRK 4-ELK 5-POflD 6-5RKiCON 7-CUY E-FVC LINEOfZYEsDNO 1-CEMENTITlOUS 2 CAST-IN-FLACE 3-CURED-IN-FLACE 4-EFOX'i' l-.NONE 2-FRECAST 3-5RICK 4-5LOCK E-.=CU=ED UNEDirZYEsDNO N7 / 1-NONE 2-PHECAST 2-POUREO 4-VCP 5FVC E-E.=:CK ^ \/^(Xv^f 1-NONE 2-WORTAR 3-GASKET '-^ ' l-NONE 2-5.AH 3-CAST I.RON ^ PLASTiC "l^ff ^ fi ^ 1-GOOO 2 C0RR0DED 3-.V:S,--UG:.ED i ~'Z<.~>. :-V:SS:NG e-UNSA=E J/C cI/ * I EFECTS FLOV/ OBS. BROKEN CORROSION ROOTS l/l -NU.'/5ER0F CODE (GPM) S D S 0 S D CODE HOLES CLACKS JO!NTS COVER FRAME FRAME SEAL -L GRADE ADJUSTMENT..L JL - CON= I li . W.ALL I ll . cHNCH 1 11 , TROUGH 1 11 O.V CODE SEVERITY CODE -LIGHT 1 - MILD - \'ODERATE 2 - MODERATE -HEAVY 3-SEVERE / J L y ± I ^ J I I I ! I I l-^l I I I \ I I DENSITY CODE CODE ) - STRUCTURAL 1 -<10% 2-10%-25% 3 - 25% - 50% 4 - >50% 1 - INFLOW 2 • INFILTRATION t( i, ACCESS JLl?....Z>t^l.l ( I l-ORIVE(PAVEO) 2-CfilVE(UNPAV=0) 3-CR1V5 i WALKOO" < OR.VE4 WAU>30 S-TO\UI.VT, ACCESSfSASYWA^K) 6-NO MA-NT. ACCESS (OlFrlCULT WALX) T-NO MA..VT. ACCESS;£AST WALK CCSTACT PROPERTY CW.NER) Cm ?-'ORTAR DETERIORATION. i"-'^.ECIPlTATION fl - NO .'.(A:.NT. ACCESS (DIFFICULT WALK CCVTACT PROPERIY Ovf\;?| .Ui_l 1-NO 2-YES _| INCHES IN PAST 3 DAYS I I I 1 I I I I I 1 1 I 1. 2. 3. 4. 5. 6. 7. 9. PIPES UPSTREAM MANHOLE # DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE :.. PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL (O (2) IS 4-\i \\\ ^ I I i PIPE LINER MATERIAL. J ENTER APPROPRIATE NUMBER OR "SVC" OR 'STUB' J J 1-UPSTREAM 2-DOWNSTREAM Jl-12CLOC*KPOSITION i Jl-ROUND 2-ELUPTlCAL 3-BOX 4-'D0UBLEB0X J 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-ClP 7-CM 8-TlLE 9-BRICK 10-TRUSS .11-CIPP 2-FOLDaFORM 3-SLIPLINEO 4-SPIRAL WOUND RIM TO CROWN (FT).. 10, FLOW DEPTH (IN) 1 7^ (? II '^^P 11. DEPOSITION: INCHES I <S t iL Jr^- TYPE.:.... ^IL.i^ 16. F.LOW VELOCITY (FPS) I ^'<' INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUOGE 2-MUD 3-ROCKS 4-DEBRlS ESTIMATED OR MEASURED (CIRCLE) PIPE* FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 ' • 1 ! 1 1 1 1 I 1 1 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. j 1-YES 2-NO J 1-YES 2-NO >^^//?^ \(\ft/ ^ J^se . COMMENTS; FIPE SKETCH N Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 WYO Service 6 Break-in Ccnn 6 Break-irvConn 7 Extended Tap 7 Extended Tao 6 Upper Riaht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 lOebHS ——— -X^ Cfowr; ____ 12 Grease 13 Invert 13 Corrosion 14 Camera Submerqed 14 Scalina 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below oround level) 23 Exposed Cut-off v/all (>2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE — INSPECTION ,TYpfe .'.! I ( I I-IMTERNAL 2-SURFACE 3-NOT INSPECTED 4-SURlEO 5-NOT FOUND STRUCTURE TYPE. l-STNO 2-CLN OUT 3-lN DROP 4-OUT DROP 5-ROCK TRAP 6-FlLLEO IN 7-TEE B-JUNCTIOM" LOCATION I /^O I l-STREET 2-ALLEy VSOWIX 4-ORV^/Y5-PKWY 6-YAfip 7-STfiM&TCH S-CRKBEO »-?OSSCPXBED 10-OPE.SSPACE It-CALTflANSfl/W J l-ASPHALT 2-CONCRETE 3-GRAVEL <-ERODE0SOlLA7 RAiSSD MH S-TREE 6-ERCCED SCIL ASO TflEE 7-OlRT/GP.ASS SURFACE TYPE | 2- COVER •TYPE FIT SEAL SECURING. I i-PlCK 2-CpNCEALEDPICK 3-VfeNTED 4-STOR.M . | J 1-GOOO 2T1GHT 3-LOO* 4-ROCKING S-BOLTS MISSING 6-GASKET BAOrtSONE 7-GOOO A-RING f I l-NONE 2-GASKET 3-SILICONE [ / 1 l-NONE 2-STRAPPING BAH 3-ANGLE IRONS 4-Sfi* ALLEN EaT 5-3/4: ALLEN EOLT 6-5POINTBOLT 7.ALr; • BOLT 8- 6 POINT BOLT 9-BURtED 10-ASPHALT CAP li-CONCRETECAP 1-SHEET FLOW 2-LOWPaNT INFLOW DtSH OFFSET (IN}.. 1 RISER HEIGHT flN)....l TYPE..... ! 2_ DEPTH (IN) I MIN. DIA (IN) I I ^ .1 ^/ I 1-NO 2-YES E. # OF HOLES I / I F. PONDING DEPTH flN)t — 1 G. PONDING TYPE 1 _—- I H. SIZE (DIA IN).-.. I • I 1-24" 2-36'3-48" 4-OTHERS I. FRAME A. B. GRADE ADJ. A. B. C. COHE/VOP A. B SHAPF It, Lintr Tvw: 1- Cemendtious 2- Cai[ in Plac; 3- Cu{cd in ICC • TYPE. I 1-NONE 2-PRECAST 3-ERICK 4-BLOCK E-POURED UNEfc^SVcSDNO 1-NONE 2-PREGST 3-8flK 4-ELK 5-PORD €-BRK&CON 7-CLAY E-PVC LlN=0:HrESnNO 1.r•f^N^•F^^•Rlr ^-FCCFNTPIC 3-CLAT TQQ WALL A. MATERIAL B. LINING TYPE. C. DIAAE.NGTH (;N) { D. DIAAVIDTH (IN) 1 ^ I 1-NONE 2-Pn£CST 3-BfiK 4-ELK 5-PORD E-ERKSCON 7-CLAY E-FVC LI.SEDQfEsDNO • Y 1-CEMENTlTIOUS 2-CAST-IN-FLACE 3-CU=ED-IN-FLAC^^F0)Ci' 2ENCH TYPE TROL'GHTYPE r'-.PE SEAL TYPE r~EPS A. TYPE B. CONDITION '.•ANHOLE DEPTH (FT) \//^ I EVIDENCE OF SURCHA.RGE (FT) 1-.S'0NE 2-FRECAST 3-E.=^!CK 4-ELOCK E-.=CURED UNED:[3VE5D .SO 1-NONE 2-PRECAST 3-POURED 4-VCP 5-FVC e-=.=;CK J 1-NONE 2-MORTAR 3-GASKci .1 / I l-NONE 2-E.AR 3-CAST inO.N i-FLASTC J 1-GOOO 2 C0RR0DED 3-.'.::SAJGNHD i-z~Z<~\ :-V:S=:.\G 6-lV.SAFE •EFECTS FLOV/ OBS. CODE (GPM) BROKEN COR.^OSION ROOTS I/I -- -NU\'=EROF S O SO S D CODE HOLES CRACKS JOINT COVER l_ FRA.ME 1_ FRAME SEAL GRADE ADJUSTMENT.L COME L V/ALL L EENCH L Jl TROUGH I II v.V CODE SEVERITY CODE J L 2. J L^llJLi L J L l_2JL^ 1 l_^l_ill L DENSITY CODE l/l CODE - LIGHT - \'.ODERATE . - l-iEAVY ) - STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 • INFLOW 2 - INFILTRATION ACCESS I ^S_l 1-ORIVE(PAV£0) 2 CfilVElUNPAV=D) O-CRIVE 4 WAUtJO' 4 OR.VE 4 V/ALK>;0- S-WO ^U1.VT. ACCESSiEASV iV AlK) 6-NO KU-MT. ACCESS (DIFFICULT WALK) 7-.\0 >.U.yT. ACCESSitASY WAL^ CC.VTACT PROPERTY CW.SE.^) 8 - KO KWINT. ACCESS (DIFFICULT WALK CCNTA:r PR0FE3TT Ov/\:?] .'.•ORTAR DETERIORATION LTll 1 • NO 2-YES i\--HCIPlTATlON I'NCHES IN PAST:-DAYS • : I i: A = v 1. 2. 3. 4. 5, 6. 7. PIPE# UPSTREAM MANHOLE # U DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE PipE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... | PIPE MATERIAL (1) 2^ (2) 3r 3S 4-I 1 ^!/_l^_li^ / 1! X- Ji I 8. . PIPE LINER MATERIAL 9. ' RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES TYPE.i... 16. FLOW VELOCITY (FPS) J ENTER APPROPRIATE NUMBER OR "SVC- OR 'STUB' J J 1-UPSTREAM 2-DOWNSTREAM J1-12CL0CKP0S1TI0N \ J 1-ROUND 2-ELLIPTICAL 3-BOX 4-DOUBLEBOX J 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRlCK 10-TRUSS 1-CIPP 2-FOLD&F0RM 3-SUPLINEO 4-SPIRAL WOUND 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. X I 1-YES 2-NO J 1 1-YES 2-NO COMMENTS: FIPE SKETCH J INCLUDES DEPOSITION AT PIPE MOUTH I-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS J ESTIMATED OR MEASURED (CIRCLE) PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS -1 1 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 i • • 1 • 1 1 1 , 1 I 1 1 1 1 1 1 Defects Location 0 NV\ 1 US Manhole 1 1 Crack-Radial 2 DS Manhole 1 2 Grack-Hofizonlal 3 Camera Blocked 1 3 Broken Pioe 4 Joint 4 Colapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tas 6 Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left -XX Debris Crown-— 12 Grease 13 Invert 13 Coaosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Saq 16 Pipe Exterior 16 Infiltralion 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at around level) 22 Exposed Encasement (erosion below around level) 23 Exposed Cut-off wall i >2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) B^J^/^r^^ [AJS ADDRESS: OBSERVATION CODE NO. CODE -INSPECTlON.TYpfe l! I / | 1-IMTERNAL 2-SURFACE 3-NOT INSPECTED ^-SUfllED 5-NOT FOUND STRUCTURE TYPE LOCATION 1 fCf SURFACE TYPE | 2- COVER A! -TYflE ;l /, B. RT I L C. SEAL I /_ D. SECURING I / E. # OF HOLES I L F. PONDING DEPTH (IN)|_j:i:^ G. PONDING TYPE : _ • FRAME a SIZE (DIA. IN) I J^/- I. INFLOV/DISH I —-• - A. OFFSET (IN) I ^—• B. RISER HEIGHT (IN)....t GRADE ADJ. A. TYPE B. DEPTH (IN)... C. MIN. DIA (IN) CONE/TOP A. TYPE R SHAPF V.ALL A. MATERIAL B. LINING TYPE C. DIAAE.NGTH (IN) ]_.._ D. DIAAV:0TH{1N) I SE.NCHTYPE 1 ^ TROL'GHTYPE... :^?E SEAL TYPE. r-EP3 A. TYPE 1 L B. CONDITION 1 1 '.•A.\;HOLE DEPTH (FT) i <^ EVIDENCE OF SURCHARGE (FT) I l-STND 2-CLN OUT 3-IN DROP 4-OUT DROP S-RCCK TRAP 6-FlLLEO IN 7-TEE B-JUNCTION 1-STREET 2-ALLEY 3-SOWlK <-ORW/Y 5-PKWY 6-YAfip 7-STRMClTCH e-CRKBEO S-FOSS C?j< 660 10-OPE.S SPACE 11 .CALTRANS ftW 1-ASPHALT 2-CCNCfiETE J-GRAVEL 4-EROOEO SOIL AT RAISED MH J-TREE 6-ERCCEO SOIL ASO TflEE 7-DlflT/GPJi£S 1-PlCK 2-CpNCEALEOPlCK 3-VfeNTEO 4-STOR.M . j , 1-GOOO 2-TlGKT S-LOO* 4-ROCKING 5-BOLTS MISSING E-GASKET EAOflSONE 7-C-OOoiRING 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-5'S'ALLEN COLT 5-3/4: ALLEN EOLT 6-SPOINTBOLT 7.ALr;; ' BOLT 8- 6PO1NT80LT 9-BURIED 10-ASPHALTCAP Il-CONCRETECAP 1-SHEET FLOW 2-LOW POINT 1-24' 2-36" 3-48" 4-OTHERS 1-NO 2-YES Liner Typt: 1- Ccmeno'dous 2- Cut in Place 3- Curcd in 1-NONE 2-PRECAST 3-ERlCK 4-BLOCK 5-POUREO LINEO:0?CSDNO 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD E-BRKiCON 7-CLAY 8-PVC LINEDIBYESQNO l-rONCFNTRir. 2-FrCFNTPlC S-^UT TQP \ i. i 1-NONE 2-Pn£CST 3-6fiK 4-ELK 5-POaO E-5RK4CON 7-CLAY E-FVC U.\=D0VESDNO 1-CEMENTlTlOUS 2-CAST-IN-FLACE 3-CU.=.ED-IN-FLACE(4;gFOX-i' 1-NONE 2-FRECAST 3-5RiCK 4-510CK 5-FC'JRED U.\ED:DYE5D.'';0 1-NONE 2-.'=RECAST 3-POURED 4-VCP 5-FVC e-==;CK l-NO.NE 2-.V0RTAR 3-GASKET 1-NONE 2-E.Aa 3-CAST IRO.