Form CS-6 "Pipe Installation Inspection Form" - Pennsylvania

What Is Form CS-6?

This is a legal form that was released by the Pennsylvania Department of Transportation - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the Pennsylvania Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CS-6 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Transportation.

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Download Form CS-6 "Pipe Installation Inspection Form" - Pennsylvania

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CS-6 (3-19)
PiPe installation insPection Form
www.penndot.gov
Project # ___________________________________________
County, Route & Segment
Inspector ___________________________________________
Installation Date
Item # ______________________
Ref. # ________________
Producer Code _____________ Contractor______________
Description ____________________________________________________________________________________________
Station ______________________
Plan Page ____________
Pipe Mat’l (RCP, Metal, HDPE, Iron, Other) ______________
Do not lay slope back or cut extra
Pipe Size _________ inches
trench width below top of pipe
W = Width of trench at Top of Pipe
feet
W
Refer to RC – 30M
Note: Trench or shoring walls to be vertical to Top of Pipe
B = Thickness of bedding under pipe.
inches
Backfill
Do
T
T = Outside diameter of pipe to trench wall.
inches
S = Total Depth of bedding.
inches
Bedding
S
Do = Outside diameter of pipe
inches
B
Trench & Bedding Checks* (Actual Field Measurements)
Check Stations & Location
T
W
B
S
Do
Initial
Date
* Check every 50 feet, with a minimum of two checks per run.
Grade
Field
Check
Measurements
Method
Compaction
Soil or
Lift
Density
Date
% passing
# compactor
(Depth - ft)
(Ruler,
Method/
Aggregate
Thickness
required
3/8” sieve
passes/lift
laser)
Equipment
Type
(inches)
(% SPD)
0’ - 3’
100 %
mmm
3’ -
%
100
%
100
%
100
%
100
Type of Joints (601.3d) ____________________
Joints Installed Satisfactorily?. . . . . . . . . . . . . . . . . . .
Yes
No
Materials: Certified or Tested and approved prior to incorporation into the project? . . . . . . . . . . . . . . . . . . . . . .
Yes
No
All pavement undermining cut back and removed prior to compaction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
CS-6 (3-19)
PiPe installation insPection Form
www.penndot.gov
Project # ___________________________________________
County, Route & Segment
Inspector ___________________________________________
Installation Date
Item # ______________________
Ref. # ________________
Producer Code _____________ Contractor______________
Description ____________________________________________________________________________________________
Station ______________________
Plan Page ____________
Pipe Mat’l (RCP, Metal, HDPE, Iron, Other) ______________
Do not lay slope back or cut extra
Pipe Size _________ inches
trench width below top of pipe
W = Width of trench at Top of Pipe
feet
W
Refer to RC – 30M
Note: Trench or shoring walls to be vertical to Top of Pipe
B = Thickness of bedding under pipe.
inches
Backfill
Do
T
T = Outside diameter of pipe to trench wall.
inches
S = Total Depth of bedding.
inches
Bedding
S
Do = Outside diameter of pipe
inches
B
Trench & Bedding Checks* (Actual Field Measurements)
Check Stations & Location
T
W
B
S
Do
Initial
Date
* Check every 50 feet, with a minimum of two checks per run.
Grade
Field
Check
Measurements
Method
Compaction
Soil or
Lift
Density
Date
% passing
# compactor
(Depth - ft)
(Ruler,
Method/
Aggregate
Thickness
required
3/8” sieve
passes/lift
laser)
Equipment
Type
(inches)
(% SPD)
0’ - 3’
100 %
mmm
3’ -
%
100
%
100
%
100
%
100
Type of Joints (601.3d) ____________________
Joints Installed Satisfactorily?. . . . . . . . . . . . . . . . . . .
Yes
No
Materials: Certified or Tested and approved prior to incorporation into the project? . . . . . . . . . . . . . . . . . . . . . .
Yes
No
All pavement undermining cut back and removed prior to compaction? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes
No
CS-6 (3-19)
Remarks: Record problems, soft foundations, under cuts, rock, obstructions, utilities encountered, deviations, etc. Describe and
note location of existing conduits encountered, whether connected, plugged and abandoned, reconnected, etc.
Sketch Area:
Inspector’s Signature
Date
By signing below, I certify that my company performed the work, the information on both pages of this form is accurate, the work
complied with Publication 408, including Section 601 and references therein, and any deviations are noted on this form.
Name (print): ___________________________________________________ Title:
Company Name: ________________________________________________________________________________________
Signature: _____________________________________________________ Date:
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