841 Ivy Lane - Inspection Form4 City of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date 031 2'6 k2
n �
Name 4 4Yer !€ 5 Disk #
PID Number
House Number Street Name
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
V No roof drain connection
0 / Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transition 3
4" to 6" Tr ansition:
! F
White Copy: Property Owner
v l
% G 4 ingiOccupant Signature
• 7 ,r -m
Time V 8 a
• V p pm
0
L
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
Length of Service:
Yellow Copy: City of Eaga
) 7Z1
Record Number
Phone g i ) ?/• . 72i?
i nspector Signature
Obstruction
Unable to push past
feet
Entered S . at
/,/;. - 7 _> f
Time
0 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Final Cleanout: j i , ft
Pink Copy: SEH
Total
Notes .:.. 6 747 .6. ,-
f
/� 0 2.) 5f! l `�
4/0 1 /
hr -r. - r' f
!!11
6/A% 61, 1 4::,
,2 —
te,,., - A - . (r E_.
-1,,m (.
'' %!J
t,
J`V� /1.�f
.� 4.----4-%(...
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
,
Foundation drains
Roof drains
- ...° _."
l_
4 City of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date 031 2'6 k2
n �
Name 4 4Yer !€ 5 Disk #
PID Number
House Number Street Name
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
V No roof drain connection
0 / Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transition 3
4" to 6" Tr ansition:
! F
White Copy: Property Owner
v l
% G 4 ingiOccupant Signature
• 7 ,r -m
Time V 8 a
• V p pm
0
L
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
Length of Service:
Yellow Copy: City of Eaga
) 7Z1
Record Number
Phone g i ) ?/• . 72i?
i nspector Signature
Obstruction
Unable to push past
feet
Entered S . at
/,/;. - 7 _> f
Time
0 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Final Cleanout: j i , ft
Pink Copy: SEH