2102 Jade Lane - Inspection FormSump pumps
f `
Foundation drains
73,
Roof drains
Vi
4411
.City of Fa ai
Residential Sanitary Sewer Service
Compliance Inspection
Date 1(11
r
Name - A I f
PID Number
House Number . l % Street Name
pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
1,
, No sump pump
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: PA operty Owner
Owner /Occupant Signature
Total
�0 3 Liam
Time �c •
r
Disk #
pm
7
Number Discharged
Correctly Incorrectly Unknown
f !
Alternative Mailing Address
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
Record Number I
1f -2/• �!� � am
Mime i
1 77 i
n �� 1
Phone
Inspect r Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Service Lateral lnspectibn Findings Number of stacks - I Entered S.L. at
Roots ✓�
=�r
O pm
No Access
O No one in
Poor Pipejoints
Length of Service: 1/.1 Final Cleanout: !
Notes
moo' = ,M11
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Fagan Pink Copy: SEH