4760 London Lane - Inspection Form411
City of Ca i
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
House Number
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
. j. s7 an
Time °? • p
4- 1 1 / . e-" /( I Disk # I ''
PID Number
/its:' : Street Name
Owner /Occupant Signature
Compliance
• No foundation drain connection
.0 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Number of stacks
Length of Service:
Yellow Copy: City of Pagan
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
Record Number
Time
Obstruction
Unable to push past
feet
•
Phone • i ..•
Inspector Signature
0 a
e pm
Entered SL,at —.'.
For information call 651.470.2788
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
D Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number Discharged
Correctly Incorrectly Unknown
Notes
Total
Sump pumps
MI',
Foundation drains
'1
Roof drains
411
City of Ca i
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
House Number
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
. j. s7 an
Time °? • p
4- 1 1 / . e-" /( I Disk # I ''
PID Number
/its:' : Street Name
Owner /Occupant Signature
Compliance
• No foundation drain connection
.0 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Number of stacks
Length of Service:
Yellow Copy: City of Pagan
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
Record Number
Time
Obstruction
Unable to push past
feet
•
Phone • i ..•
Inspector Signature
0 a
e pm
Entered SL,at —.'.
For information call 651.470.2788
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
D Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH