1323 St Andrew Blvd - Inspection Form46—
City a1 Faaan
Residential Sanitary Sewer Service
Compliance Inspection
1
Date l / ) (!
J J) Name ,
PID Number
House Number —) Street Name
Alternative Mailing Address
Compliance
dwnerlOcciipant Signature
For information call 651.470.2788
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Ser vice Lateral Inspection Findings
Time if • •
Disk #
4
an
Pm
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
Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Length of Service:
Number Discharged
Sump pumps
Foundation drains
Roof drains
Total
0
Correctly Incorrectly Unknown
i
Record Number
Notes
Time
i
A
am
) n •yr4 !C
i • Q pm
75,
Phone /:,
Inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: / fc
Yellow Copy: City of pagan Pink Copy: SEH
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