^ 4-FLAST:C 1-GOOO 2-CORROD5D 3-\;:SA:IG:;£D 4.r=C<EN :-V:S = :NG e-U:.SA=£ [ h/iin^^ :-ErECTS FLOV/ CODE OBS. TGPM) BROKEN CORROSION ROOTS l/l -- -NU\r=£ROF S 0 S 0 S D C00£ HOLES CRACKS JOINTS COVER 1 !L FRAME I II. FRAME SEAL | !|_ GRADE ADJUSTMENT..L JL COME I IL V.'.ALL, •L Jl EENCH... TROUGH O.V CODE -L J L IS i : m SEVERITY CODE DENSITY CODE I I L_ l/l CODE - LIGHT - MODERATE -1-iHAVY - STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<ior. 2- 10%-25% 3 - 25% • 50% 4 ->50% 1 - INFLOV/ 2 • IN.RLTRATION PP ACCESS. I_j3 I l-DRIVc(PAV£D) 2.CRIVE(UNPAV=0) 3 CRiVS i V.'ALK<;0- 4 Ofi,V£ i WALKJW S-NO MAl.VT, ACCESSiEASY WALKJ 6-KO WA:NT. ACCESS tDlfrlCULT WALK] 7.N0 .«.W.V:, ACCtSSlEASY WALK CCsTACT F.qOPERTY CW.S£.^) ft e - NO .VA.:.ST. ACCESS (DIFFICULT WALK ccNTAcr psoFEaTY ows:=i ^.'ORTAR DETERIORATION l_o(_l 1-NO 2-YES r-EClPlTATlON INCHES IN PAST 3 DAYS Ir9 G PIPE# 1. UPSTREAM MANHOLE # d 2. DOWNSTREAM MANHOLE ff... d 3. INSPECTED MANHOLE 4. PipE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN).. 7. PIPE MATERIAL im 8. PIPE LINER MATERIAL (1> Jl3- .11 1^ 3t/ ,, 3H .1 ENTER APPROPRIATE NUMBER OR 'SVC* OR "STUB- 2i X 24 II L j II pv6. II—-I- 9. 10. 11. 16. RIM TO CROWN (FT) FLOW DEPTH (IN) |. DEPOSITION: INCHES 1 TYPE.i I Jl-JZi? IS J 1-UPSTREAM 2-DOWNSTREAM ji-i2CLockPosmoN i J 1-ROUND 2-ELLlPTlCAL 3-BOX 4-DOUBLE BOX J 5-TRlPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-ClP 7-CM 8-TILE 9-BRICK 10-TRUSS .11-CIPP 2-FOLOaFORM 3-SLIPUNED 4-SPIRAL WOUND FLOW VELOCITY (FPS) 1 -ff,^ II '"^'O—H f?' ^ J . J INCLUDES DEPOSITION A^ PIPE MOUTH $^IL —-J- 9 I! — PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS [ 1 1 I-SLUDGE 2-MUD 3-ROCKS 4-OEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPEff FOOTGE LOC. DEF RATNG INFLT(gpm) COMMEf^TS 1 • 1 1 1 1 • 1 1 1 1 1 1 1 1 1 1 1 1 I I I 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE, J 1-YES 2-NO J 1-YES 2-NO COMMENTS: PIPE SKETCH Defects Location 0 NW 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Grack-Henzontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Eidended Tap 7 Extended Tao 8 Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 Oety-is —— i -4Z Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Seating 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 InriHration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below around level) 23 Exposed Cut-off v;all (>2 feet of wall exposed) GEN.LOCATION: (INDICATES IF STREET R/W OR CANYON) So^/ef./^^'^-^ /^a ^Cry^ >^DDBESS: /^^k>Jay^r?o l^' /P. ^> r OBSERVATION CODE NO. CODE - INSPECTION ,TYPfe. STRUCTURETYPE. 1-lNTERNAL 2-SURFACE 3-+J0T INSPECTED 4-eURlEO 5-NOT FOUND 1-STND 2-CLN OUT 3-IN DROP 4-OUT DROP S-ROCK TRAP 6-FlLLEO IN 7-TEE fl-JUNCTO LOCATION t /O 1 1-STR6ET 2-ALLEY 3-SGWLK 4-OflW/Y5-PKWY «-YARp T-STRMClTCH B-CRKBEO 9-?0SSC?i(GEO 10OFE.SSPACE II-CALTRAWSRAV J l-ASPHALT 2-CONCfiETE J-GRAVEL 4.ER0DED SOIL AT RAISED MH J-TREE 6-ERCCEO SOIL ASO TREE 7-OiRT/GPJSS SURFACE TYPE. 1. I COVER l-PICK 2-CpNCEALED PICK 3-VfeNTED 4-STOaM j A. 'TYPE.........x::...'. ;l /, [ I F - ' I B. FIT 1 f \ vGOOO 2-TIGKT 3-LOO* 4-ROCKING 5-BOLTS MISSING e-GASKET BAD/GONE 7-GOOOO-RING C. SEAL I / I 1-NONE 2-GASKET 3-SILICONE D. SECURING I / I l-NONE 2-STflAPPtNG BAH 3-ANGLE IRONS 4-S-S" ALLEN EOLT 5;3M:_AUEN EOLT 6-5POINTBOLT 7-ALr; E. # OF HOLES I L F. PONDING DEPTH (IN)|_::r: G. PONDING TYPE : _•— * BOLT 8- 6POINTB0LT 9-BUflIED 10-ASPHALT CAP Il-CONCRETECAP 2 \ 1-SHEET FLOW 2-LOV/POI^^T "H, SIZE (DIA IN) I i?Y I 1-24- 2-36" 3-48" 4-OTHERS . I. INFLOV/DISH I ' I 1-NO 2-YES FRAME A. OFFSET (IN). I I iJ B. RISER HEIGHT nNL...I ^ '^eJ f^/h G PADE ADJ. A. TYPE I A LintrTvpe: 1- Ccmenddaus 2- Cast in PUc: 3- Cured in EJace l-NONE 2-PflECAST 3-ERlCK 4-BLOCK 5-POURED UNEOIO'ESDNO B. DEPTH (IN), \^/0 \ C. MIN. DIA (IN) I o?4^ I CONEn-OP A. TYPE -V—^ I 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD E-5RK4CON 7-CLAY E-PVC LINEOGYESDNO ' B SHAPF I I l-QOMrFfyn-RIC P-FCCFNTPiC 3-R AT TO^ , \ 1-NONE 2-Pn£CST 3-BRK 4-ELK 5-PORD e-ERKiCON 7-CLAY E-FVC LIXEolZlYESnNO 1-CEME.NTlTIOUS 2-CAST-i:;-FLACE 3-CUF.ED-IN-FLACE 4-EFOX't' V;ALL A. MATERIAL B. LINING TYPE \ C. DIAAENGTH (IN) L M3 D. DIAAV:DTH (IN) I y>r SENCH TYPE I f TROUGH TYPE.. ^;?E SEAL TYPE r"£PS A. TYPE I / B. CONDITION I '.•A.\HOLE DEPTH (R) I EVIDENCE OF SURCHA.RGE (FT) 1 l-NONE 2-FRECAST 3-5.S:CK 4-ELOCK S-.=CUR=0 U-NEDi-Q^ESD.SO 1-NONE 2-Pn£CAST 3-POU.RED 4-VCP 5-FVC e-=F:CK l-NONE 2-^.^0RTAR 3-GASKET 1-NONE 2-5AR 3-CAST IRON 4-FLAST;C 1-GOOO 2-CORRODED 3-.v:SALlG.'.-ED 4-=-C-;=N :-V;S=:.\G 6-Ur;SA.=£ I CEFECTS FLOV/ OBS. CODE (GPM) BROKEN S D CORROSION S D ROOTS S D CODH — -NU.V5ER OF HOLES C=ACKS JOiNTS COVER FRAME FPAME SEAL •L GRADE ADJUSTMENT.L CONE L V.ALL L EENCH L Jl TROUGH L __!l O.V CODE SEVERITY CODE J L J L J L J L J L I \ L J I I L J L .1 L DENSITY CODE • ii I/l CODE - LIGHT - S'ODERATE . - HEAVY I - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% • 50% 4 - >50% 1 • INFLOW 2 - INFILTRATION ;cEss. .'.'ORTAR DETERIORATION. rA£CIPlTATION .|_-<_l l-DRIVctPAVED) 2-CfllV£lUNPAVcD) 3-CRiVE 1 V-'ALKOO' « OB.VS i V/ALK>30- S-NO .MAl.VT. ACCESSiEASY WAiK) 6-NO kUNT. ACCESS (OlFrlCULT WALK) 7-NO .'.U.NT. ACCESS;£ASY WAL< CC-STACT FflOPERTY O.V\£Sl 8 - NO SIAINT, ACCESS (DIFFICULT WALK CCffTACr PRCFERIY 0V(S;5j 1-NO 2-YES INCHES IN PAST 3 DAYS PIPES (1) , (2) V-i) 1. UPSTREAM MANHOLE tt L 33 .i II 2. DOWNSTREAM MANHOLE tt.... I ^ ll 3 11 3. INSPECTED MANHOLE :.. | / " 2 II 4. PipE DIRECTION I ' /7 III / 11 5. SHAPE OF PIPE 1 I II L !L L 6. PIPE DlAMETERA^ElGHT (IN)... I 11 3H It_ 7. PIPE MATERIAL I ' 11 L 11 8. ^ PIPE LINER MATERIAL ! ' ^ " L' . ' il-^ 9. ^ RIM TO CROWN (FT). •. t—g*? H^jJ^ " ' 10. FLOW DEPTH (IN) .^1 Z IL Z-Ji 11. DEPOSITION: INCHES ^AP^_^ _tL ,A^QJL TYPE.; J V_ ;iL JL 1! 16. FLOW VELOCITY (FPS) I . ^ ll J'tP \\ J ENTER APPROPRIATE NUMBER OR 'SVC* OR 'STUB* J 1-UPSTREAM 2-DOWNSTREAM J 1-12CLOCkPOSlTlON j J 1-ROUND 2-ELUPtlCAL 3-BOX 4-0OUBLE8OX J 5-TRIPLEBOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP tCIP 7-CM 8-TILE 9-BRICK 10-TRUSS .11-CIPP 2-F0LD&F0RM 3-SUPUNEO 4-SPIRAL WOUND INCLUDES DEPOSITION AT PIPE MOUTH I-SLUOGE 2-MUD 3-ROCKS 4-OEBRlS ESTIMATED OR MEASURED (CIRCLE) I PiPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 17, POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO 1 1-YES 2-NO COMMENTS: FIPE SKETCH I N PIPE'S FOOTGE LOC. DEF RATNG tNFLT(gpm) COMMENTS * • • 1 • 1 1 1 1 1 1 1 1. 1 1 1 5e ^ Defects Location 0 NM 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Hofizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44-Oebfis- 1 -12 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerped 14 Scalina 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 16 Other 31 Pipe Seal 20^ Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement {erosion below qround level) 23 Exposed Cut-off wall ( >2 feel of wall exposed) t/? • GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) /^^'g^ ^ , y^^X ^^^g^g5!?7>^ " ADDRESS: ^ ' ^ ^ >o ^ T O OBSERVATION CODE NO. CODE - INSPECTION .TYpt.. li' |_/ I 1-lf^ERNAL 2-SURFACE 3-NOT INSPECTED 4-eURlED &-NOT FOUND STRUCTURE TYPE. -L-Z—J l-STNO 2-CLN OUT 3-lN DROP 4-OUT DROP 5-HOCK TRAP 6-FILLEO IN 7-TEE 8-JUNCTlON LOCATION I I I-STR6ET 2-ALLEY 3-SCWUC 4-ORW/Y 5-PKWY 6-YAAp 7-STRMCITCH 8-CRXBEO 9-?0SSC?jC EEC 1(M3FE?^ tl-CALTRANS RW SURFACE TYPE | I I-ASPHALT 2-CCNCRETE S-GRAVEL 4.EROD£0SOIL AT RAISED MH I-TREE 6-ERCCEO sen. ASO TREE TOIRT^PJISS COVER A. 'TYPE ...._.i:....v ;| B. FIT L L_i. C. SEAL I /_ D. SECURING 1 L E. # OF HOLES L / 1-PICK 2-CpNCEALED PICK 3-VfeNTED 4-STOflW . j .... 1-COOO 2-TIGKT 3-LOOdE 4-flOCKlNG 5-BOLTS MISSING E-CASKET EAD^ONE 7-GOOOO-RING ' J 1-NONE 2-GASKET 3-SILICONE J 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-SB'ALLEN EaT 5-^4: ALLEN EOLT 6-5POINTBOLT 7-ALF^ * BOLT 8- 6P0INTB0LT 9-BURieO 10-ASPHALTCAP li-CONCRETECAP n FRAME F. PONDING DEPTH (IN)|.. G. PONDING TYPE 1 a SIZE (DIA. IN).. I. INFLOW DISH... A. OFFSET (IN). I I . B. RISER HEIGHT flNl....! 7 I ^a,i^C^ ; :— I i-SHEET FLOW 2-LOV/PaNT I P(/ • I 1-24- 2-36' 3-48" 4-OTHERS I •—r I 1-NO 2-YES LintrTvpe: 1- Ccmenddous 2- Cul in Pbc: 3- Cured in ^^poxy I GPADE ADJ.A.TYPE \ ^ 1 1-NONE 2-PHECAST 3-ERlCK 4-BLOCK 5-POURED UNED:[>CSDNO B. DEPTH (IN) I I C. MIN. DIA (IN) I I CONE/TOP A. TYPE :\ ' Jl I 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORO £-5RKiC0N 7-CLAY fi-PVC LINEOIDYESDNO B SHAPF ' .1^1 i.r.nNr.Fi^Rir. P-ECCFNTPIC S-^^LATTQ^ A MATERIAL L_S^ 1-NONE 2-Pn£CST 3-BRK 4.ELK 5-PORD E-ERKACON T^OAY E-FVC LINEOQYESD.V B. LINING TYPE ' y , l-CEMENTITiOUS 2-CAST-IN-FL£.CE 3-CU=.ED-IN-FLAC^j4.=0V^ im m VrALL C. DIAAENGTH (:N) 1___2^ D. DIAJW'DTH (IN) I V '< 5ENCHTYPE I g TROUGH TYPE I 3 --:=E SEAL TYPE I •---PS A. TYPE 1 l_ B. CONDITION.; 1 •.•A.V;HOLE DEPTH (FT) I ^?*^ EVIDENCE OF SURCHA.qGE (FT) | J l-NONE 2-FRECAST 3-ERlCK 4-HLOCK E-PCUR50 UNHDiQrESD.