4603 Penkwe Way - Inspection Form
Residential Sanitary Sewer Service
41' City of ir Compliance Inspection
Date. > 1 t' 1 ! Time pm Record Number
Name i f .i 1~,Disk# Time Pm
PID Number
House Number Street Name
Alternative Mailing Address ~T, Phone
T' wnerlOccupant *ature Inspector Signature
For information call 651.470.2788
Compliance Non-Compliance Obstruction No Access
O No foundation drain connection O Clear water connections to Unable to push past O No one in
.Q No roof drain connection sanitary sewer feet O Access to service
O Service lateral defects lateral needed
0 Sump pit not connected to O Defective manholes
sanitary sewer O Inspection
O Sump pump connected to sanitary
O Sump pump properly piped sewer, refused
O No sump pump O Flexible sump pump piping
Service Lateral Inspection Findings Number' of stacks! _ Entered S,L. at
Roots _
Poor-Pipejoints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6"Transition: Length of Service: Final Clean out:
Notes.
Number Discharged
Total Correctly Incorrectly Unknown y i'/ ! c ^"ff''
Sump pumps f
Foundation drains _
Roof drains
White Copy: Property Owner Yellow Copy: Ciry of Pagan ' _ Pink Copy: SEH