4649 Penkwe Way - Inspection FormC pi Iv o
Residential Sanitary Sewer Service
Compliance Inspection
Date`•. 1
Name
7
f ig ' t` s �-
Compliance
V O No foundation drain connection
; O \ No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Sag /Pipe Deflection
Damaged Pipe Transition
1
4" to 6 "Transition:
White Copy: Proper ty Owner
Time
PID Number
House Numbere Street Name
Disk #
Alternative Mailing Address
OwnerlOccupant Signature
For information call 651.470.2788
Non - Compliance
0
O
O
O
O
Service Lateral Inspection Findings Number of stacks i Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
v 0 am
• pm
Clear• water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
. f
Length of Service:
Yellow Copy: City of Fagan
Record Number
4 it
1�
Time f
•
: pm
Obstruction
Unable to push past
feet
Phone,
inspector Signature
Final Cieanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SE H
Total
Notes
,�
�
! /
�i
�,
C7.
1
f^ r�
'(';?/
--
_.,,)
, r
/
/I
l''''"::2(-73,6371----'-e.-'7
\
�^ 1
- _---'
�, 1
.- �:.
l� ,
--1
n
r-3
)
/ �.
%
Number
Discharged
Correctly
Incorrectly
Unknown
ump pumps
Sump
..�,r�
/i
.�
rj
Foundation drains
j
Roof drains
1
C pi Iv o
Residential Sanitary Sewer Service
Compliance Inspection
Date`•. 1
Name
7
f ig ' t` s �-
Compliance
V O No foundation drain connection
; O \ No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Sag /Pipe Deflection
Damaged Pipe Transition
1
4" to 6 "Transition:
White Copy: Proper ty Owner
Time
PID Number
House Numbere Street Name
Disk #
Alternative Mailing Address
OwnerlOccupant Signature
For information call 651.470.2788
Non - Compliance
0
O
O
O
O
Service Lateral Inspection Findings Number of stacks i Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
v 0 am
• pm
Clear• water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
. f
Length of Service:
Yellow Copy: City of Fagan
Record Number
4 it
1�
Time f
•
: pm
Obstruction
Unable to push past
feet
Phone,
inspector Signature
Final Cieanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SE H