Manhole Inspection Form
Inspected by
First Name
Last Name
Inspection Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Manhole ID Number
Depth
Diameter
Rim Elevation
Invert Elevation
Construction Material
Brick
Concrete
Polymer
Combination
Please specify apron condition
Good
Fair
Poor
Is there evidence of surcharge?
Yes
No
Additional Comments
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Inspector Signature
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