Attachment_E_-_MH_Inspection_Location_Criteria_Form.pdf
PDF 20 KB Posted
- Attached to
- On-Call CCTV Sanitary Sewer Inspection
- Solicitation number
- 2026-RFSQ-00541
- Issued by
- San Mateo County, California
About this file
This is a Manhole Inspection Location Criteria Form attachment to an On-Call CCTV Sanitary Sewer Inspection contract opportunity issued by the County of San Mateo Department of Public Works in California. The form serves as a standardized tool for documenting and prioritizing sanitary sewer manhole inspection locations based on multiple assessment criteria. The document includes fields for recording camera numbers, location sketches, drainage information, sewer line details, asset numbers, and photo documentation with directional references. The form is designed to be completed during field inspections to capture essential location and condition data for each manhole and downstream segments.
The form establishes a prioritization framework using three primary scoring categories: Public Impact (rated 1-5 based on proximity to public facilities, traffic levels, and economic considerations), Environmental Assessment (rated 1-5 based on distance to waterways and storm drain inlets), and Operations and Maintenance Access and Safety (rated 1-5 based on accessibility and working conditions). These criteria enable the County to systematically evaluate and rank inspection locations to support ongoing sanitary sewer system condition assessment, maintenance planning, and regulatory compliance with the County's Sewer System Management Plan. The scoring system ranges from minimal impact or accessibility concerns (rating of 1) to significant public safety risks or severe access limitations (rating of 5), allowing systematic resource allocation for the on-call inspection program.
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Text version
Camera No.
General Picture No.
LOCATION SKETCH BY SANITARY SEWER MANHOLE Drainage Picture No.
Sewer Line Sewer MH Asset #:
Storm Drain Line Drain Inlet Water Line Valve Likely spill path Photo Direction Date:
LOCATION CRITERIA FORM
Completed by:
LEGEND NOTES
N
Likely spill path Photo Direction Date:
(Applies to manhole and segment downstream of manhole)
LOCATION DESCRIPTION PRIORITY
Public Impact
(Proximity to public facilities, Economic impact, Public health or safety concerns) Picture No.
Environmental
(Proximity to nearest drain inlet and waterway of the U.S. / Description of conditions) Picture No.
Access / Safety
(Safe, readily accessible area, Traffic level, Strategic importance to operation of system ) Picture No.
Inspection #:
Group Project#:
O & M HISTORY
N
Location – Public Impact Public Impact
Rating
> 1000 feet from public facilities, limited public traffic, limited economic impact within 1000 feet of public facilities, moderate public traffic, moderate economic impact within 100 feet of public facilities, significant public traffic, significant economic impact, high construction cost
Location – Proximity to Waterways Environmental
Score
Upstream SSMH > 2500 ft to waterway 1
Upstream SSMH > 2500 ft to waterway & < 500 ft to storm DI 2
Upstream SSMH < 2500 ft to waterway 3
Upstream SSMH < 2500 ft to waterway & < 500 ft to storm DI 4
Upstream SSMH < 1000 ft to waterway 5
Location – O&M Access and Safety O&M Access and
Safety Rating
In roadway, residential street 1
In roadway, arterial roadway 2
Not in roadway, can access with truck 3
Not in roadway, must walk equipment to site 4
Not in roadway, no safe working area, under buildings 5
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