^O J 1-NONE 2-PRECAST 3-POUREO 4-VCP 5-FVC £-==:CK J 1-NONE 2-^^0HTA,R 3-GASKET J 1-NONE 2-5.AR 3-CAST InO.N i-.^LASTlC .1 1-GOOO 2-CORRODED 2-.V:SALlG-.'£D 4-==:KE.\ :-V.££:.*.-G E-LV.SAFE J CEFECTS FLOW 06S. CODE "(GPW) BROKEN S D COH.ROSiON FOOTS l/l -NU.'/5ER0F SO S D C0G£ HOLES C.=ACKS JOiNTS COVER L_ FRAME L FPAME SEAL L JL GRADE ADJUSTMENT..L CONE L V.ALL L . EENCH L Jl TROUGH 1 1|_ O .V CODE SEVERITY CODE 1 II I I 3 11 I I^LS i 311 ^1 J I I DENSITY CODE CODE [ -LIGHT - .VODEFLATE .- HEAVY )-STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 • INFLOW 2- INFILTRATION 4e ^6 P ACCESS I X- I l-ORIVc(PAVEO) 2-CRIVE{UNPAVED) 3-OaiVE i VVALK*W * Ofi.VE4WALK>:0 S-NO .«AI.VT.ACC£SSiEAST-.VALK| 6-NO MA:.NT. ACCESS (DIFFICULT WAI.S) 7 NO .".(A-VT. ACCESSitASY WALK CCSTACT P.10PERIY Cw\£ai a - KO f.(A:.NT. ACCESS (DIFFICULT WA:,K CCffTACf P.'iOFERIY 0V/.S-=1 ^.•ORTAR DETERIORATION |_^_| 1-NO 2-YES r.-7ECIPlTATION 1_ Ll h^CHES IN PAST 3 DAYS 1. 2. 3. 4. 5. 6. 7. PIPE tt UPSTREAM MANHOLE # DOWNSTREAM MANHOLE #.... INSPECTED MANHOLE PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL V) 1 .. 11 11 I 3/ II ?2 11 11 1 / II a II 11 I' ll 1 ^ ll 11 1 fii " / 11- 1 II j 1 11 1 / ll / .1 II 8. PIPE UNER MATERIAL. I I 9. ' RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE.;.... 16. FLOW VELOCITY (FPS), f IIJ.^ h II 4' -IL _ J ENTER APPROPRIATE NUMBER OR "SVC" OR 'STUB' 1-UPSTREAM 2-DOWNSTREAM 1-12 CLOCK POSITION j J 1-ROUNO 2-ELUPTICAL 3-BOX 4-DOUBLEBOX I 5-TRlPLE BOX e-HORSESHC .11-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRlCK 10-TRUSS .1 l.CIPP2-FDLDaF0RM 3-SLIPLINEO 4-SPIRAL WOUND J INCLUDES DEPOSITION AT PIPE MOUTH _j I-SLUOGE 2-MUO 3-ROCKS 4-DEBRlS _J ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. 1 1-YES 2-NO J 1-YES 2-NO PIPEfl! FOOTGE LOC. 1 DEF RATNG INFLT(gpm) - COMMENTS * 1 1 • . 1 1 1 ' 1 1 1 I 1 1 ! /^^/^ //)fif CfOos^ /'> Defects Location 0 N\A 1 US Manhole 1 Crack-rRadial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Rioht e Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44 Debris .42 Crown 12 Grease 13 Invert 13 Conosion 14 Camera Submerged 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infillration 17 New Manhole 18 aher 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below qround level) 23 Exposed Cut-olf wall (>2 feet ol wall exposed) GEN.LOCATION: (INDICATES IF STREET RAV OR CANYON) Sa¥i^ui^A^^ ^^ry-ZTH ADDRESS: OBSERVATION CODE NO. CODE •" INSPECTION .TYpfe J.! [_ / ! 1-iraERNAL 2-SURFACE 3-NOT INSPECTED *-eURIED 5-NOT FOUND STRUCTURE TYPE. .1 f \ 1-STND 2-CLN 0UT3-1N DROP 4-OUT DROP 5-RCCK TRAP 6-FlLLED IN 7TEE fl-JUNCTION^ J 1-STREET 2-ALLEy 3-SOWLK 4-OfiV//Y5-PKVnr 6-YASp 7-STfiMClTCH B-CfiXBEO ^rOSSCRX EEO lOOFENSPACE M-CALTRANS RAV LOCATION I \0 I I l-ASPHALT 2-CCNCRETE 3-GRAVEL ^-ERODEOSOlLATflAlSEO WH ».TR££ 6-ERCCEO SOIL A.SO TREE 7-DlflT/GRA£S SURFACE TYPE. COVER A!'TYPE 7 B. FIT I /_ C. SEAL I / D. SECURING I / i;; E. # OF HOLES L F. PONDING DEPTH (1N)L G. PONDING TYPE L / I •PICK 2-CpNCEALED PICK 3-VfeNTEO 4-STOR.M . j , ^ GOOD 2-TIGKT 3-LOO* 4-ROCKING 5-BOLTS MISSING 6-GASKET BAD^ONE 7-GOOO 5-RING ' 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-S-S" ALLEN EaT 5-3^4: ALLEN EOLT 6-5POINTBOLT 7-ALFA * BOLT 8-6P0INTB0LT 9-BURlED 10-ASPHALTCAP li-CONCRETECAP I 1-SHEET FLOW 2-LOV/POINT H. SIZE (DIA IN) I • I 1-24- 2-36- 3-48- 4-OTHERS I. INFLOW DISH I . I 1-NO 2-YES A. OFFSET (IN). I • I , / FRAME B. RISER HEIGHT (IN) GRADE ADJ. A. TYPE Liner Tvpt: 1- Ccmenddous 2- Cast in Pbc: 3- Cured in Place : B. DEPTH (IN) I ^ I C. MIN. DIA (IN) I <3*^ I CONE/TOP A. TYPE :t_p2_l 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD E-5RK4CON 7-CLAY E-PVC LlN=0:[]JrESDNO B. SHAPF ' \ A ' 1•CON^•F^^^RIC P-ECCFNTPIC 3-R AT T0° . 1-NONE 2-PnECST 3-6RK 4-ELK 5-PORO E-ERK&CON mAY E-FVC LLSzOCSfESDNO 1-C£ME,NTITI0US 2-CAST-IN-PLACE 3-CUF.ED-IN-FLACEuiFOX'C J l-NONE 2-PRECAST 3-ERlCK 4-BLOCK E-POUREO UNE0:[37c5nN0 V;ALL A. MATERIAL I P B. LINING TYPE ! ^ C. DIAAENGTH (IN) L ' D. DIAAV'DTH (IN).. 2E.NCHTYPE TROUGH TYPE M.=E SEAL TYPE T'EPS A. TYPE B. CONDITION '.•A.NHOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT). W- 22 1-NONE 2-FRECAST 3-5.n!CK 4-SLOCK E-PCURED L!.NED:(3YESD.SO 1-NONE 2-PRECAST 3-POURHO 4-VCP £ FVC E-=.=;CK 1-NONE 2-MOaTAR 3-GASKET 1-NONE 2-5AR 3-CAST IRON 4.FLi.ST;C 1-GOOO 2-CORROOED 3-V;SAUG:;EO i z-.z<z\ :-V:S=::;G E-U'.SAFE I CEFECTS FLOV/ OBS. CODE (GPM) BROKEN S D CORROSION S D ROOTS S D CODE — -NUMBER OF HOLES CRACKS JOIfiTS COVER L_ FRA.ME L F.RAME SEAL L. GRADE ADJUSTMcNT..L Jl CONE I ll WALL L Jl EENCH L JL TROUGH L Jl 0;V CODE SEVERITY CODE J l_/!l_^i — J L-/.lli^ L J L i..3 11 f^l I ^11 ^1 J L J L DENSITY CODE l/l CODE - LIGHT - V.ODEFIATE . - HEAVY > - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10'!'. 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 - INFLOW 2-INRLTRATION SI r 7 •- ACCESS 1 I 1-0RIV£(PAVED] 2-CfllVElUNPAVED) 3-CaiVE 4 V.'ALKOO < OR.VE 4 V/AU>:0 S-NO \UI.Vr, ACCESSJEAST WALU) 6-NO ktAJNT. ACCESS (Dl.'^?lCULT WALK) 7-NO MA..NT. ACCtSSitASr WALK CC-N~ACT FROPERTY C\VN=;i) r.'ORTAR DETERIORATION ]_ /_ rr.EClPlTATION !_ _| INCHES IN PAST 3 DAYS (Di.'^?lCULT 1 e - NO J.(A:NT, ACCESS (OIFFICULT WAIK CONTACT PKCFERIY OWN:=;I 1-NO 2-YES c I I 1. UPSTREAM MANHOLE *f 2. DOWNSTREAM MANHOLE ft.... 3. INSPECTED MANHOLE 4. PlpE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN)... 7. PIPE MATERIAL I AL 3^ JL AL 1 8. PIPE LINER MATERIAL.. 9. * RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE.:.... J ENTER APPROPRIATE NUMBER OR 'SVC OR -STUB' J J 1-UPSTREAM 2-OOWNSTREAM Jl-12CL0CkP0SITI0N \ Jl-ROUND 2-ELLIPTlCAL 3-BOX 4-OOUBLE BOX J 5-TRlPLE BOX 6-HORSESHC _11-VCP 2-PVC 3-cdNCRETE 4-RCP 5-DtP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS J 1-CIPP 2-FOLDaFORM 3-SUPUNEO 4-SPIRAL WOUND 16. FLOW VELOCITY (FPS) I / V JL 17. POSSIBLE PIPE EXPOSURE. 2_ I 1-YES 2-NO 18. PIPE CHECKED FOR EXPOSURE I f I 1-YES 2-NO COMMENTS: FIPE SKETCH J J INCLUDES DEPOSITION A^" PIPE MOUTH 1-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS _1 ESTIMATED OR MEASURED (CIRCLE) P1PE# FOOTGE LOC. DEF RATNG lNFLT(gpm) COMMENTS . 1 1 PIPE'S FOOTGE LOC. DEF RATNG iNFLT(gpm) COMMENTS 1 • • • 1 1 1 1 1 Defects Location 0 NVk 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Hcfizonlal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Riaht 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44 Debris-.4? Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerqed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Otfier 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cut-off wall (>2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) (f%^A^J^»^ ADDRESS: OBSERVATION CODE NO. CODE INSPECTION ,TYPk | ^ | 1-INTERNAL 2-SURFACE 3-NOT INSPECTED 4-eURlED 5-NOTFOUND I >P STRUCTURE TYPE. ;1 f \ l-STNO 2-CLN OUT 3-lN DROP 4-OUT DROP S-RCCKTRAP 6-FlLLEO IN 7TEE 8-JUNCTION 4 LOCATION 1 iO \ 1-STflEET 2-ALLEY 3-SCWLK 4-ORW/Y 5-PKWY frYAflp 7-STfiMClTCH B-CRXeED S-rOSS CPj< BED lO-OFE-V S?AC£ 1I-CALTFWJSRAV m SURFACE TYPE 1 "7 | VASPHALT 2-CONCfiErE 3-GRAVEL 4-ERODEDSOILATRAISEOWH J-TREE S-ERCCED SOIL A.SO TREE 7-OlRT/GRASS E COVER A. 'TYPE .........J.:....'. :l ' /, B. FIT 1 /_ C. SEAL I f l-PICK Z-CpNCEALEO PICK S-VINTEO 4-STORM . j 1-GOOO 2TIGKT 3-LOO* 4-ROCKING 5-BOLTS MISSING 6-GASKET EAD«JONE 7-GOOO i-RING 1-NONE 2-GASKET 3-SlLICONE D SECURING I / I l-NONE 2-STHAPPING BAR 3-ANGLE IRONS 4-S'8-ALLEN EOLT 5-3/4: ALLENBOLT 6-5POINT BOLT 7-ALF^ ' * BOLT 8- 6 POINT BOLT 9-BURIED 10-ASPHALTCAP Il-CONCRETECAP E. # OF HOLES..... I / I •2 FRAME F. PONDING DEPTH (IN)|. G. PONDING TYPE 1 H. SIZE (DIA. IN) I. INFLOW DISH. A. OFFSET (IN).. 1 I ^ , // I....I If \/Ui'sc^ f^f^ ; ^— I 1-SHEET FLOW 2-LO//P01l^ I I 1-24- 2-36' 3-48' 4-OTHERS I ^ I 1-NO 2-YES Lintr Tvpe: 1- Cemenddous 2- Cast in Plac: 3- CurEd in £!ace B. RISER HEIGHT (IN). GRADE ADJ. A. TYPE..... I I 1-NONE 2-PRECAST 3-ERlCK 4-BLOCK 5-FOURED L1NEO:07ESDNO B. DEPTH (IN) .....I ( ^ m C. MIN. DIA (IN) I . CONEH-OP A. TYPE :| ' I R SHAPF \ 0 I l-CONrFrfTRIC 2-Fr.rPNTPlC 3-RATTOP 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD E-BRKiCON 7-CLAY e-PVC LINHOQYESDNO V,ALL A. MATERIAL I ^ B. LINING TYPE C. DIAAENGTH (IN) L I 1-NONE 2-PnECST 3-BRK 4-ELK 5-PORD e-~RK5C0N 7-CLAY E-FVC LLSEDnYESnko" 1-CEMENTlTlOUS 2-CAST-IN-FLACE 3-CU==D-IN-FLACE/?-3F0r^ D. DIAJVV'OTH (IN) I ::ENCH TYPE TROUGH TYPE '^:?E SEAL TYPE f-EP3 A. TYPE 1 L_ B. CONDITION.; I •.•A.NHOLE DEPTH (FT) I EVIDENCE OF SURCHA.SGE (FT) 1 J 1-.\0NE 2-FRECAST 3-5nlCK 4-BLOCK 5-.=CUR£D U-NEOiQ YESQ NO ^ I 1-NO.NE 2-PSECAST 3-POURED 4-VCP 5-FVC 6-E-=;CK A ^, I ^ 1 1-NONE 2-MORTAR 3-GASKci J l-NONE 2-B.AR 3-CAST InO.N 4-PLAST J 1-GOOD 2-CORF.OOED 3-.V.:S,-.LIG:.ED •;'=.=.:<EN :-V;S5:.*.-G 6-U,'.SA.=£ •EFECTS FLOV/ OBS. CODE TGPM) BROKEN S D CORROSION S D ROOTS l/l — -NU?