We are sometimes asked to supply one of those forms too. We keep one pre-printed copy in our office and fill in only the job address and numbers as per job requirement. But basically, it is only description of work with list of materials and safety precautions to be taken.
Also, they want to know whether you have clay pipe under the footprint of your new addition. If positive, than they will ask you to re-routed or maybe to change it to PVC or ABS.
As for your case, ( and for example ) you would type on piece of stationary what you intent to do. The engineer at the Building Department has to understand your intent w/o coming out to physically check out your project. He also wants to be sure you have the minimal knowledge of the procedure.
You would write something like: Replace existing (4" clay ) sewer line with new ( 4" ABS ) sewer, bonded with ABS glue, sloped 1/8" per foot between front of your house and property line. Give number of existing and new plumbing fixtures in your house. List degree of bends you plan on using, location and position of Clean Outs, developed length of new sewer pipe and estimated depth. Put down water test you plan on doing on this new pipe ( 10' of water column on the high end ). List connectors between new and existing. If trench deeper than 5', mention approved shoring. List local number for "Dig-Alert" service so they know you are aware of standard excavation practices. We always include hand-sketched plot plan with new sewer as bold line.
In our area we can log-in into Dept of Street and Maintenance system and use their own numbers in our Statement, like: depth, soil composition, size of lateral, type of sewer, point of entry, property lines, etc.
The overall statement may sound complicated to somebody who does it once in his/her lifetime, but it is nothing else but formality.
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