4721 Westminster Cir - Inspection Form4 1101P'
City Ca ti
Residential Sanitary Sewer Service
Compliance Inspection
Date /S1 24
Name /J' r�.�e .,
PID Number
House Number (72
Alternative Mailing Address
Disk #
0
Street Name
Owner /Occupant Signature' -
For information call 651.470.2788
Compliance
O No foundation drain connection
X
No No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump purnp properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection 5Y s :=
Damaged Pipe
Transition 4
,-1/7/
4" to 6" Transition:
;
White Copy: Property Owner
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number
Obstruction
Unable to push past
feet
Entered S.L at ,.)
T
r� • o am
Time °" • Q1 pm
Phone '/ Z C 7 s i
/t7/
Inspector Signature
�T
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SPH
Number
Correctly
Discharged
Incorrectly Unkno
Notes ° 1� �. .
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1°55 i 4 67 - i . : — ,
: 4 I ' , i , 1 ,,_.
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Sump pumps
Foundation drains
Total
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!} fr
II
El
Roof drains
s
_
i i
4 1101P'
City Ca ti
Residential Sanitary Sewer Service
Compliance Inspection
Date /S1 24
Name /J' r�.�e .,
PID Number
House Number (72
Alternative Mailing Address
Disk #
0
Street Name
Owner /Occupant Signature' -
For information call 651.470.2788
Compliance
O No foundation drain connection
X
No No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump purnp properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection 5Y s :=
Damaged Pipe
Transition 4
,-1/7/
4" to 6" Transition:
;
White Copy: Property Owner
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number
Obstruction
Unable to push past
feet
Entered S.L at ,.)
T
r� • o am
Time °" • Q1 pm
Phone '/ Z C 7 s i
/t7/
Inspector Signature
�T
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SPH