DDW-2024-008765

Water/Sewer Separation - Exception Request Form
INSTRUCTIONS
Send the completed Exception Request Form, drawings, and Water/Sewer Exception Request Spreadsheet to [e-mail]
PROJECT INFORMATION
Water System Number*: DDW File Number:
Water System Name*:
Project Title*:
Project Description*:
Attachments: ☐Drawings of water line and sewer line alignments☐Water/Sewer Exception Request Spreadsheet
SUBMITTED BY
Engineer of Record
Name (Print):
PE License Number: Title:
Email: Phone:
Organization:
Signature: Date:
REVIEWED BY
DDW Permitting Engineer
Name (Print) Date:
APPROVED BY
DDW Permitting Manager
Name (Print):
Signature: Date:
Enclosures:
CC:
Water/Sewer Separation - Exception Request Spreadsheet
STA 11+69.27, Sheet PP-4 STA 17+40.61, Sheet PP-6 STA 34+34.42, Sheet PP-10 STA 35+99.19, Sheet PP-10 STA 42+56, Sheet PP-12
Water Main below Sewer Main Water Main below Sewer Main Water Main below Sewer Lateral Water Main below Sewer Lateral Water Main less than 18" above sewer lateral
0'0'0'0'0'
12"12"12"12"12"
Below Below Below Below Above
Condition (New/Existing)New New New New New
Material PVC PVC PVC PVC PVC
Size 8"8"8"8"8"
Pressure Rating C-900 DR14 C-900 DR14 C-900 DR 14 C-900 DR 14 C-900 DR 14
Is the line pressurized year-round?Yes Yes Yes Yes Yes
Condition (New/Existing)New New New New New
Material PVC PVC PVC PVC PVC
Size 8"8"4"4"4"
Pressure Rating SDR-35 SDR-35 SDR-35 SDR-35 SDR-35
Is the line pressurized?No No No No No
20' of Steel or DR21 (or thicker) welded
HDPE Pipe Casing around sewer with
wrap-around end seals centered over
water crossing
20' of Steel or DR21 (or thicker) welded
HDPE Pipe Casing around sewer with
wrap-around end seals centered over
water crossing
20' of Steel or DR21 (or thicker) welded
HDPE Pipe Casing around sewer with
wrap-around end seals centered over
water crossing
20' of Steel or DR21 (or thicker) welded
HDPE Pipe Casing around sewer with
wrap-around end seals centered over
water crossing
20' of Steel or DR21 (or thicker) welded HDPE
Pipe Casing around waterline with wrap-
around end seals centered over sewer
crossing
1. Separation distances shall be measured edge-to-edge.
2.     Examples of proposed means to mitigate risks include:
a.     remove/replace the aged vitrified clay sewer pipe;
b.     replace the aged or cracked existing sewer pipe;
c.      use thicker or higher pressure class PVC instead
d.     of the typical thin-wall sewer pipe; install an in-situ lining to the existing sewer pipe for XX feet;
e.     center the sewer line over the crossing to keep the joints as far as possible from the water line;
f.      add detectable or magnetic warning tape placed 12 inches above the sewer and/or the water line(s) to minimize possible damage during future excavations;
g.     use HDPE pipe for water line or sewer line to eliminate the joints [if there is no sagging or lack-of-sufficient slope problems for HDPE sewer pipes];
h.     use restrained joints for water line and/or sewer line near the crossing
Sewer
Line
Mitigation Efforts2
Station or Location
Reason for not meeting R309-550-7
Horizontal Clearance1
Vertical Clearance1
Water is Above or Below Sewer
Groundwater conditions
Water
Line