DRNACH ENVIRONMENTAL, INC.

MANHOLE INSPECTION FORM

Surveyor's Name

Project Name

Manhole Identification

Site Description

Street

Date

Site Photo

Frame And Cover

Cover:

Solid

Pick holes

Diameter (in.):

At Grade:

Below:

Above:

DS Rim to Invert (in):

Interior

Brick:

Precast:

Other:

Ladder Present:

Safe:

Infiltration Observed

Describe:

Inlets

Interior Photo

Size:

Pipe Material:

Notes:

Indicate Flow metering potential (Good, Fair, Poor)

inch

inch

inch

inch

inch

Outlets

Size:

Pipe Material:

Notes:

inch

inch

GPS Information

Accuracy:

feet

Elevation:

feet

Latitude:

40°

Longitude:

79°

Notes