Surveying Form

Free Fillable As-Built Survey

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LS-0639 fieldsdocumentation

Project Information

Project Name*

Project Number*

Surveyor Name*

Survey Date*

Client Name

General Contractor

Design Engineer / EOR

Permit / Plan Set Number

Construction Completion Date

Design Drawing Reference

Feature ID & Description

Feature ID / Point Number*

Feature Category*

Feature Code

Feature Description*

Pipe Size & Material

Structure Material / Specification

As-Built Coordinates & Elevation

As-Built Northing*

As-Built Easting*

As-Built Rim / Top Elevation (ft or m)

As-Built Invert Elevation (ft or m)

As-Built Depth / Cover (ft)

Coordinate System*

Vertical Datum

Collection Method

Design Deviation Notes

Design Northing

Design Easting

Design Elevation (ft or m)

Horizontal Deviation (ft)

Distance between as-built and design horizontal position

Vertical Deviation (ft)

Difference between as-built and design elevation

Within Design Tolerance*

Deviation Notes

RFI / Change Order Reference

Compliance Verification

Complies with Approved Plans*

Complies with Permit Conditions

Inspector / Owner's Rep Name

Inspection Status

Punch List Items NotedPunch List Items Noted

Compliance Notes

Photo Documentation

Location

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