DDW-2024-009432

CC:
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:
EQ Docs #:
Enclosures:
Administrative Contact:
Address:
Is a Water/Sewer Separation Exception Required per R309-550-7?

Are all requirements of R309-500-7(3)* met?
No. Exception required
Yes. Do water and sewer cross?
No. Is there at least 10' of horizontal separation?
No. There at least 6' of horizontal separation, sewer pipes in good condition, AND there is not high groundwater?
Yes. Is water at least 18" above the sewer?
Yes. Exception not required
No. Exception required
No. Exception required
Yes. Exception not required
Yes. Is water at least 18" above sewer?
No. Exception required
Yes. Exception not required
Requirements of R309-500-7(3) are met if:
 The groundwater is not high
 Water transmission lines that may become unpressurized will not be installed within 20 feet of sewer lines
 Disturbances of existing lines are prevented or minimized
 Corrosive conditions do not exist
 When sewer force main crosses under existing water main, all portions of the sewer force main within 10’ (horizontally) of the water main will be enclosed in a continuous sleeve
 When a new water main crosses over an existing sewer force main, the water main will be constructed of pipe materials with a minimum rated working pressure of 200 psi or equivalent pressure rating
 Water service laterals will conform to requirements for separation of water and sewer lines