/=ER OF S D CODE HOLES CRACKS JOINTS COVER 1_ FRA.ME L_ F.RAME SEAL I GRADE ADJUSTMENT.L . CONE i 11 V.'ALL 1 ll . e^NCH 1 ll . TROUGH 1 |l O.V CODE SEVERITY CODE - LIGHT 1 - MILD • - MODERATE 2 - MODERATE .-HEAVY 3-SEVERE f- STRUCTURAL w DENSITY CODf l/l CODE 1 -<10% 2-10%-25% 3 - 25% • 50% 4 ->50% 1 - INFLOW 2 - INFILTRATION (tntn^g. Mi A>7gr /?usr^J Chnrr\Z ;CESS. I , \ l-DHlVEtPAVEO) 2-CfilVE(UNPAV=0) 3-CaiVE 4 V.'ALK<:0 4 OBiV= 4 WALIC>;0 S-NO MAI.VT ACCESSiEASY WALK) 6-NO fcU-NT. ACCESS (Ol.^f 1CULT WALK) 7-NO MA..NT. ACCESSitAST WALK CCsTACT FROPERIY CVI\l^) \'ORTAR DETERIORATION 1-NO 2-YES »\-. = CiPlTAT10N I_ ^ INCHES IN PAST 3 DAYS 0 . NO M.A:.ST. ACCESS (DIFFICULT WALK COmACt P.t^OFERTY OVi.S:=; E MM 1 I I I I I I I 1. UPSTREAM MANHOLE # 2. DOWNSTREAM MANHOLE tt.... 3. INSPECTED MANHOLE :.. 4. PipE DIRECTION 5. SHAPE OF PIPE 6. PIPE DWMETER/HEIGHT (IN)... 7. PIPE MATERIAL K*l JJL 3L I 8. PIPE LINER MATERIAL. 9. RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES, J ENTER APPROPRIATE NUMBER OR 'SVC- OR 'STUB' J J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOCK POSITION \ Jl-ROUND 2-ELUPTiCAL 3-BOX 4-OOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP SDIP 6-ClP 7-CM 8-TILE 9-BRICK 10-TRUSS J 1.CIPP2-F0LD&F0RM 3-SLIPLINEO 4-SPIRAL WOUND ^ II 3 TYPE.i I 16. FLOW VELOCITY (FPS) \ ^ ll ^xO INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUDGE 2-MUD 3-ROCKS 4-DEBRlS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 1 1 1 1 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO I 1-YES 2-NO COMMENTS: Defects Location 0 NA 1 US Manhole 1 Crack-Radial 2 OS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Sennce 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44-Debris- — .1.2 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scalina IS Camera Emerqed 15 Sag 16 Pipe Exterior 16 InHItralion 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cul-off v/all (>2 feet o( wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ADDRESS: 7^ OBSERVATION CODE NO. CODE - INSPECTION TYPt ll 1_ ( I l-INTERNAL 2-SURFACe S-NOT INSPECTED i-SURlEO 5-NOT FOUND STRUCTURE TYPE LOCATION I //y SURFACE TYPE | 2- COVER A. 'TYPE B. FIT C. SEAL D. SECURING. 1 E. # OF HOLES I L FRAME F. PONDING DEPTH {1N)L G. PONDING TYPE I a SIZE (DIA. IN) L I. INFLOW DISH L A. OFFSET (IN).. L B. RISER HEIGHT (IN)....l J2. GRADE ADJ. A. TYPE..... B. DEPTH (IN) I C. MIN. DIA (IN) I ^ CONE/TOP A. TYPE P. ^SHAPF '. ' e< V.ALL A. MATERIAL I B. LINING TYPE V W C. DIAAENGTH (IN) |_ D. DIAAV.DTH (IN) L 3ENCHTYPE L TROUGH TYPE P:?E SEAL TYPE L "EPS A. TYPE B. CONDITION i • '.• A.N'HOLE DEPTH (FT) EVIDENCE OF SURCHA.RGE (FT) I 1 1 -STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FILLEO IN 7.TEE fl-JUNCTION l-STREET 2-ALLEY 3-SuWU< *-OnV/rf 5-PKWY «-YASp 7-STfiM CITCH 8-CRKBEO 9-?0SS C?J<GEO 10-OFE.N SPACE It-CALTRAWSRAV 1-ASPHALT 2-CON'CfiETE 3-GaAVEL 4-EaOOED SOIL ATRAlSEO MH J-TflEE 6-ESCCEO SCIL A.SO THEE T-OIRT/GPJiSS l-PICK 2-CpNCEALED PICK '3-VfeNTEO 4-STORM \ . 1-GOOO 2TIGHT 3-LOOdE 4-ROCKING S-BOLTS MISSING 6-GASKETEAD«30NE 7-GOOOO-RING 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-S-S-ALLEN EOLT S-3f4; ALLEN EaT 6-5PaNTBOLT 7-AL " BOLT 8- 6POtNTB0LT 9-8URIED 10-ASPHALTCAP Il-CONCRETECAP I 1-SHEET FLOW 2-LDV/POINT 1-24" 2-36' 3-48' 4-OTHERS 1-NO 2-YES l-NONE 2-PRECAST 3-ERICK 4-BLOCK 5-POUREO LIN LintrTvpe: 1- Ccmenddous 2- Cast in PIjci 3- Cured in Place ' NED70?ES[ • NO 1-NONE 2-PflEGST 3-BRK 4-ELK 5-PORO E-BRKiCON 7-CLAY E-PVC LINEDIB^SQN LrnNCFNTRir: P-FCCENTPIC 3-RATTOa NO 1 lii Mi l-NONE 2-Pn£CST 3-6RK 4-ELK 5-PORD e-SHKaCON ^£LAY E-FVC UN=DS^SDN0 1 -CEME.NTITIOUS 2-CAST-I.*;-PLACE 3-CU=.ED-IN-FLAC^^F0)Ci' 0/<£ Ta^ ^^>y^//ut^ l-NONE 2-FRECAST 3-5.^!CK 4-ELOCK 5-.=C'J=.ED U.^HD:^ VESD NO 1-NONE 2-PRECAST 3-POU.RED 4-VCP 5-FVC 6-E-=:CK l-NONE 2-^.'.0RTAR 3-GASKET l-NONE 2-EAa 3-CASTInO.N 4-FLAST;C 1-GOOO 2-CORRODED 3-.V.:SALiGNED <-==:-;E,\ :-V:S=::.-G E-LV-SAFE I :• EFECTS FLOV/ OSS. CODE (GPW) BROKEN S D CORROS;ON S D ROOTS S 0 CODE — -NU.SfEER 0= HOLES C.=ACK5 JOINTS COVER Jl FRA.ME... 1 IL F.3AMESEAL | jl, GRADE ADJUSTMENT..L _JL CONE I IL V/ALL L JL e^NCH L Jl TROUGH I II O .V CODE SEVERITY CODE I I L - LIGHT • - S'.ODERATE . - hiEAVY )- STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 • >50% 1 - INFLOW HFILTRATION ACCESS L-'^l ?.'ORTAR DETERIORATION l_ r.-~.EClPlTATlON I *^_| l-DRIVE(PAVED) 2-CfilVE(UNPA7=D| 3-DaiV? i WALKOO 4 OR.VE 4 WALIC>;0- J-NO \UI.VT. ACCESSiEAST IVALK) 6-NO K\XHT. ACCESS plFrlCULT WALX) 7.,S0 WA;NT. ACCESSiEASr WALK CCsTACT FflOPEPTY OV.\£?ll 8 - NO KWNT. ACCESS (DIFFICULT WALK COMTACf PRCrSaTY QviM^] 1- NO 2-YES INCHES IN PAST 3 CAYS L D I I I I I I I I I I I PIPE tt 1. UPSTREAM MANHOLE tt 2. DOWNSTREAM MANHOLE ff .... 3. INSPECTED MANHOLE 4. pIpE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN)... 7. PIPE MATERIAL \''S 30 £2_ii_^ X .24-^\ ^ II 11- 11—,^ W-U li- 8. PIPE LINER MATERIAL. J ENTER APPROPRIATE NUMBER OR "SVC OR 'STUB* J J 1-UPSTREAM 2-DOWNSTREAM Jl-12CL0CkPOSITI0N i Jl-ROUND 2-ELUPTlCAL 3-BOX 4-DOUBLEBOX J 5-TRlPLEBOX 6-HDRSESHC J 1-VCP 2-PVC 3-cdNCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRlCK 10-TRUSS J 1-CIPP 2-FOLOaFORM 3-SUPLINED 4-SPlRAL WOUND, 9. ' RIM TO CROWN (FT) L 10. FLOW DEPTH (IN) I ^sJl 11. DEPOSITION: INCHES 1. . *^ I TYPE.I \ 11 -~ 16. FLOW VELOCITY (FPS) I -^^ H tf/' ^ ' 7 II 7a J INCLUDES DEPOSITION AT PIPE MOUTH J' — I! _ •I C li PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 17. POSSIBLE PIPE EXPOSURE. 13. PIPE CHECKED FOR EXPOSURE I. J l-YES 2-NO I 1-YES 2-NO COMMENTS: FIPE SKETCH N __j l-SLUDGE 2-MUO 3-ROCKS 4-DEBRIS _J ESTIMATED OR MEASURED (CIRCLE) PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS • • 1 1 1 1 1 1 1 ^4 J> Defects Location 0 NVk 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tas 8 Upper Riaht 8 Offset S Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 Debris — -X2 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submerqed 14 Scalinq 15 Camera Emerqed 15 Saq 16 Pipe Exterior 16 Inliltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below oround level) 23 Exposed Cut-off v/all | >2 leet o( wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE INSPECTION ,TYpfe L' | [ | l-INTERNAL 2-SURFACE 3-l<0T INSPECTED 4-BURlED 5-NOT FOUND STRUCTURE TYPE. -—.-L—LJ 1-STND 2-CLN OUT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6-FILLEO IN 7-TEE fl-JUNCTlON LOCATION [ I i-STREET 2-ALLEY 3-SCWU< *-OflV//Y 5-PKWY 6-YAnp 7-STRM CITCH fl-CfiXeEO 9-FOSS CPJ( GEO lO-OPE.N SPACE Il-CALTRA-VSRAV SURFACE TYPE | I I.ASPHALT 2 C0NCfiET£ a-GOAVEL 4-EaOOED SOILATRAJSEDUH J-TPEE 6-£nCC£0 SOIL A,NO TREE 7-0inT/GPA£S co^/ER A.'TYPE .........ll. B. FIT I C. SEAL I J_ D. SECURING I f _1 l-PICK 2-CpNCEALED PICK 3-VfeNTED 4-STOR.y ' ^ J 1-GOOD 2-TIGHT 3-L00* 4-ROCKING 5-BOLTS MISSING 6-GASKET BAD/GONE 7-GOOO 4-RING / 1-NONE 2-GASKET 3-SIUCONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-ALLEN EOLT £-3/4: ALLEN EOLT 6-5POINTBOLT 7-ALr; " BOLT 8- 6P0INTB0LT 9-BURIED (0-ASPHALT CAP Il-CONCRETECAP 1-SHEET FLOW 2-LDV/POINT FRAME E. # OF HOLES F. PONDING DEPTH flNU 1 G. PONDING TYPE ; ^ I H. SIZE (DIA IN)..... I I 1-24' 2-36' 3-48- 4-OTHERS I. INFLOW DISH I . I 1-NO 2-YES A. OFFSET (IN).. B. RISER HEIGHT (IN).... Liner Tvpe: 1- Cemenddous 2- Casim Pbcs 3- Cured in _>€poxy l-NONE 2-PflECAST 3-ERICK 4-BLOCK 5-POURED LINEOrt^^cSQ NO GRADE ADJ. A. TYPE I j) B. DEPTH (IN) 1^7 I C. MIN. DIA (IN) I I CONE/TOP A. TYPE :| ' $L I 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD 6-DRK4C0N 7-CLAY fi-PVC LlNEO^i'ESnNO ' R .SHAPF I 1 vrnNCFt^RlC P-CCCFNTPtC 3.CLAT TO^ , V/ALL A. MATERIAL I ^ I 1-NONE 2-PnECST 3-BRK 4-ELK S-PORD E-ERKiCON 7-CLAY £-FVC LINEOj^YEsDNO B. LINING TYPE. C. D1A7LENGTH (:N) .j^ , . D. DIAAV'DTH (IN) I ^=KCH TYPE I TROUGH TYPE I V •^=E SEAL TYPE I ^ r-EPS A. TYPE I j B. CONDITION I. •.•A.\HOLE DEPTH (FT) L EVIDENCE OF SURCHA.RGE (FT) I. 1-CEMENTITIOUS 2-CAST-1.'J-=LAC= 3-CUF.E3-IN-FLACE 4-EFOX*^ 1-NONE 2-FRECAST 3-E.RlCK 4-5LOCK E-=CU.=.£0 UNED^YESDNO 1-.\0N= 2-PRECAST 3-POURED 4-VCP £-rVC 6-=.=:CK l-NONE 2-MORTAR 3-GASKET 1-N'ONE 2-cAR 3-CAST InO.N 4-.CLAST;C 1-GOOO 2-CORF.ODED 3-.V;SALIG.';ED i-l?.Z<~>. :-V:S=:.\G e-U:;SA.=E m W m PR I •EFECTS FLOV/ OBS. CODE "(GPM) BROKEN COn.ROSiOiN ROOTS l/l -- -NU.MEEROF- S D S 0 S D CODE HOLES CRACKS JOINTS COVER FRA.ME FPAME SEAL -I IL GRADE ADJUSTMENT..L Jl CONE I II V/.ALL L Jl eniNCH L Jl TROUGH I II O'.V CODE SEVERITY CODE JL J I y 1 \ 1 ^ 1 1 3II <^ 1 1 3 ^1 I I L I I L DENSITY CODE CODE -LIGHT - N'OOERATE -HEAVY - STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 • INFLOW 2 - INFILTRATION ACCESS. \'ORTAR DETERIORATION, i"-~.HClPlTATION I I 1-0RIVE(PAV£D] 2-CBIV£{UNPAVED) 3-CaiVE S V/ALKOO 4 OB.VE 4 WALK>;0 VKO KULH. ACCESSiEAST IVALK) 6-KO MAJNT. ACCESS (Ol?rlCULT WALK) 7.N0 MA..V7. ACCESSitAST WAL>t CCVTACT PflOPEPTY CW.SE.q) 0 - NO W.A:.NT. ACCESS (DIFFICULT WA:.K CC.'fTA;r P.SCPEaTY OVi\l=.