4613 Ridge Cliffe Dr - Inspection Form1 Cityof Ra p
Residential Sanitary Sewer Service
Compliance Inspection
Date ,. > /
Name
°
Roots
Damaged Pipe
/
Transition
4" to 6" Transition:
White Copy: Property Owner
Time i =: • pm
Disk #
PID Number
House Number Street Name
Alternative Mailing Address
/ OwnerlOccupant Signature
Compliance
O No foundation drain connection
; •O No roof drain connection
i u Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
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
Length of Service:
Yellow Copy: City of Fagan
Record Number
Phone
Service Lateral Inspection Findings Number of stacks_ °I Entered S L at
/
Inspector Signature
Obstruction
Unable to push past
feet
o, am
pm
— Final Cleanout:`',`,
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Pink Copy: SEH
Total
Notes
I /
.0 r-,
)
7
]
r t
r f
i
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
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)
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Foundation drains
Roof drains
1 Cityof Ra p
Residential Sanitary Sewer Service
Compliance Inspection
Date ,. > /
Name
°
Roots
Damaged Pipe
/
Transition
4" to 6" Transition:
White Copy: Property Owner
Time i =: • pm
Disk #
PID Number
House Number Street Name
Alternative Mailing Address
/ OwnerlOccupant Signature
Compliance
O No foundation drain connection
; •O No roof drain connection
i u Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
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
Length of Service:
Yellow Copy: City of Fagan
Record Number
Phone
Service Lateral Inspection Findings Number of stacks_ °I Entered S L at
/
Inspector Signature
Obstruction
Unable to push past
feet
o, am
pm
— Final Cleanout:`',`,
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Pink Copy: SEH