4770 Beacon Hill Rd - Inspection FormCity of bpi
Y �
Residential Sanitary Sewer Service
Compliance Inspection
Dace L Th A
1 L/
Name "-" , a. Disk #
POD Number
House Number
Compliance
. i
No foundation drain connection
3 No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Time __. ..
n
! !' Street Name
OwnerlOccupant Signature
Service Lateral Inspection Findings
Transition
4" to 6" Transition:
White Copy: Property Owner
am
0 pm
4=7. (. 7
"a e / / r,' � .�.')• !• —r�-
Length of Service:
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
Yellow Copy: City of Fagan
Record Number
n
ii am
Time �" o pm
I
J .r
/
r
Phone .
Inspector Signature
For information call 651.4
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks Entered 5.L at ' - -- ar - ;� - ' '>
Roots
Poor Pipe Joints
Mineral Deposits 3
(SagtPipe Deflection L- � 1 -t
Damaged Pipe
i S
, Cleanout: ='
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
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Foundation drains
Roof drains
i 3
City of bpi
Y �
Residential Sanitary Sewer Service
Compliance Inspection
Dace L Th A
1 L/
Name "-" , a. Disk #
POD Number
House Number
Compliance
. i
No foundation drain connection
3 No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Time __. ..
n
! !' Street Name
OwnerlOccupant Signature
Service Lateral Inspection Findings
Transition
4" to 6" Transition:
White Copy: Property Owner
am
0 pm
4=7. (. 7
"a e / / r,' � .�.')• !• —r�-
Length of Service:
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
Yellow Copy: City of Fagan
Record Number
n
ii am
Time �" o pm
I
J .r
/
r
Phone .
Inspector Signature
For information call 651.4
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks Entered 5.L at ' - -- ar - ;� - ' '>
Roots
Poor Pipe Joints
Mineral Deposits 3
(SagtPipe Deflection L- � 1 -t
Damaged Pipe
i S
, Cleanout: ='
Pink Copy: SEH