\ ..|_ T NO 2-YES II IfJCHES !.\ PAST :• DAYS : I \': i: - 1. d 2. 3. 4. ll 5. 6. wm 7. m 8. 9. 1 I I I I I I 1 PIPE tt UPSTREAM MANHOLE # DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE :.. PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL 9-7 m 'a ' PIPE LINER MATERIAL. RIM TO CROWN (FT) 10 FLOW DEPTH (IN) 11. DEPOSITION: INCHES. TYPE.i.... d 16. FLOW VELOCITY (FPS) \ . ^. <^ 3c£ L 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO I 1-YES 2-NO COMMENTS PIPE SKETCH J ENTER APPROPRIATE NUMBER OR 'SVC OR 'STUB* J J 1-UPSTREAM 2-DOWNSTREAM J l-12CLOCkPOSlTlON i J 1-ROUNO 2-ELUPTlCAL 3-BOX 4-DOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-CIP 7-CM 8-TILE 9-BRICK 10-TRUSS .11-CIPP 2-FOLDaFORM 3-SLIPLINED 4-SP1RAL WOUND INCLUDES DEPOSITION A^" PIPE MOUTH _j I-SLUOGE 2-MUO 3-ROCKS 4.DEBRIS _J ESTIMATED OR MEASURED (CIRCLE) PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 i PIPEi¥ FOOTGE LOC. DEF RATNG INFLTOpm) COMMENTS * 1 1 1 • 1 1 1 1 1 1 1 1 1 1 1 1 io/i'/ Defects Location 0 NV^ 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Grack-Herizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pioe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upper Right 8 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44 Debris ~— -X2 Crown 12 Grease 13 Inverl 13 Corrosion 14 Camera Submerged 14 Scaling 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 In nitration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below oround level) 23 Exposed Cut-off wall (>2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) /^StA f //nXT /^^.f^s^T?^ ADDRESS: nocD XT OBSERVATION CODE NO. CODE - INSPECTION ,TYpfe .1: ( I I-INTERNAL 2-SURFACE 3-WOT INSPECTED •-BURIED 5-NOTFOUND STRUCTURE TYPE. ;| jf j VSTND 2-CLN OUT 3-IN DROP 4-OUT DROP 5-RXK TRAP 6-FlLLEO IN 7.TEE fl-JUNCTION LOCATION t \ I_STR£ET 2-ALLEY 3-SOWlX i-ORV/rrs-PtWY S-YASP T-STRMCITCH S-CRKeSO 9-rOSSCPJ<8£0 10-OFE.VSPACE 11.CALTRANS RAV SURFACE TYPE | "7 I VASPHALT 2-CONCfiETE O-GRAVEL 4.ER00ED SOIL AT RAISED MH J-TREE 6-ERCCED SCIL A,SO TflE! T-OlflT/GPJSS COVER A. 'TYPE J / B. FIT I L C. SEAL I / D. SECURING l-PICK 2-CpNCEALEO PICK 3-VfeNTED 4-STORW . j • • i l-GOOD 2-TlGHT 3-LOO* 4-ROCKlNG 5-BOLTS MISSING 6-GASKET EA0«30NE 7-GOOOO-RING 1-NONE 2-GASKET 3-SILICONE T I l-NONE 2-STflAPPING BAR 3-ANGLE IRONS 4- W ALLEN cOLT 5-3/4: ALLEN EOLT 6- 5 POINT BOLT 7- ALFA * BOLT 8-6POINT80LT 9-BURIED 10-ASPHALTCAP li-CONCRETECAP E. # OF HOLES. FRAME I / I F. PONDING DEPTH flNU 1 G. PONDING TYPE 1 — I 1-SHEET FLOW 2-LDV/POINT 'H. SIZE(DIAIN)„ I I 1-24- 2-36' 3-48" 4-OTHERS I. INFLOW DISH I — I 1-NO 2-YcS A. OFFSET (IN).. I •— I Liner Tvpe! 1- Ccmenddous 2- Cast in Pbc: 3- Curtd in ace ' poxy B. RISER HEIGHT (IN)....Ua£2_J ^I'^e* '^^^""^ ^^<=^^nd G.RADEADJ.A.TYPE I _/3 _I 1-NONE 2-PHECAST 3-ERICK 4-eLOCK £-POUflEO LINED:0?ESD NO B. DEPTH (IN) . C. MIN. DIA (IN) CONE/TOP A. TYPE :| -^g I l-NONE 2-PREGST 3-BRK 4-ELK 5-PORD E-BRKiCON 7-CLAY E-PVC LINED:B*?fesDNO R SHAPF ' \U I 1-CnNC-F^fTRlr: 2-FCCFNTP'C a-PLATTO'' V;ALL A. MATERIAL | \ l-NONE 2-PnECST 3-BRK 4-ELK 5-PORO E-ERKiCON 7-CLAY E-FVC LINEDSTESDNO B. LININGTYPE ! . l-CEMENTITiOUS 2-CAST-IN-FL.ACE 3-CUF.ED-lN-FLAC^EFOX'r' (^Ji^f^ W W to w IF d m [! L [ C. DIAAENGTH (IN) I ^\ \ D. DIAAVIDTH (IN) I 70 J l-.NONE 2-FRECAST 3-ERlCK 4-5LOCK E-FCU.RED UXEOIB^ESDNO \ \ I l-NONE 2-PRECAST 2-P0U=ED 4 VCP 5 rVC 6-=F:CK :E=NCHTYPE TROUGH TYPE •^?E SEAL TYPE I ^ r- = P5 A. TYPE 1 B. CONDITION I I 1-GOOO 2-CORROD5D 2-.V.:SAJG:.-=D ^ Z-Z^Z^. :-V:SS:.NG 6-U,'.SA.=E '.•A.'^;H0LE DEPTH (FT) \ f. ^ \ EVIDENCE OF SURCHA.RGE (FT) I • J l-NONE 2•^.;0RTAR 3-GASKET I l-NONE 2-E.AR 3-CAST IRON -l-PLASTiC CEFECTS FLOV/ OBS. CODE (GPM) BROKEN S D COVER I FRA.ME I_ FPAME SEAL L ll GRADE ADJUSTMENT..L COME L W.ALL L . EENCH L Jl. TROUGH I II O .V CODE SEVERITY CODE CORROSION S D ROOTS l/T "- -NUV5ER OF S D COD£ HOLES CRACKS JOINTS J L I II / 1 l_3Jl_^ I 311 y I I I J I I J L DENSITY CODE CODE -LIGHT ~ VODERATE .- HEAVY f - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2-10%-25% 3 - 25% - 50% 4 ->50% 1 - INFLOW 2 - INFILTRATION r d ;cESS. ' VORTAR DETERIORATION ]_ / _| ' r.-~£CIPITATlON I ll l-DRlVE(PAVEO) 2 CfilVE(UNPAV=0) 3-DatVE S V.'ALK<30' 4 OR.VS 4 WALK>;0 S-NC^ULVT ACCESSiEASYWALK) 6-KO MA-NT. ACCESS (Ol.^rlCULT WALK) I HQ S.W..VT. ACCESSJEASY WAL>( CCVTACT P.^OPEPIY CW.vEa) fl - NO MAINT. ACCESS {DIFFICULT WALK COfrTA:rPSCF£arYOW.S:?l 1-NO 2-YES INCHES IN PAST 3 DAYS PP 1. 2. 3. 4. 5. 6. 7. PIPE # UPSTREAM MANHOLE tt DOWNSTREAM MANHOLE # .... INSPECTED MANHOLE :.. PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL J ENTER APPROPRIATE NUMBER OR "SVC" OR 'STUB* 3L1 3 X. 4 8. PIPE LINER MATERIAL 9. 10 11 RIM TO CROWN (FT) • \ ^7' ^ FLOW DEPTH (IN) L DEPOSITION: INCHES... I. TYPE.i L J 1-UPSTREAM 2-OOWNSTREAM J 1-12 CLOCK POSITION i J 1-ROUNO 2-ELLIPTiCAL 3-BOX 4-'D0UBLEB0X J 5-TRIPLE BOX 6-HORSESHC _l 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DlP 6-ClP 7-CM 8-TlLE 9-BRlCK 10-TRUSS _l 1-CIPP2-F0LD&F0RM 3-SUPLINED 4-SPIRAL WOUND -IL _il 16. FLOW VELOCITY (FPS) I -J. ci? INCLUDES DEPOSITION AT PIPE MOUTH l-SLUDGE 2-MUO 3-ROCKS 4-0EaR(S ESTIMATED OR MEASURED (CIRCLE) PIPE* FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. COMMENTS; I I I I I I N »V J 1-YES 2-NO t 1-YES 2-NO FIPE SKETCH I 1 I PIPES FOOTGE LOC. OEF RATNG INFLT(gp(Ti) COMMENTS ' • 1 ! 1 1 1 1 1 1 I.I 1 1 Defects Location 0 NV^ 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Rioht 8 Offset 9 Lower Right 3 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left XX Oebfis -12 Crown— —— 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scaling 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 In nitration 17 New Manhole 18 Other 3J Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below qround level) 23 Exposed Cut-orr v/all ( >2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET P/W OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE - INSPECTION TYpk | ( I l-INTERNAL 2-SURFACE 3-NOT INSPECTED 4-BURlEO 5-NOT FOUND STRUCTURETYPE ..^ ^1 L LOCATION. SURFACE TYPE. 1 COVER A. TYPE x:. B. FIT C. SEAL D. SECURING.... •\—L FRAME E. # OF HOLES..... I F. PONDING DEPTH (IN)[. G. PONDING TYPE. 1 a SIZE (DIA IN) I. INFLOW DISH A. OFFSET (IN). [ L_2 I—^ B. RISER HEIGHT flNL...I GRADE ADJ. A.TYPE, B. DEPTH (IN) I C. MIN. DIA (IN) I CONE/TOP A. TYPE ;(_J2_J R SHAPF \ I ^ V;ALL A. MATERIAL I JX. B. LININGTYPE ! V C. DIAAENGTH (IN) | _C 0 D. DIAAV'DTH (IN) I 2ENCHTYPE TROUGH TYPE 'KPE SEAL TYPE fEPS A. TYPE .L_£l B. CONDITION.. I. '.'A.'^HOLE DEPTH (FT) I/ EVIDENCE OF SUHCHA.RGE (FT) I l-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FlLLED IN 7.TEE B-JUNCTlOM l-STREET 2-ALLEY 3-SuWlX 4-OflV/A'5~PKWY 6-YARP 7-STBMCliCH 8-CfiXB£0 »-?OSSCrX6£0 tO-OFE.HSPACE It-CALTRANSRAV l-ASPHALT 2-CCNCfiETE 3-GRAVEL 4.EaOOE0 SOIL AT RAISED MH J-TREE 6-ERCCEO SOIL ASO TflE; 7-OinT/GPJi«S l-PlCK 2-CpNCEALEOPlCK S-V^NTEO 4-STOR.y • f ' ' f I 1-GOOO 2-TIGKT 3-LOO* 4-ROCKlNG 5-BOLTS MISSING 6-GASKET BADrtSONE 7-GOOO i-RING ' 1-NONE 2-GASKET 3-SILlCONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-S'fi*ALLEN EOLT 5-3f4: ALLEN EOLT 6-5POINTBOLT 7.ALF^ ' BOLT 8- EPOINTBOLT 9-BUHIED 10-ASPHALTCAP li-CONCRETECAP LintrTvpe: I-Cemenddous 1 -SHEET FLOW 2-LDV/ POINT 2-Cast in Placs 1-24" 2-36'3-48" 4-OTHERS 3-Curcdln 1-NO 2-YES l-NONE 2-PflECAST 3-6RICK 4-BLOCK 5-POUREO LINED:0?£SnNO 1-NONE 2-PRECST 3-BRK 4-ELK 5-PORD €-oRK&CON 7-CLAY fi-PVC L1NED:B^('ESDNO i.rnNrFNTRin 2.FCCFNTP'C 3-R ATT0° 1-NONE 2-Pn£CST 3-BRK 4-ELK 5-PORD E-ERKSCON 7-CLAY E-FVC LINEOQYEEDNO 1-CEMENTITlOUS Z-CAST-IN-FLACE 3-CU=ED-IN.FLACE 4-EFOX'I' 1-NONE 2-FRECAST 3-EHICK 4-ELOCK S-FCUREO UNED:0V=SD ."^0 f . 1-NONE 2-PRECAST 3-POURED 4 VCP 5 rVC 6-=-=;CK 1-NONE 2-f.'.0RTAR 3-GASKET l-NONE 2-5AR 3 CAST IRON -i-FLASTlC l-GOOO 2-CORP.OD5D 3-.V:S.A-JGr.-=D -•==.:KE.\ :-V:S=:.*,-G e-L-r.SA.= E P m w c c r W L :=rECTS FLOV/ OSS. CODE "(GPM) BROKEN S D CORROSiON FOOTS l/l — -NU>/5cR OF- S D S D CODE HOLES C=ACK5 JOiNTS COVER L_ FRAME L F.=>AMES£AL L II GRADE ADJUSTMENT..L CONE L V.'.ALL L EHNCH L Jl TROUGH L —II OW CODE SEVERITY CODE DFNSITY CODE - LIGHT - .VODERATE . - HEAVY (- STRUCTUFIAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2-10%-25% 3 - 25% - 50% 4•>50% 1. INFLOW 2 • INFILTRATION ACCESS. l__*2_l I-OntV£(PAV=D) 2 CRIVE(UfJPAV=0) 3.CaiV= 1 V.'ALKOO 4 Ofi.VS 4 lVALK>iO S-NO.WI.VT ACCESSfEASYWALK} 6-NO I*IA;.NT. ACCESS [OlFr'lCULT WALK) 7 NO ^^A,.vr. ACC£SS;EASY WALK CCSTACT FRCPEnTY DV\e;;) fl . NO V-».:.NT. ACCESS (OlFrlCULT WALK CCWTACr PRCFEflTY Ov/\:=l VORTAR DETERIORATION l_ |_l 1-NO 2-YES fr-^ECIPlTATlON !_ —_1 IN'CHES IN PAST 3 D.AYS [ [ 1- -I 2. 3. 6. 