N.P.Quality Control Sub Dn.No.2/4A,Bharuch.

REPORT ON UGPL WORKS INSPECTED BY QUALITY CONTROL DEE/AEs

Block No: Date: / /2017

Minor: Name of Sub Minor(Chak No.):

Sr.
Particular Observations
No
1 1 Inner Diameter of pipe
2 length of pipe laid: (i) provision
(ii) laid
3 Pipe manufacture Name /batch no.
4 Pipe brand approved by SSNL YES/NO
5 Test results of UPVC pipe YES/NO
IF yes Testing Agency:

6 Whether all pipes on site are ISI approved YES/NO

and LOGO match on pipes
7 Depth of trench (excavation)
8 Line & Level condition of laid pipe
9 Sluice Valve- manufacturer Brand

10 pipe joint status

2 1 Size of off taking well Inner Dia. of well

2 Thickness of offtaking well at top
3 Whether Cement Plaster done or Not YES/NO
4 Coping YES/NO thickness ______ mm
5 No. of Stairs/steps provided
6 Strainer provided YES/NO
7 Cover slab on off taking well provided YES/NO
3 1 No. of TO Kundies
2 Size of TO kundi

3 Whether Cement Plaster done or Not YES/NO

Sr.
Particular Observations
No
4 1 Type of UGPL System Lift / Gravity
2 Trial run status by TPI / Field staff with
Rojkam
3 No. of Air vent provided
4 ELBOW/BEND/TEE-ISI mark - YES/NO
5 Pipe line for Sub minor network during visit OPEN / PARTIAL / BACKFILLED

6 Layout Drawing of Subminor at site of work YES/NO

7 Test result of Bricks/sand/kapachi YES/NO
5 Other Observations:
1
2
3
4
5

Sign of Agency:

Sign of Field Staff:

AE/AAE/WA
N.P.Canal sub Dn No. DEE/AE
N.P.QUALITY CONTROL SUB DN NO.2/4A,
BHARUCH