Project Name:
Project Owner Information
Owner Name:
Contact Name:
Phone No:
Engineering Firm Information
Name:
Address:
Prj. Manager:
Prj. Engr:
Engineer
Project Location
Email:
Main Office Phone:
Email:
Jurisdiction:
Street Address or Intersection:
Tax Map, Parcel ID or GPIN:
Military Facility (if applicable):
NOTE: Please provide general location map (no smaller than 1”-2000’) showing the project location. General wastewater flow path, if applicable, should be indicated as well.
Project & Sewer Utility Infrastructure Description
(attach additional sheets, if necessary)
Project Type
(check only one)
Residential Industrial
Commercial Single Residential
Pump Station Proposed Work
(check only one)
Military Development
Mix Use
VDOT/Roadway
Utility Crossing
New Pump Station - Replacement
Project Development Type
(check only one)
Ex. Pump Station Modifications
New Development
Project Catchment Basin Status
(check only one)
Within Ex. Catchment Basin
Redevelopment
Outside Ex. Catchment Basin New Catchment Basin
Last Revised - July 15, 2014

Proposed Project Sanitary Sewer Service Connection Point Type
(check only one)
Pressure Analysis & Flow Acceptance Required Only Flow Acceptance Request Required
Existing HRSD IFM Branch Valve
New HRSD IFM Tap valve
Jurisdiction FM Directly Connected to HRSD
Existing HRSD Gravity Sewer Manhole
New HRSD Gravity Sewer Manhole
Existing/New Jurisdiction Gravity Sewer Manhole
Jurisdiction Low Pressure FM (gravity outfall)
Estimated Project Design Flow (per the Regional Technical Standards Flow Projection Table )
Number of
Units
Flow per Unit
(gpd)
Flow Duration
(hours)*
Peak Factor
Avg Daily Flow
(gpd)
No. of Units x Flow/Unit
Peak Daily Flow
(gpd)
ADF x Peak Factor
Residential
Commercial
Industrial
Totals:
* Flow duration should be 24 hours for public sewer infrastructure
Industrial Permitted – Regulated Waste Stream
Will your project generate industrial waste and discharge into HRSD’s interceptor network?
Yes No
If Yes, please call Chris Carlough at 757.460.7048 for South Shore or Mike Martin at 757.833.1750 for North
Shore.
Additional Information
Please note the following available HRSD Resources:
1.
2.
3.
4.
5.
HRSD GIS information can be accessed online at http://www.hrsd.com/gis.shtml
HRSD record drawings can be requested directly from the HRSD Drafting Division by sending an email with specific description of the area needed to dpq@hrsd.com
. Map attachments in PDF or JPEG format illustrating the area of interest are encouraged to ensure expedited service.
Connection details and notes are available online at http://www.hrsd.com/interceptorstandardconnectionreq.shtml
.
HRSD construction standards are available online at http://www.hrsd.com/standardsandpreferences.shtml
.
All projects that use these details and notes must still be submitted for HRSD review and approval.
Other Forms
For projects that will need a Pressure Analysis Letter and/or a Flow Acceptance Letter, the necessary Forms can be found online at http://www.hrsd.com/iec.shtml
.
Notice to Applicant
All pressure analysis and flow acceptance requests must be accompanied by this form herein fully completed prior to processing the requests.
Please allow 15 HRSD working days from the date of submittal of all required documents to HRSD pertaining to site plan review, pressure analysis and flow acceptance requests.
All applications need to be emailed to developrequest@hrsd.com
. Electronic versions of all corresponding documentation should be included in the application email as attached files.
For those that cannot email an electronic version of the supporting documentation, please send it via regular mail, along with a copy of the application to: HRSD Development Services, P.O. Box 5911, Virginia Beach VA 23471-0911.
Signature: Date: Click here to enter a date.
Last Revised - July 15, 2014