7. PIPE ff UPSTREAM MANHOLES DOWNSTREAM MANHOLE » .... INSPECTED MANHOLE :.. PipE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL V) ^i-^ II i ^ -It J ENTER APPROPRIATE NUMBER OR 'SVC OR 'STUB' 3 JL i^II^ 8. PIPE LINER MATERIAL. I I J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOCk POSITION i J 1-ROUNO 2-ELUPtlCAL 3-BOX 4-'0OUBLEBOX J 5-TRIPLEBOX B-HORSESHC J 1-VCP 2-PVC S-CONCRETE 4-RCP 5-OIP 6<;iP 7-CM e-TILE S-BRICK 10-TRUSS J 1-CIPP 2-FOLDaFORM 3-SLIPLINED 4-SPIRAL WOUND 9. 10. 11. 16. 4 RIM TO CROWN (FT) .'. ( ^ FLOW DEPTH (IN) I_ DEPOSITION: INCHES I. ^ ^ ^ TYPE.; J r II _ 2^1 FLOW VELOCITY (FPS) \ . ^. €> \} - ^ (aij^ IL INCLUDES DEPOSITION A^^ PIPE MOUTH j; _j 1-SLUDGE 2-MUD 3-ROCKS 4-DEBRlS Jl I ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 1 • • 1 1 1 1 1 1 1 1 1 1 1 1 I I I I 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO J 1-YES 2-NO COMMENTS: FIPE SKETCH Defects Location 0 N\A 1 US Manhole 1 CracK-Rsdial 2 OS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 W^e Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao e Upper Riaht 6 Offset 9 Lower Righl 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44 Detjfis-02 Crown — 12 Grease 13 Invert 13 Corrosion 14 Camera Submerged 14 Scaling 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 Inntralion 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cut-off wall (>2 leet ol wall exposed) ' /y^'/^t" "' GEN. LOCATION: (INDICATES IF STREET R/W OR CANYON) ADDRESS: OBSERVATION CODE NO. CODE •" INSPECTlON,TYpt. STRUCTURETYPE. LOCATION •L/l SURFACE TYPE. i_Z CON/ER A. TYPE B. FIT.... C. SEAL I L D. SECURING, .L-L E. # OF HOLES. / F. PONDING DEPTH flNH — 1 G. PONDING TYPE \--^ ' H. SIZE (DIA. IN) I I. INFLOW DISH ...I — A. OFi=SET(IN).. I • B. RISER HEIGHT (IN)....L_Z^_ GRADE ADJ. A. TYPE I ^ FRAME B. DEPTH (IN) I /7 C. MIN. DIA (IN) I J?^ CONE/TOP A. TYPE ;|_ 2_l ' R SHAPF I ^ V.ALL A. MATERIAL B. LININGTYPE C. DIAAENGTH (:N) L li D. DIAAV!DTH{1N) I uENCHTYPE I c" TROUGH TYPE I ^ -:?E SEAL TYPE I ^ A. TYPE I I B. CONDITION.: I "—' "EPS '.•ANHOLE DEPTH (FT) 1 ^..C EVIDENCE OF SURCHARGE (FT) I ' l-I^fTERNAL 2-SURFACe 3-UOT INSPECTED 4-eURlED 5-NOT FOUND 1-STNO 2-CLN OUT 3-lN DROP 4-OUT DROP 5-ROCK TRAP 6-FILLEO IN 7-TEE 8-JUNCTlON 1-STREET 2-ALLEy S-SOWLK 4-0RV//Y 5-PKWY frYAfiP 7-STfi.yClTCH «-CRi(8E0 9-rOSS CfiX fiEO 10-OPE.S SPACE lI-CALTRAiNSBAV l-ASPHALT 2-CCNCfiETE S-GRAVEL 4-EflOOED SOIL AT RAJSED MH S-TREE fi-£RCCEO SOIL ASO TflEi 7-D(flT/GfiA£S 1-PICK 2-CpNCGALED PICK 3-vtNTED 4-STORM . j . , . , l-GOOD 2-TlGKT 3-LOOdE 4-ROCKING 5-BOLTS MISSING 6-GASKET EAO/GONE 7-GOOOO-RING l-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAH 3-ANGLE IRONS 4-S'E* ALLEN EaT 5-3^4; ALLEN EOLT 6-5POINT60LT 7-ALr ' BOLT 8- 6P0INTB0LT 9-BURlEO 10-ASPHALTCAP Il-CONCRETECAP 1-SHEET FLOW 2-LOV/POINT 1-24- 2-36' 3-48" 4-OTHERS 1-NO 2-YES Liner Tvpe: 1- CemenQiious 2- Cut in PIJCS 3- Curcd In Q^poiy l-NONE 2-PRECAST 3-ERICK 4-BLOCK 5-POURED LINEJCIYCSDNO 1-NONE 2-PREGST 3-8RK 4-ELK 5-PORO 6-BRKiCON 7-CLAY E-PVC LINE^^'i'ESnNO i.r.nNrFi^Rir ?.crrFNTPir 3-CLATTQP r Mil 1-NONE 2-PnECST 3-BRK 4.ELK E-PORO E-ERKSCON 7-CLAY E-FVC UNEO^YESDNO 1-CEMENTlTlOUS 2-CAST-IN-FL.A.CE a-CUFED-IN-FLACE^f^FOr^ 1-NONE 2-FRECAST 3-5RICK 4-ELOCK E-FCURED U.\=D:0YESD.SO 1-NONE 2-PRECAST 3-P0U=.ED 4-VCP 5-FVC e-=.=:CK l-NONE 2-^.!0RTAR 3-GASKET 1-NONE 2-5.Aa 3-CAST IRON -J-FLASTiC l-GOOO 2-CORF.ODED 3-V:S.AUGN=D ^•z?.Z<z>. :-V;SS:.\G E-U.'.SAFE 'EFECTS FLOV/ CODE OBS. (GPM) BROKEN S D COVER I 11 FRAME I |! F.RAME SEAL I \\, GRADE ADJUSTMENT..L Jl CONE I ll V.ALL L Jl EENCH L TROUGH L JL CORnOS;ON ROOTS S D SO l_^iiU I I J L I I I I O.V CODE SEVERITY CODE DENSITY CODE l/l CODE -LIGHT -VODERATE -HEAVY - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 - <10% 2- 10%-25% 3 - 25% - 50"/, 4 ->50% 1 - INFLOW 2 - INFILTRATION m ;CESS. VORTAR DETERIORATION. r.-ECIPlTATION I-OftlVE(PAVE0} 2-CRIV£[UNPA7=0( 3-CniVS4 V;ALK<:0 4 ORiVE4V/ALK,;0 S-NO .^Wi.VT, ACCeSSiEAST WAM(] 6-NO MA;NT. ACCESS (Ol.'^rlCULT WALK) 7.N0 ACCESS;£ASY WAL< CCSTACT F.^OPEflTY CW\=3) 0 - NO .V.A:NT. ACCESS (DIFFICULT WALK CCNTACr PROPERTY Ov(.>.:;| 1-NO 2-YES ir;CHES IN PAST : DAYS 1. 2. 3. 4. i 5. 6. 7. m 1 I I I I I I I I I I I I PIPE tt UPSTREAM MANHOLE tt DOWNSTREAM MANHOLE ft.... INSPECTED MANHOLE :.. PipE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL !L ENTER APPROPRIATE NUMBER OR 'SVC' OR "STUB" ll 5r ll -^i/ ll 8. PIPE UNER MATERIAL. 9. 10. 11. 16. RIM TO CROWN (FT) .| ^.3 11 ^.1^ II ^/i3 II .\ A J 1-UPSTREAM 2-DOWNSTREAM J l-12CL0Ck POSITION j J 1-ROUND 2-ELUPTICAL 3-BOX 4-DOUBLE BOX J 5-TRlPLE BOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-ClP 7-CM B-TlLE 9-BRlCK 10-TRUSS 11-CIPP 2-FOLDaFORM 3-SUPLINED 4-SPIRAL WOUND FLOW DEPTH (IN) I ^ DEPOSITION: INCHES I. TYPE.i J FLOW VELOCITY (FPS) | / ^ T T- J INCLUDES DEPOSITION AT PIPE MOUTH I-SLUDGE 2-MUD 3-ROCKS 4-DEBRIS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 PIPES! FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 • • 1 '• 1 1 1 1 1 1 1 1 1 1 17. POSSIBLE PIPE EXPOSURE 13. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO J 1-YES 2-NO |0 COMMENTS: FIPE SKETCH Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Herizonlal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Senrice 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao B Upper Riaht 6 Offset 9 Lower Righl 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left XX 0«t)C4S — -12 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cut-off wall {>2 (eet of wall exposed) I -r. - ' . GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) /f^Ui f-t^S ADDRESS: OBSERVATION CODE NO. CODE " INSPECTION .TYpt ll I ( I 1-irTTERNAL 2-SURFAC6 3-flOT INSPECTED 4-aUfllED 5-NOT FOUND STRUCTURE TYPE. LOCATION ID SURFACE TYPE | 2- COVER A. 'lypE :l /, B. FIT I L C. SEAL D. SECURING. -! L .\—L E. # OF HOLES L_^ F. PONDING DEPTH (IN)LJ: G. PONDING TYPE FRAME H. SIZE (DIA IN) I L INFLOV/DISH I —r A. OFFSET (IN).. L ^ B. RISER HEIGHT (IN)....L 7L GRADE ADJ. A. TYPE | ^ CONE/TOP B. DEPTH (IN) t /7 C. MIN. DIA (IN) I A. TYPE I B_ SHAPF ' I -7 V;ALL A. MATERIAL B. LININGTYPE. C. DIATLENGTH (IN) I OA D. DIAJW:DTH{IN) I 9^ I^ENCHTYPE I TROUGH TYPE I 3 '=:?= SEAL TYPE I ^ r-EPS A. TYPE I I 8. CONDITION.; I 1 -STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FILLED IN 7-TEE 8-JUNCTlON 1-STREET 2-ALLEY »-S5WU< 4-0RVW5-PKWY 6-YAfip 7-STRMCiTCH 6-CfiXeEO 9-rOSSCRX8EO 10OF 11-CALTRANS RAV l-ASPHALT 2-CCNCfiETE J-GRAVEL 4.ER0OE0 SOIL A* RAJSED WH J-TREE 6-EKCCEO SOIL A\D TREE 7-OlRT/GPJiSS 1-PICK 2-CpNCEALED PICK 3-VfeNTEO 4-STOay . ^ l-GOOD 2-TIGHT 3-LOOdE 4-ROCKING 5-BOLTS MISSING 6-GASKET 6A0A30NE 7-GOOo4-RING 1-NONE 2-GASKET g-SlLCONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-S'E* ALLEN EaT 5-3f4: ALLEN EOLT 6-SPOmTBOLT 7-ALF; ' BOLT 8- ePOIt^BOLT 9-BURIED 10-ASPHALTCAP 11-CONCRETE CAP Liner TvT)<: l-Cemenddous 1-SHEETFLOVV 2-LO//P0tNT 2-CistinPIaci 1-24" 2-36'3-48-4-OTHERS 3-Oin:din l-^O 2-YES 1-NONE 2-PRECAST 3-ERICK 4-BLOCK E-POURED i:iNED:|i3*cSDN0 1-NONE 2-PREGST 3-BRK 4-ELK 5-PORD E-oRKiCON 7-CLAY E-PVC L1NEDJ07ESDNO vr.nMr.F^fTR^r: 9.Fr:rFNTPic 3-t:LATTo:' l-NONE 2-Pn£CST 3-BRK 4-ELK S-PORD E-5RK4CON 7-CLAY E FVC U.S=Dj3YEsDN0 1-CEMENTITiOUS 2-CAST-IN-FLACE 3-CUF.ED-IN-FLACE 4-EFOri' ^ ^ l-.S'ONE 2-FRECAST 3-5.^!CK 4-5LOCK £-=CU.=.ED U.\ED^0V5SD-SO 1-N0.\= 2-PnECAST 3-POU.REO 4-VCP 5-PVC E-=.~:CK l-NONE 2-MORTAR 3-GASKET 1-NONE 2-EAR 3-CASTIRO.N ^-PLASTIC 1-GOOO 2-CORRODED 3-.V:SALIG:;=D 4-5.=.:-;=.S :-V:£3:.\G e-U:.SAFE '.•ANHOLE DEPTH (FT) I ^.3 I EVIDENCE OF SURCHARGE (FT) I i 'EFECTS FLOV/ CODE OBS. "(GPM) BROKEN S D CORROSiON S 0 ROOTS S D l/l COC€ — -NU.S'BER OF HOLES C.=ACKS JOINTS COVER |_ FRA.ME... L F.RAME SEAL I GRADE ADJUSTMENT..L CONE L V.ALL L E^NCH L Jl TROUGH i ll O .V CODE SEVERITY CODE J L_LII_^^ J L I zwY \ I 3 11/ I .1 L J L^I.^ L J I I L 3jEzr DENSITY CODE CODE -LIGHT - .^•OD£Fl^TE . - HEAVY ) - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 - >50% 1 - INFLOW 2 - INFILTRATION :cESs. [ X I I-ORIVE(PAVEO) 2-CfllVE[UNPAV=0| 3-CRIVE 4 V-'ALKOO" * Dfi,V=4V/ALK»:0 ^NO .^UI.VT ACCESSiEASY WALK) e-NO MA.NT. ACCESS (Ol.^rlCULT VVALK) 7 NO "-lAi-V:. ACCESSitASY WALK CCSTACT F,=10PEaTY CWN£.5) a - KO KWl.ST. ACCESS (OlFrlCULT WALK CO^^TACr PRCFERIY 0VA:5| ' \'ORTAR DETERIORATION l_ (_1 1-NO 2-YES ' r.-'^.HCIPlTATlON 1_" _\ INCHES IN PAST 3 DAYS •m 1. m 2. 3, 4. k 5. 6. m 7. PIPE ff UPSTREAM MANHOLE « DOWNSTREAM MANHOLE It.... INSPECTED MANHOLE PlpE DIRECTION SHAPE OF PIPE PIPE DIAMETER/HEIGHT (IN)... PIPE MATERIAL V) I ^ i WJ ENTER APPROPRIATE NUMBER OR "SVC" OR "STUB" i L 4- 8. PIPE LINER MATERIAL. J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOCK POSITION i J 1-ROUND 2-ELUPTICAL 3-BOX 4-DOUBLEBOX J 5-TRIPLE BOX 6-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP SDIP 6-ClP 7-CM B-TILE 9-BRlCK 10-TRUSS J 1-CIPP 2-FOLOaFORM 3-SLIPLlNED 4-SPIRAL VVOUND I I I I I I I I I I I + I C'-y II 9. • RIM TO CROWN (FT) 10. FLOW DEPTH (IN) 11. DEPOSITION: INCHES..... TYPE.: 16. FLOW VELOCITY (FPS) I /. 