2030 Jade Lane - Inspection Form' 1. City of b!a au
Residential Sanitary Sewer Service
Compliance Inspection
Date (75-. / 07/
Name / 1 -4!174 �r rf Disk #
PID Number
•
Compliance
No foundation drain connection
No roof drain connection
y
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Sag /Pipe Deflection
Damaged Pipe
Transition i'i
4" to 6" Transition:
White Copy: Property Owner
Time 43 • • dzpm
Ownerl0ccupant Signature
0
5J-
0
House Number 2 -....76 ) Street Name _C, ?7 L4/
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
,4 Sump pump connected to sanitary
\ sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Fagan
Record Number
r _
Time / • • / m°m
Alternative Mailing Address Phone ![? .9
r
r
/k7
; Cn`s pector Signature
{
For information call 651.470.2788
Obstruction
Unable to push past
feet
No Access
O No one in
/7- 17 ,r /
�i 7. ` v- -- -.24,- /r1 ; -v ;/ ( , rr f 1
/4 5 < 4/ 4 >�= 1 Z >, / /vf l' "7:n., CV 7 -.. , ( -
r !
O Access to service
lateral needed
O inspection
refused
Service Lateral Inspection Findings Number of stacics I Entered S . at c_ _f2
Poor Pipe joints
Mineral Deposits
Final Cleanout: 7
3
Notes l�r t I.. DSc, -//A% 4
t ezz:)...f may' b
rev
JGi. /G f i
te r'
0,;-„, J. (7 74,6
Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
Unknown
Sump pumps
i
Foundation drains
Roof drains
: -
' 1. City of b!a au
Residential Sanitary Sewer Service
Compliance Inspection
Date (75-. / 07/
Name / 1 -4!174 �r rf Disk #
PID Number
•
Compliance
No foundation drain connection
No roof drain connection
y
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Sag /Pipe Deflection
Damaged Pipe
Transition i'i
4" to 6" Transition:
White Copy: Property Owner
Time 43 • • dzpm
Ownerl0ccupant Signature
0
5J-
0
House Number 2 -....76 ) Street Name _C, ?7 L4/
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
,4 Sump pump connected to sanitary
\ sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Fagan
Record Number
r _
Time / • • / m°m
Alternative Mailing Address Phone ![? .9
r
r
/k7
; Cn`s pector Signature
{
For information call 651.470.2788
Obstruction
Unable to push past
feet
No Access
O No one in
/7- 17 ,r /
�i 7. ` v- -- -.24,- /r1 ; -v ;/ ( , rr f 1
/4 5 < 4/ 4 >�= 1 Z >, / /vf l' "7:n., CV 7 -.. , ( -
r !
O Access to service
lateral needed
O inspection
refused
Service Lateral Inspection Findings Number of stacics I Entered S . at c_ _f2
Poor Pipe joints
Mineral Deposits
Final Cleanout: 7
3
Notes l�r t I.. DSc, -//A% 4
t ezz:)...f may' b
rev
JGi. /G f i
te r'
0,;-„, J. (7 74,6
Pink Copy: SEH