1692 Covington Lane - Inspection Form4 City of two
Residential Sanitary Sewer Service
Compliance Inspection
} i
Date--.t"7 1 ) 6" 1
Name
PID Number
House Number 1 li /, Street Name
Alternative Mailing Address
Transition
For information call 651.470.27$$
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection -2
I 1 `'
Damaged Pipe
4" to 6" Transition:
White Copy: Property Owner
Time • pm
Disk #
Owner /Occupant Signature
Non — Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks ;' Entered S L at
,."
Yellow Copy: City of Fagan
r
Record Number �l
Ej Time
/ f
• Xam
• O pm
Phone r < i- 7( -1 - 771
Inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
• ".Final Cleanout: j ,_
Pink Copy: SEH
Number Discharged
Notes / � )
7' . T 2 , , ..w � � 7 f . - . L .�7 /
6
' 'r'% — ,. � � - '
Total
Correctly
Incorrectly Unknown
Sump pumps
__W
/,
' 1'. _
a
Foundation drains
I
Roof drains
4 City of two
Residential Sanitary Sewer Service
Compliance Inspection
} i
Date--.t"7 1 ) 6" 1
Name
PID Number
House Number 1 li /, Street Name
Alternative Mailing Address
Transition
For information call 651.470.27$$
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection -2
I 1 `'
Damaged Pipe
4" to 6" Transition:
White Copy: Property Owner
Time • pm
Disk #
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
Number of stacks ;' Entered S L at
,."
Yellow Copy: City of Fagan
r
Record Number �l
Ej Time
/ f
• Xam
• O pm
Phone r < i- 7( -1 - 771
Inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
• ".Final Cleanout: j ,_
Pink Copy: SEH