Gesick & Associates, P.C.

Survey Request Form

Please feel free to fill out and send on-line, or print and Fax to (860) 669-5833.

Call (860) 669-7799 with questions you may have.

Name:
Tel:
E-mail:

PURPOSE OF TOPOGRAPHIC SURVEY

PRELIMINARY PLANNING
FINAL DESIGN
BUILDING SITE
ADDITIONAL (EXPANDED) WORK
OTHER (PLEASE NOTE)

BOUNDARY DATA

OCCUPATION (EXISTING FENCES)
RECORD DATA
FIELD SURVEY/BOUNDARY RESOLUTION

VERTICAL DATUM REQUIRED

COUNTY
CITY
U.S.G.S
ASSUMED
MATCH PREVIOUS
(PLEASE PROVIDE JOB NO.)

SITE FEATURES

CONTOUR INTERVAL = FOOT
SPOT ELEVATIONS GRID
TREES INCH DIAMETER OR GREATER
DRIPLINES
DRAINAGE FEATURES (SWALES, DITCHES, ETC.)
PLEASE OUTLINE ANY AREAS OF CRITICAL DESIGN MATCH TOLERANCES:

UTILITIES

SANITARY SEWER MANHOLES, CLEANOUTS
CURB MARKS
RIM, INVERTS AND PIPE SIZES

STORM DRAIN MANHOLES, CATCH BASINS, DI'S
FIELD DRAINS
RIM, INVERTS AND PIPE SIZES

WATER VALVES, METERS, HYDRANTS
CL&P, SNET: VAULTS, POLES ANCHORS

SIZE, ORIENTATION, DIRECTION OF WIRES
STREET LIGHTS, SIGNALS, SIGNAL BOXES
SERVICE DROPS
PAINTED UTILITY MARKINGS*

*PLEASE NOTIFY "CALL BEFORE YOU DIG" EARLY ENOUGH TO ENSURE THAT UTILITY LOCATIONS WILL BE MARKED PRIOR TO FIELD SURVEYING.

STREET CROSS-SECTIONS AT INTERVALS:
FEET LEFT & FEET RIGHT OF CENTERLINE

CROWN
EDGE OF TRAVELED WAY
LANE/FOG STRIPING
GUTTER LIP @ EP
FLOWLINE OF GUTTER
EDGE OF PAVEMENT
TOP FACE OF CURB
BACK OF SIDEWALK
TOP OF BANK
FLOWLINE OF DITCH
TOE OF BANK
FENCE LINES
CENTER DIVIDERS & OPENINGS OFF-SITE TOPOGRAPHY
DATA TO BE PROVIDED OUTSIDE PROJECT BOUNDARY
CRITICAL VIEW DIRECTIONS (PLEASE NOTE)
SPOT ELEVATIONS GRID
X-SEC'S INTERVALS FEET OFF SITE
SITE PHOTOGRAPHS