3793 South Hills Cir - Inspection Form
Residential Sanitary Sewer Service
01~
City I p Compliance Inspection
Date ? Time p pm Record Number
W
I~€ame J/~` =Disk n Time m
PID Number
House Number, Street Name
Alternative Mailing Address Phone
j
_ ( 7i1 1_
OwnerlOccupont Signature Inspector Signature
For information call 651.470.2788
Compliance Non-Compliance Obstruction No Access
No foundation drain connection O Clear, water- connections to Unable to push past O No one in
D No roof drain connection sanitary sewer- feet O Access to service
O Service lateral defects lateral needed
O Sump pit not connected to O Defective manholes
sanitary sewer O Inspection
O Sump pump connected to sanitary
refused
O Sump pump properly piped sewer,
;Q No sump pump O Flexible sump pump piping
I A--
Service Lateral Inspection Findings Number of stacl<s_ ~ Entered S L at
Roots
Poor Pipejoints _
Mineral Deposit
Sag/Pipe Deflection
Damaged Pipe _
Transition a
4" to 6"Transition: Length of Service: _ Final Cleanout:
Notes
Number Discharged .
Total Correctly Incorrectly Unknown
Sump pumps '
Foundation drains
Roof drains
White Copy: Property OFn1ei Yellow Copy: City of Pagan Pink Copy: SEH