4662 Stonecliffe Dr - Inspection Formr
Number
Correctly
Discharged
Incorrectly Unknown
Notes r.
' jai I - f %1 , ft' j
1 3 ` i
� � -
, 1 ` ' Off _ i
;,' �� ��( / `'' r _�
Total
Sump pumps
Ell
Foundation drains
r :
Roof drains
My of Ea ii
Residential Sanitary Sewer Service
Compliance Inspection
/y
Date,-/- / 1 /
Name 7"
PID Number
House Number
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
,6 Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
Disk #
Time •
Street Name
Owner /Occupant Signature
am
Pm
Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number 1
/ : , ---) • ,. o am
- ! Time > a b pm
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
1J i i
, ,q /
Phone
Obstruction
Unable to push past
feet
Entered S. at
Inspector Signature
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
, -- 1 L Final Cleanout: ,C%
Pink Copy: SEH