2033 Bluestone Lane - Inspection FormCity of Eaiq
Residential Sanitary Sewer. Service
Compliance Inspection
Date / ! / Time . • a a
Name / Disk#
HD Number
House Number .---)
umber ,✓"',Y1 )Street Name
Alternative Mailing Addr
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
11
Transition i f
4" to 6" Transition:
Owner /Occupant Signature
3
Length of Service:
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
O Flexible sump pump piping
Record Number
Notes
Obstruction
Unable to push past
feet
•
O am
D pm
Phone _ J _ 2 2 `"' : {16
Inspector Signature
.- lFinal Cleanout:
.1�
For information call 651.470.2788
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at ` 7
Yellow Copy: City of Fagan Pink Copy: SEH
Total
Number
Discharged
Correctly
incorrectly Unknown
Sump pumps
C—/
Foundation drains
'I .-./
Roof drains
/11)
City of Eaiq
Residential Sanitary Sewer. Service
Compliance Inspection
Date / ! / Time . • a a
Name / Disk#
HD Number
House Number .---)
umber ,✓"',Y1 )Street Name
Alternative Mailing Addr
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
11
Transition i f
4" to 6" Transition:
Owner /Occupant Signature
3
Length of Service:
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
O Flexible sump pump piping
Record Number
Notes
Obstruction
Unable to push past
feet
•
O am
D pm
Phone _ J _ 2 2 `"' : {16
Inspector Signature
.- lFinal Cleanout:
.1�
For information call 651.470.2788
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at ` 7
Yellow Copy: City of Fagan Pink Copy: SEH