7 ll / 17. POSSIBLE PIPE EXPOSURE IB. PIPE CHECKED FOR EXPOSURE. J 1-YHS 2-NO I 1-YES 2-NO COMMENTS: J INCLUDES DEPOSITION A^ PIPE MOUTH _j l-SLUDGE 2-MUD 3-RDCKS 4-OEBRIS _J ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 PIPES FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 • • 1 1 1 1 1 1 1 1 1 1 1 1 ,0 Defects Location 0 NW 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pice 5 Wye Sen/ice 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 8 Upper Rioht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Lett 44 Dettfis — -X2 CKHvn — 12 Grease 13 Invert 13 Corosion 14 Camera Submeraed 14 Scaling 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infillration 17 New Manhole 16 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below ground level) 23 Exposed Cut-off wall (>2 leet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) >^DP»ESS: Go.hk>fa^O pr A Hlj OBSERVATION CODE NO. CODE "INSPECTlON.TYpt. STRUCTURETYPE. l-INTERNAL 2-SURFACE 3-NOT INSPECTED 4-eURlEO 5-NOT FOUND l-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FUEO IN 7TEE 8-JUNCTION LOCATION I f O I l-STREET 2-ALLEY 3-SOWLK 4-ORW/Y 5-PKWY 6-YARp 7-STRMCITCH l-CfiXflEO 9-?0SSCf=J<EED 1 1 l-CALTRAMS R/W SURFACE TYPE ) V I I.ASPHALT 2-CCNCfiETE S-GRAVEL 4.ER0DEDSOIL AT RAISED WH J-TREE 6-ERCCEO SOIL ANO TREE 7^3inT/GRASS COVER A. -TYPE .........i:....'. .\ / B. FIT ! f_ C. SEAL D. SECURING. E. # OF HOLES. F. PONDING DEPTH (1N)L •l_£ I •I / I .! I I 2 1-PICK 2-CpNCEALED PICK 3-VfeNTEO 4.ST0RV \ • • , ' i 1-GOOO 2-TIGHT 3-LOO* 4-ROCKING 5-BOlTS MISSING 6-GASKET BAOrtSONE 7-GOOOO-RING 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPtNG BAR 3-ANGLE IRONS 4-S-S" ALLEN EOLT 5-3/4: ALLEN EaT E-SPOINTBOLT 7-ALr; ' BOLT 8- 6P0INTB0LT 9-BURlED 10-ASPHALTCAP li-CONCRETECAP G. PONDING TYPE ' ^ I 1-SHEET FLOW 2-LO//POirfT H. SIZE (DIA IN)..... \ 0IJ{ - \ 1-24- 2-36' 3-48" 4-OTHERS I — FRAME I. INFLOV/DISH A. OFFSET (IN) 1 B. RISER HEIGHT (1N)....I 1-NO 2-YES IK I W <Y1 Lintr TvTw: 1- Cemenddous 2- Cut in Place 3- Curc(I in flacc ' l-NONE 2-PRECAST 3-ERlCK 4-BLOCK £-P0UflED LINED:0?ESDNO GPADEADJ. A. TYPE I 2_ B. DEPTH (IN) I (0- \ C. MIN. DIA (IN) I y I > jYPE_ :l_5_J 1-NONE 2-PREGST 3-BRK 4-BLK 5-PORD E-oRKiCON 7-CLAY E-PVC LINEOIBYESDNO 2 I i-r.nNr.FrjTRir: ?.Fr.CFNTPin 3-RATTQP E I C CONE/TOP SHAPF V.ALL A. MATERIAL B. LININGTYPE. C. DIAAENGTH {'N) I > ^"l •I yTi 0^ I 1-NONE 2-Pn£C5T 3-BF,K 4-ELK S-PORO E-ERKACQN 7-CLAY E-FVC LI.SEDQY^SDNQ tf , 1-CEMENTlTiOUS 2-CAST-l,'J-FLt.CE 3-CUF.ED-IN-FLACE 4-EFOX'f' D. DIAJW-OTH (IN).. 5ENCHTYPE TROUGH TYPE ^:PE SEAL TYPE r-=PS A. TYPE I I B. CONDITION 3tA '.•A.SHOLE DEPTH (FT) I EVIDENCE OF SUHCHA.RGE (FT) L 1-NONE 2-FRECAST 3-5.=^ICK 4-ELOCK S-FCURED L!.N=D:0^=sD .SO l-NONE 2-PRECAST 3-POURED 4-VCP 5-FVC 6-=.=:CK l-NONE 2-MORTAR 3-GASKET 1-NONE 2-5.AR 3-CAST IRON ^ PLASTIC i I l-GOOO 2CORF.ODE0 2-.V:S.ALIG.-;EO i.-irz<zv, :-V;S=:NG e-U:;SAFE I I Mil 4 DEFECTS FLOW CODE OBS. fGPM) BROKEN S D CORnOSiON ROOTS 1/1 -- -NU.VSEnOF- SO S D CODE HOLES CRACKS JOIJfTS COVER I ll FRAME i 1!. FRAME SEAL 1 !|, GRADE ADJUSTMENT..L Jl CONE I ll v.-ALL L Jl E:ENCH L TROUGH L IL J 1- 11 .1 L J i_:Ui£j L J \3JL2 L ^1 J L :rn: O.V CODE SEVERITY CODE DENSITY CODE 1/1 CODE -LIGHT - VODEFIATE . - HEAVY I - STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<10% 2- 10%-25% 3 - 25% - 50°/, 4 ->S0% 1 • INFLOW 2 - INFILTRATION ;cESS. .'-•ORTAR DETERIORATION. r.--^.ECIPlTATION -U^l .1 / _l l.OfllVE(PAVEO) 2-CRIVElUNPAV=D| J-DRiVS 4 V,'ALK<:0" 6-NO KU.NT. ACCESS (OlFr-|CULT WALK) 7.N01.W.VT. ACC < OR.VE A WALK»;0 >-N0 MAINT. ACCESSiEAST WALK} 6-NO KU.NT. ACCESS (OlFr'ICULT WALK) 7-NO l.«.>fT. ACCESSitAST WAL< CCSTACT PROPERTY CW\£a) e • NO J.tA:.NT. ACCESS (OlFrlCULT WALK CONTACT PSCFERTY 0V/S=-1 1-NO 2-YES INCHES IN PAST 3 DAYS hi d IM PIPE P 1. UPSTREAM MANHOLE # 2. DOWNSTREAM MANHOLE # .... 3. INSPECTED MANHOLE :.. 4. PipE DIRECTION 5. SHAPE OF PIPE 6. PIPE DIAMETER/HEIGHT (IN)... 7. PIPE MATERIAL (1) (2) (3) 8. PIPE UNER MATERIAL. X •t-9. RIM TO CROWN (FT) 10. FLOW DEPTH (IN) I £ 11. DEPOSITION: INCHES \, i'- ^ — TYPE J ri^lL _— 16. FLOW VELOCITY (FPS) I / 75" II /^S (4) 1 '^-^ 1 1 dU ll 11 I 1 ?-i ll ll I 1 ( 1 5^ 11 11 I r // 1 1 11 ll I 1 / ri / 11 ^11 i 1 1 \ ^¥ 11 • 11 1 I / 1 / II II ENTER APPROPRIATE NUMBER OR 'SVC' OR "STUB' 1-UPSTREAM 2-DOWNSTREAM 1-12 CLOCK POSITION i I- ROUND 2-ELLIPTlCAL 3-BOX 4-OOUBLE BOX 5-TRIPLE BOX 6-HORSESHC II- VCP 2-PVC 3-CdNCRETE 4-RCP 5-DIP 6-ClP 7-CM e-TlLE 9-BRlCK 10-TRUSS .11-ClPP2-F0LDfiF0RM 3-SUPLlNED 4-SPIRAL WOUND INCLUDES DEPOSITION AT PIPE MOUTH -K_ _j 1-SLUDGE 2-MUO 3-ROCKS 4-DEBRlS _J ESTIMATED OR MEASURED (CIRCLE) I I I I 1 1 1 PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 1 1 PlPEi¥ FOOTGE LOC. DEF RATNG INFLT(gpfn) COMMENTS 1 1 1 • 1 1 1 1 • 1 1 1 1 1 1 1 1 i i 1 i 1 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE, J 1-YES 2-NO J ^YES 2-NO COMMENTS: Delects Location 0 NW 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pioe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Conn 6 Break-in Conn 7 Extended Tap 7 Extended Taa a Upper Riaht 6 Offset 9 Lower Right 9 Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 11 Debris 12 Crown 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scaling 15 Camera Emerged 15 Sag 16 Pipe Exterior 16 Infiltration 17 Nev/ Manhole 16 Oltier 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at qround level) 22 Exposed Encasement (erosion below around level) IMSPECTION CREV/- i^/fymfJ:> L)A 11 f-^f- —e^^= li^^u.^^^^^^^ ^ y GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) /'/z?X /~ClOj^)0 /n ADDRESS: CODE NO. OBSERVATION " INSPECTION ^TYPt. ..' j j(. STRUCTURETYPE —i— LOCATION I to CODE SURFACE TYPE. COVER A. TYPE .1 / 8. FIT I f C. SEAL D. SECURING T •I L E. # OF HOLES ! L FRAME F. PONDING DEPTH (tN)L G. PONDING TYPE H. SIZE (DIA IN) L I. INFLOW DISH L A. OFFSET (IN). 2 B. RISER HEIGHT (IN)....L_/2_ GRADE ADJ. A. TYPE I B. DEPTH (IN) I .3 "7 C. MIN. DIA. (IN) I 3^ CONE/TOP A. TYPE P SHAPF \ ' ^ V.ALL A. MATERIAL B. LININGTYPE. C. DIAAENGTH (:N) I ^CP D. DIAAV.OTH (IN) I i £;=NCH TYPE I TROUGH TYPE I --:?E SEAL TYPE r~=PS A. TYPE B. CONDITION •.•nNHOLE DEPTH (FT) EVIDENCE OF SURCHARGE (FT) 1-irrrERNAL 2-SURFACE 3-NOT INSPECTED 4-SURlED &-N0r FOUND 1-STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-RCCK TRAP 6 FILLED IN 7-TEE B JUNCTiON 1-STREET 2-ALLEY S-SOWLK 4-ORW/Y S-PKWY 6-YARp 7-5TR.UCrrCH B-CRXBEO J-FOSSCRXBEO IO-OFE.'TSPACE 11XALTRANSRAV l-ASPHALT 2-CCNCfiETE 3-GRAVEL 4.ERO0ED SOIL AT RAISED UH J-TREE 6-ERCCEO SOIL ASO TREE 7-OiRT/GP>5S 1-PICK 2-CpNCEALED PICK 3-VfeNTED 4-STORW • ( . - 1-COOD 2-TlGKT 3-LOOdE 4-ROCKING 5-BOLTS MISSING C-GASKET EAD^JONE 7-GOOO 0-RING 1-NONE 2-GASKET 3-SlLlCONE 1-NONE 2-STRAPPtfJG BAR 3-ANGLE IRONS 4-SB'ALLEN EOLT S-3/4: ALLEN EaT 6-5 POINT BOLT 7-AL • BOLT 8- 6 POINT BOLT 9-BUflIED 10-ASPHALT CAP 11-CONCRETE CAP LintrTvpe: 1- Cemendrious 2- CaHmPIjc: 3- Curcd in Place 1-SHEET FLOW 2-LOV/POINT 1-24- 2-36' 3-48' 4-OTHERS 1-NO 2-Y£S 1-NONE 2-PRECAST 3-6R1CK 4-BLOCK 5-FOURED L1NED:0?^ESDNO 1-NONE 2-PRECST 3-BRK 4-ELK 5-PORD 6-5RKiCON 7-CLAY 6-PVC LINHaB^ESDNO i.rnNr.FNfTRir. g-crcFNTPic ^-RATTO^ l-NONE 2-PnECST 3-BRK 4-ELK 5-PORD E SRKiCON 7-CLAY E-FVC LLSEDQ^ESDNO 1-CEMENTITIOUS 2-CAST-IN-FLACE 3-CU==D-IN-FLACE 4-EF0)C^ 1-.\0NE 2-FnECAST 3-ERiCK 4-=L0CK ^-PCU=.=D UNED:B'':'H£D SO l-NONE 2-PnECAST 3-POURED 4-VCP £-=VC e- = =:CK l-NONE 2-\^0RTAR 3-GASKET 1-NONE 2-5.AR 3-CAST InO.N ^-PLASTIC 1-GOOD 2-CORROCED 3-.V.:S,-^,JG:."=D 4-E=.:-;£.\ :-V.S=:.".-G e-LV.$A.=H [ DEFECTS FLOV/ OBS. CODE (GPM) BROKEN S D COR.nOSiON S D BOOTS S D CODE -- -NUVEER 0= HOLES CFACKS JOINTS COVER FRA.ME FRAME SEAL II •L GR.ADE ADJUSTMENT..L Jl CONE 1 ll V.ALL I II . ESISICH... TROUGH O.V CODE -L MXA L SEVERITY CODE DFNSITY CODE l/l CODE - LIGHT - '.'.OOERATE .-HEAVY 1 - STRUCTURAL 1 - MILD 2- MODERATE 3- SEVERE 1 -<ioro 2- 10%-25r,> 3 - 25% - 50% 4 - >50% 1 • INFLOW 2 - INFILTRATION :CESS. I Q_\ j.OniVE(PAVEO) SCRIVeiUNPAVEO) 3-CRiVEiV;At.K<30' * OR.VEiWALX>;0 J-NO.U ' 6-NO MA:.NT. ACCESS (OlFrlCULT WAIK) 7.N0 ^<A..VT. ACCESSJEASYWAL< CCsTACT FS e • NO .yj.:.NT. ACCESS (OIFFCULT WALK ccwTAcr pRCFEaiY ov/s;=i .'.'ORTAR DETERIORATION 1_ (_1 1-NO 2-YES f'.~ECiP!TAT10'N !_— J.N0.MA1.VT, ACCESSiEASTW^K] .OPERTYCiv.NCR) Pi INCHES !N PAST 3 DAYS (2) 5^ JL PIPE# (1) 1. UPSTREAM MANHOLE tt L 2. DOWNSTREAM MANHOLE it.... | ik\ 3. INSPECTED MANHOLE I (_ 4. PipE DIRECTION I ' 5. SHAPE OF PIPE..! j / 6. PIPE DIAMETER/HEIGHT (IN) ...I__^i^L—!l__2^ II 7. PIPE MATERIAL I ( ll j. 11 8. PIPE LINER MATERIAL p 7Z1»-^ '— 9. * RIM TO CROWN (FT) L-^l3j\ 10. FLOW DEPTH (IN) 1 jT ll 11. DEPOSITION: INCHES L —• t'- TYPE J — ll 16. FLOW VELOCITY (FPS) I / ?