4118 Nicols Rd - Inspection FormGil of Eakao
Residential Sanitary Sewer Service
Compliance Inspection
Date // J (�
Name \ ( (!/q /0c'4/(
Disk # [J.
PID Number
House Number Street Name /` j f
Alternative
Mailing Ad eels
C s
OwnerlOccupan Signature
For information call 65
.470.2788
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
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection L( 1 �/Jr / i o‘ 1/ P
Damaged Pipe
Transition L
4" to 6" Transition:
White Copy: Property Owner
Time // ,. r
1
0
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
l,/ Co . -5 ,
i
Length of Service:
Yellow Copy: City of Fagan
Record Number
r
Notes
Time / •
f i
�i �'),72 f
Phone i !�
inspector Signature
Obstruction
Unable to push past
feet
Entered S.L at ('(
r
Final Cleanout: ,l �'-7
(D/$2J . i
- &am
_O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Number
Correctly
Discharged
Incorrectly
Unknown
Sump pumps
.w - -- -----.__
Foundation drains
Roof drains
— �
Gil of Eakao
Residential Sanitary Sewer Service
Compliance Inspection
Date // J (�
Name \ ( (!/q /0c'4/(
Disk # [J.
PID Number
House Number Street Name /` j f
Alternative
Mailing Ad eels
C s
OwnerlOccupan Signature
For information call 65
.470.2788
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
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection L( 1 �/Jr / i o‘ 1/ P
Damaged Pipe
Transition L
4" to 6" Transition:
White Copy: Property Owner
Time // ,. r
1
0
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
l,/ Co . -5 ,
i
Length of Service:
Yellow Copy: City of Fagan
Record Number
r
Notes
Time / •
f i
�i �'),72 f
Phone i !�
inspector Signature
Obstruction
Unable to push past
feet
Entered S.L at ('(
r
Final Cleanout: ,l �'-7
(D/$2J . i
- &am
_O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH