Proposed Materials
             PROJECT NAME:____________________________________________________________________________________
             PROJECT ID #  ________________________________________            DATE:  _______________________________
             CONTRACTOR:  _____________________________________  SUPPLIER:  ___________________________________
             This form is for use on land development projects being done under a Construction Permit from Loudoun Water. 
              Where work is governed by a capital construction contract between contractor and Loudoun Water, see 
             contract documents for submittal requirements.  By submitting this form, the contractor confirms that all water, 
             reclaimed water and/or sanitary sewer materials used in the construction will conform to Loudoun Water's 
             Engineering Design Manual, including the Standard Details and Approved Materials List.  Where specialized 
             installations or materials are needed, a request for installation specific shop drawings will be within the 
             approval letter for the project (from Loudoun Water to the developer).  Please list all specialized materials 
             being proposed below.  Add any specialty items not already listed.  Provide shop drawings for the specialized 
             materials only, except where other items are specifically requested by Loudoun Water.
             Are there any specialized materials required for this project? (circle one)                     Yes/No
             Specialized Material                      Manufacturer           Name/Model #          Intended Application
             General Use Items
             casing
             casing spacers
             Water
             restrained joint piping system
             vault
             Reclaimed Water
             restrained joint piping system
             vault
             plumbing plans for systems 
             served by more than one water 
             source
             blow down meter configuration
             reclaimed water labeling and 
             signage
             Gravity Sewer
             restrained pipe through casing
             manhole with reducing slab
             grease interceptor
             oil/water separator
             grit collector/other pretreatment
             reclamation system (e.g at car 
             wash)
             Other Items
             Engineering Design Manual, Appendix A                                                                Page 1 of 1
             Proposed Materials
             October 2016