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SEWER REPLACEMENT
NOTIFICATION AND REQUEST FOR INSPECTION (NRI)
METROPOLITAN WATER RECLAMATION DISTRICT OF GREATER CHICAGO
111 EAST ERIE STREET, CHICAGO, ILLINOIS 60611
312-751-3260
1. PROJECT INFORMATION
Name and description of project: _______________________________________________________________________________________
__________________________________________________________________________________________________________________
Location of project (street address or with respect to two major streets): ________________________________________________________
__________________________________________________________________________________________________________________
Municipality (Township, if unincorporated): _____________________________________________________________________________
Related MWRD Sewer Permit and/or Watershed Management Permit Number, if known ________________________________.
2. PROJECT
Development Area: __________acres Is the project located within the floodplain? [ ] Yes [ ] No
3. PROJECT TYPE
Government/Municipal [ ]; Commercial [ ]; Industrial [ ]; Residential [ ]; Private Utility [ ]; Institutional [ ];
Recreational [ ]; Sewer Rehabilitation [ ]; Other ________________________________.
4. SCOPE OF CONSTRUCTION
Work consists of : Sewer main reconstruction [ ]; Replacement [ ]; Relining [ ]; Spot repairs [ ]; Building sewer service
replacement/relining [ ]; Existing manholes to be reconstructed [ ]; New manhole(s) [ ]; Grease trap (s) [ ];
Oil separator(s) [ ]; Mud basin (s) [ ]. Other______________
Reason for replacement/repair: Collapse [ ]; Deterioration [ ]; Suspected breaks [ ]; Excessive Infiltration/Inflow [ ];
Building Alterations [ ]; Other ________________________________________________.
Bedding must be used for new or replacement sewer work as required by MWRD specifications.
5. PIPE MATERIAL AND JOINTS
Diameter
Length
Material and
Specification
Joint and
Specification
No. of Structure (s).
EXISTING
PROPOSED
6. PERMITTEE (MUNICIPALITY) 7. CO-PERMITTEE (OWNER)
I hereby certify that the project described herein will be We have read and thoroughly understand the conditions
constructed in accordance with all applicable requirements and requirements of this permit application.
and necessary supervision will be provided.
Address: ____________________________________________ Address: __________________________________________
____________________ Zip ____________________ _____________________ Zip __________________
Name: ____________________________________________ Name: __________________________________________
Title: ____________________________________________ Title: __________________________________________
Signature: ____________________________________________ Signature: __________________________________________
Date: ___________________ Phone:_______________________ Date: _________________ Phone: _______________________
FOR MWRD USE ONLY…………………………………………………………………………………………………………………
NRI APPROVAL
By: _________________________________________________ Date Issued: _________________________________________
(Local Sewer Systems)
Fee Paid $_______________________
Atlas Sheet _______ Location: Horizontal (hh) _______ Vertical (vv) ________ Service Basin _______ Drainage Basin Code Number_______
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1. APPLICABILITY: This form may be used in lieu of a standard Watershed Management Permit form only if the works consist of:
A. A development area less than 0.5acres, or the new impervious area created for a ROW project is less than 0.5acres.
B. Sewer reconstruction, relining, rehabilitation.
Sewer reconstruction, replacement, repair (including spot repairs involving excavation) on public right-of-way or utility easement,
including appurtenances, using the same alignment (same trench); or,
Reconstruction of an existing building sewer service, including the addition of an inspection or maintenance manhole, with no change in
alignment. Reconstructed sewers must be of the same diameter as that being replaced; and/or,
C. MinornNew construction
The addition of a grease trap/separator, triple basin, or maintenance inspection manhole or mud basin with less than 25 linear feet of new
sewer service construction with no new connection to an existing sewer main, in conjunction with building alteration, and/or change in
ownership or use. Plans are required for new construction.
This form shall not be used if the alignment is changed more than 5 feet horizontally, if new service areas are added, or if new sewer work
would require stormwater management facilities, or if reconstructed/replaced sewers will be larger in diameter than the existing sewer
(including via pipe bursting). For these cases, a standard Watershed Management Permit is required.
2. INSTRUCTIONS FOR FILING FORMS: Submit typed NRI form in quadruplicate; complete all information or indicate non-applicability; do
not leave any blank spaces; use “X” for checking applicable information. Submit four (4) copies of location map and plans. Submit two (2)
copies of specifications, where applicable. Address all correspondence to Local Sewer Systems Section; for any inquiries or assistance, call
(312) 751-3260.
Make written submittal sufficiently in advance. Give advance notice of at least two (2) working days before any work is started (telephone
(708) 588-4055). For emergency repairs, give advance notice and obtain permission to start before any work is started, and proceed with
written submittal. Failure to give advance notice and make written submittal as required constitutes a violation of the Watershed Management
Ordinance.
3. EXPIRATION: This NRI will expire if construction has not started within one (1) year from the date of issuance. Construction under an
expired NRI is deemed construction without a permit. Construction must be completed within one (1) year after start of construction.
4. REVOCATION: In issuing this NRI, the MWRD has relied upon the statements and representations made by the Applicant or his/her agent.
Any incorrect statements or misrepresentations will be cause for revocation of this NRI, and all rights of the Applicant hereunder will
immediately become null and void.
5. PERMIT FEES: The permit fee to be presented with the NRI applications is XXX plus XX per linear foot of sewer. (There is no fee for
government public works projects.) The Fee Payment Voucher form is to be completed and submitted as instructed on that form. This NRI
application will not be processed unless the fee, where applicable, is paid in full.
INSPECTION REPORT: (FOR MWRD USE ONLY) ---------------------------------------------------------------------------------------------------------------
1. TIME SCHEDULE: (a) Verbal telephone notice received ____ (b) Work started ____ Work completed _____ (c) First inspection made ____
Total number of inspection made ________.
2. SUPERVISION: (a) Construction supervision provided: Yes __ No __. If yes, supervision by Municipal employee ____ by Consultant ____
(b) Name of inspector _________________________.
3. MANHOLES: (a) With respect to the ground immediately adjacent, existing rims are below ____; at or above ____ immediate surroundings.
(b) Existing /new manholes are located in a low area and are subject to entry of surface runoff: Yes ___ No ___. If yes, watertight manhole
covers are provided: Yes __ No __ (c) Condition of walls, bench, and frame of existing manholes: Subject to infiltration ___; Satisfactory
____.
4. MATERIALS: (A) Existing pipe ___ Existing bedding ____; Existing joint ___. (b) New pipe ____; New bedding ____; New joint ____.
5. TESTING AND APPROVAL: (a) Visual inspection only ___; Other tests (specify) __________________.
(b) Test or inspection performed by: Municipal employee _____; Consultant ______; MWRD _______.
(c) Names of persons performing or witnessing test or inspection:
_____________________________________________________________.
__________________________________________________________________________________________________________________
Comments: ________________________________________________________________________________________________________
__________________________________________________________________________________________________________________.
-----------------------------------------------APPROVAL BY METROPOLITAN WATER RECLAMATON DISTRICT--------------------------------------
The project has been inspected and is hereby approved. (Test method _______________________________.)
This approval does not constitute a release from other obligations under the Watershed Management Ordinance.
Date: _____________________________________ ___________________________ ___________________________________________
MWRD Area Inspector MWRD Area Engineer/Field Supervisor
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