4531 Lake Park Dr - Inspection Form4 111111 - •
City ol Eapn
Residential Sanitary Sewer Service
Compliance Inspection
▪ A:t am
• 0 pm
,2.. 7 1 (
Date / _
Name j_ 1- Disk # FRI
PiD Number
House Number
Alternative Mailing Address
Compliance
0 No foundation drain connection
‘21 No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
▪ Transition
)(2 '7
'4" to 6" Transition:
White Copy: Property Owner
Time
Street Name
Owner/Occupant Signature
•
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
Yellow Copy: City of Fagan
Record Number
k
Phone
Roots
Poor PipeJoints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
ri t;
Length of Service:
Time 7 • •
/-
inspector Signature
arn
Pm
For information call 651.470.2788
Obstruction
Unable to push past
feet.
Number of stacks _ I Entered S L at
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
)
Final Cleanout: ;
r
Pink Copy: SE H
Number Discharged
Correctly Incorrectly
.
Unknown
Notes , ---,
./1
- / ,„ ri ,_ r
i i 1_, , ----, --: ---,---- 1 .-- i --
- / i
' ) i
11 / A
j
, ,/..t...„,„:::...,.,_._.:_,y,L.,/{7-,_-_-_;f5..,_,/
Total
Sump pumps
4
Foundation drains
y
Roof drains
1, „
4 111111 - •
City ol Eapn
Residential Sanitary Sewer Service
Compliance Inspection
▪ A:t am
• 0 pm
,2.. 7 1 (
Date / _
Name j_ 1- Disk # FRI
PiD Number
House Number
Alternative Mailing Address
Compliance
0 No foundation drain connection
‘21 No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
▪ Transition
)(2 '7
'4" to 6" Transition:
White Copy: Property Owner
Time
Street Name
Owner/Occupant Signature
•
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
Yellow Copy: City of Fagan
Record Number
k
Phone
Roots
Poor PipeJoints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
ri t;
Length of Service:
Time 7 • •
/-
inspector Signature
arn
Pm
For information call 651.470.2788
Obstruction
Unable to push past
feet.
Number of stacks _ I Entered S L at
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
)
Final Cleanout: ;
r
Pink Copy: SE H