^l (3) (4) ^5 J ENTER APPROPRIATE NUMBER OR 'SVC* OR "STUB- _I J 1-UPSTREAM 2-DOWNSTREAM J 1-12 CLOCK POSITION i J 1-ROUND 2-ELLIPTlCAL 3-BOX 4-DOUSLE BOX J 5-TRlPLE BOX &-HORSESHC J 1-VCP 2-PVC 3-CdNCRETE 4-RCP 5-DlP 6-CIP 7-CM B-TILE 9-BRlCK 10-TRUSS J 1-CIPP 2-FOLDeFORM 3-SLIPLINEO 4-SPIRAL WOUND /^ J INCLUDES DEPOSITION AT PIPE MOUTH 1-SLUDGE 2-MUD 3-ROCKS 4-DE8RIS ESTIMATED OR MEASURED (CIRCLE) PIPE# FOOTGE LOC. DEF RATNG INFLT(gpm) COMMENTS 1 1 PlPEi¥ FOOTGE LOC. DEF RATNG lNFLT(9pm) COMMENTS * • 1 III 1 III 17. POSSIBLE PIPE EXPOSURE I ^ I 1-YES 2-NO 18. PIPE CHECKED FOR EXPOSURE I I I 1-YES 2-NO COMMENTS: FIPE SKETCH N Defects Location 0 N\A 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Horizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-in Ccnn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upoer Riaht 8 Offset 9 Lower Right g Gapped Joint 10 Lower Left 10 Rools 11 Upper Left 11 Debris 12 Crown 12 Grease 13 Inverl 13 [Corrosion 14 Camera Submerced 14 Scalina 15 Camera Emeraed 15 Sa<^ 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below around level) 23 Exposed Cut-off v/all (>2 feet of wall exposed) I'J.SHl-t, I I^JIN L^M^V^ GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) /^H:? S 1^^^^/^ ADDRESS: OBSERVATION CODE NO. CODE — INSPECTIONTYPE. STRUCTURETYPE. LOCATION I /tf SURFACE TYPE I ^ COVER A. TYPE I / B. FIT 1 C. SEAL I L D. SECURING I L E. # OF HOLES ! L 2 FRAME F. PONDING DEPTH (1N)[. G. PONDING TYPE ; H. SIZE (DIA. IN) I I. INFLOV/DISH I A. OFFSET (IN) 1 B. RISER HEIGHT (IN) ....I GRADE ADJ. A. TYPE B. DEPTH (IN) I — C. MIN. DIA. (IN) I CONE/TOP A. TYPE L-2. ' P SHAPF ! ,^ V-ALL A. MATERIAL I A B. LININGTYPE 7 C. DIAAENGTH (:N) I ^3 D. DIAAV:DTH (IN) I L^ENCH TYPE "ROUGH. TYPE -•;=£ SEAL TYPE r'EFS A. TYPE B. CONDITION. JL -i_^ •-•ANHOLE DEPTH (FT) I 1-INTERNAL 2-SUflFACE 3-+J0T INSPECTED 4-2URIED 5-NOTFOUND 1 -STND 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FILLEO IN 7TEE B-JUNCTlON l-STREET 2-ALLEY J-SCWLK 4-0RV//Y5-PKWY 6-YAnp 7-5TfiMDITCH 8-CRKBEO »-FOSSCrXE£D I&-OFE.'j SPACE ll-CALTRANSRW l-ASPHALT 2-CCNCfiETE S-GRAVEL 4.£flODEO SOIL AT RAJSED MH S.TREE 6-ERCCED SOIL ASO TREE 7-OlRT/GRjiSS to 1-PICK 2-CpNCEALEO PICK , 3-Vfef^TEO 4-STOR.y - ( . . 1-GOOD 2-TIGKT 3-LOOSE 4-ROCKlNG S-BOLTS MISSING E-GASKET EAO/GONE p-GOOO O-RING 1-NONE 2-GASKET 3-SILICONE 1-NONE 2-STRAPPING BAR 3-ANGLE IRONS 4-£,-8-ALLEN EaT £-3/4: ALLEN EOLT 6-5POINTEOLT 7-ALFA • BOUT 8- EPOINTBOLT 9-BURIED 10-ASPHALT CA? Il-CONCRETECAP 1-SHEETFLOVV 2-LOV/POINT 1-24" 2-36" 3-48" 4-OTHERS 1-NO 2-YES Lintr Tvpe: 1- Cemenddous 2- Cast in Place 3- Cuicd in lace poxy ilat 3> I ^NONE 2-PaECAST 3-BRlCK 4-BLOCK E-FOURED UNED:0^SDNO 'VNONE 2-PflECST 3-BRK 4-ELK S-PORO £-5RKiC0N 7-CLAY fi-PVC LINEDISYESDNO to 1.f.n^JCF^fTPlr^ 7-cr.rFNTPic 3-CLAT TO^ — l-NONE 2-PRECST 3-BF.K 4-ELK 5-PORO £-=RKiC0N 7-CLAY E-FVC L!.S=D0YESnNO l-CEMENTITiOUS 2-CAST-IN-FLACE 5-CU==D-iN-FLACE <-E.=0)C.' 1-NONE 2-FF.ECAST 2-E.=:CK 4-5L0CK £-.=CU=EO U.\=D-n YESD .'^O 1-NONE 2-PRECAST 2-FOUP.ED 4-VCP E-FVC E-EFiCK 1-NONE 2-.V.0RTAR 3-GASKET 1-NONE 2-5.AR 2-CAST IRO,'- -i-FLASTIC 1-GCOO 2-COR.=.0DED C-'.::SAJG:.'=-:; .:-=.=:<=•. :-V:S=:NG e-U:.SA=E EVIOENCE OF SURCHARGE (FT) I si f^- Z£rECTS FLOW OBS. CODE (GPM) BROKEN S D CORROSiON S D ROOTS S 0 "- -NU>.'=ERO= HOLES CPACK5 JOINTS COVER FRAME F=AM£ SEAL II .1 i!. -1 !1 GRADE ADJUSTMENT..L Jl COME L Jl V.ALL I tl , CLINCH L Jl TROUGH 1 !1 O.VCOOE SEVERITY CODE J I J I I 3 li ^ I 1 I L 1 I L DENSITY CODt CODE - LIGHT - V'ODERATE -hiEAVY - STRUCTURAL 1 - MILD 2 - MODERATE 3-SEVERE 1 -<10% 2-10%-25% 3 - 25% - 50% 4 - >50% 1 - INFLOV/ 2 - INFILTRATION ACCESS. \ Ol i-DfllVE(PAVeD) S-CfilVElUNPAVED) 3-CRiVS i WAI.K<:0 4 OR.VE J V/ALK»;o J.NOMAI.VT ACCESSjEASYWALK) •*—t7^^ ^j^.j^ ACCESS (Oi-^rlCULT WALK) 7..S0 WA.NT. ACCESSitAST WALK CCVTACT F?50P£aTt CVI^t^] e - tiO .^WLNT. ACCESS (OlFrlCULT WA:>< CC^TT^Zt PRCFERIY Ow.S;^] V'ORTAR DETERIORATION |_ l_l 1-NO 2-YES •'' vECIPlTATION ! -—_| INCHES IN PAST 3 D.AYS 1. 2. 3. 4. 5. 6. 7. 8. PIPEff [V<^i'tf^ftOt^^}{^tUi^r/^p f/)^ . UPSTREAM MANHOLE tt / .i ^ I JI !> T u M 11 ^ ^ 1 ENTER APPROPRIATE NUMBER OR "SVC" OR 'STUB- DOWNSTREAM MANHOLE ft.... I ? II ' Jl ^ ' It ^ / I INSPECTED MANHOLE ;.. I / 11 ' / Jl 9. II 11-UPSTREAM 2-DOWNSTREAM PipE DIRECTION | ' (O \\ i j t W ^ " ^ ' M2CLOCK POSITION j SHAPE OF PIPE I f II ^ H ^ ll / [ 11-ROUND 2-ELLIPTlCAL 3-BOX 4-DOUBLE BOX PIPFDIAMFTFRfl^ElGHT(lN).••| ^3^^ 11 W Jl / 1 S-TRIPLEBO^; 6-HORSESHC PIPE MATERIAL I ( 11 I II 11-VCP 2-PVC S-CONCRETE 4-RCP 5-DlP 6-ClP 7-CM ^TILE 9-BRlCK 10-TRUSS PIPE LINER MATERIAL -!J_^=^_l' _iJII--il-^-—l-l' "Tl- 11-ClPP 2-F0LD&F0RM 3-SUPUNED 4-SPIRAL WOUND RIM TO CROWN (FT) •. \ AC C? l| fS.O ll /Si-O ll/T.^ J T ' \ ^ FLOW DEPTH (IN) ) 9 4 " ^'^ " " ' INCLUDES DEPOSITION AT PIPE MOUTH DEPOSITION: INCHES ! ^ ^ " ? ' TYPE.i \ l_|l. _ r ' I! ' _j I-SLUOGE 2-MUD 3-ROCKS 4-DEBRIS FLOW VELOCITY (FPS) \ /' ^ ll /• .T II AS' ll /, S" I ESTIMATED OR MEASURED (CIRCLE) 9. 10. 11. 16. I I PIPE# FOOTGE LOC. DEF RATNG INFLT{gpm) COMMENTS 1 i 1 17. POSSIBLE PIPE EXPOSURE 18. PIPE CHECKED FOR EXPOSURE. J 1-YES 2-NO I 1-YES 2-NO COMMENTS; Ve^^ Jeff mjk J c^iAld f)of- nea.cf) jt^ jflPm p^lt t——d-^if/^ PIPES FOOTGE LOC. DEF RATNG lNFLT(gpm) - COMMENTS • ' • 1 1 1 1 1 1 i 1 1 1 Defects Location 0 1 US Manhole 1 Crack-Radial 2 DS Manhole 2 Crack-Herizontal 3 Camera Blocked 3 Broken Pipe 4 Joint 4 Collapsed Pipe 5 Wye Service 5 Wye Service 6 Break-In Conn 6 Break-in Conn 7 Extended Tap 7 Extended Tao 6 Upper Riaht 8 Offset S Lower Right g Gapped Joint 10 Lower Left 10 Roots 11 Upper Left 44-Oetyis 42 Crown — , 12 Grease 13 Invert 13 Corrosion 14 Camera Submeraed 14 Scalina 15 Camera Emerqed 15 Sag 16 Pipe Exterior 16 Infiltration 17 New Manhole 18 Other 31 Pipe Seal 20 Exposed Pipe 21 Exposed Encasement (at ground level) 22 Exposed Encasement (erosion below oround level) 23 Exposed Cut-off wall (>2 feet of wall exposed) GEN. LOCATION: (INDICATES IF STREET RAV OR CANYON) Lin ADDRESS: OBSERVATION CODE NO. CODE INSPECTlON.TYpfe.. J.' I ]J STRUCTURETYPE :1 M. LOCATION I ^ SURFACE TYPE I / I I l-INTERNAL 2-SURFACE 3-NOT INSPECTED 4-eURl£D 5-NOTFOUND 7| 1 .STNO 2-CLN OUT 3-IN DROP 4-OUT DROP 5-ROCK TRAP 6-FUEO IN T-TEE fl-JUNCTION l-STREET 2-ALLEY 3-SOWLK 4-0flV//Y 5-PKWY frYARp 7-STRMClTCH 8-CRK8EO 9-FOSS CfiX EEO1 11-CALTRANS flAV l-ASPHALT a-CCNCRETE 3-GRAVEL 4.ER00E0 SOIL AT RAISEO WH J-TREE B-ERCCEO SCIL A,NOTREE 7-OlRT/GP.ASS COVER A.'TYPE .........J.::...L -I T 8. FIT I L C. SEAL I L D. SECURING I L .a. FRAME E. # OF HOLES....... F. PONDING DEPTH flNU G. PONDING TYPE. H. SIZE (DIA IN) ! I. INFLOW DISH I —~ A. OFFSET (IN).. I ' B. RISER HEIGHT (IN)....Lf^C^ GRADE ADJ. A. TYPE 1 ^ B. DEPTH (IN) I -T/ C. MIN. DIA (IN) I ^ CONE/TOP A. TYPE ' R SHAPE L I A. V;ALL A. MATERIAL B. LININGTYPE. A. C. DIAAENGTH (;N) L D. DIAJVV;DTH (IN) L SENCH TYPE L TROL'GHTYPE L .-=;?= SEAL TYPE I. f-EPS A. TYPE 1. B. CONDITION.. I. I 7~" NNHOLE DEPTH (FT) 1/7 l-PlCK 2-CpNCEALEOPICK S-V^NTEO 4-STORM S - , i 1-GOOD 2-TlGKT 3-LOO* 4-ROCKING 5-BOLTS MISSING 6-GASKET BAOfljONE 7-GOOOO-RING 1-NONE 2-GASKET 3-SlLICONE 1 NONE 2-STRAPPtNG BAR 3-ANGLE IRONS 4-£.'6* ALLEN EOLT 5-3/4: ALLEN EOLT 6-5POINTBOLT 7-ALFA • BOLT 8- 6 POINT BOLT 9-BUflIED 10-ASPHALTCAP li-CONCRETECAP 1-SHEETFLOVV 2-La//POINT 1-24" 2-36' 3-48" 4-OTHERS 1-NO 2-YES Liner TYDC: 1- Cemenddous 2- CutinPIjc: 3- Curcd in Place 4- Epox)' 1-NONE 2-PRECAST 3-BRlCK 4.BL0CK E-POURED UNED:[>CS[3N0 l-NONS 2-PREGST 3-BRK 4-ELK 5-PORO 6-BRKiCON 7-CLAY 8-PVC LINEDIDYES^NO t.f.nNCFNTRir 9.Frr.FNTPiC 3-Ci ATT0° 1-NONE 2-Pn£CST 3-BfiK 4-ELK 5-PORD E-ERKACON 7-CLAY E-FVC UNEDQYESQ^O 1-CEMENTlTiOUS Z-CAST-I^J-FLACE 3-CU==D-1N-FLACE 4-EF0)C^ EVIDENCE OF SURCHARGE (FT) \_^£^ DEFECTS • FLOV/ OBS. l-.NONE 2-FRECAST 3-ERlCK 4-SLOCK £-PCU=£D U.\=D:DYE£[>;0 1-NONE 2 PRECAST 3-POU.RED 4-VCP 5 FVC £-==:CK 1-NONE 2-MORTAR 3-GASKET 1-NONE 2-5AR 3-CAST IRON 4-FLAST;C 1-GOOO 2C0R.=0D=D 3-.'.;:SAUG:.'ED i-z=Z<zS :-v;SS:.\G e-L".SAFE (JO CODE " (GPM) BROKEN S D CORROSION S D ROOTS S D l/l CODE "- -.NUS^BcR OF HOLES CRACKS JOINTS COVER L_ FRAME.... L F.RAME SEAL |_. GRADE ADJUSTMENT.L CONE L V.ALL L E3NCH L TROUGH O.V CODE -LIGHT - r.'ODERATE -hizAVY 1 - STRUCTURAL •L_l! J I- J L J L J I- .1 L J L J I 1 J L SEVERITY CODE 1 - MILD 2 - MODERATE 3-SEVERE DFNSITY CODE 1/1 CODE 1 -<10% 2- 10%-25% 3 - 25% - 50% 4 ->50% 1 . INFLOW 2 - INFILTRATION ;CESS. •u/_i 1 nfllVEIPAVcni 2.CftlV£(UNPAVE0) 3-CRiVE 4 V.'ALK<:0 * Ofi.VS 4 WALK.M S-NO .(.UI.'JT. ACCESSJEASY WALK) frKO MXHJ. ACCESS (OlFf ICULT WALK] 7-NO f-V^ST. ACCESSiEASY WALK CCVTACT PROPERTY CW\£R) a - NO MA:.NT. ACCESS (DIFFICULT WALK CONTACT pscPERrY ovis-=.) \'ORTAR DETERIORATION U j „1 1-NO 2YES r -.ECIPlTATlON I^r—_! INCHES IN PAST 3 D-AYS