1995 Zircon Lane - Inspection FormsResidential Sanitary Sewer Service
City of lia it Compliance Inspection
Date I0e/
Name C��/I. #
PID Number
House Number [ Street Name _�' �' /Ft
Alternative Mailing Address
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots i r S
4" to 6" Transition:
White Copy: Owner
Owner /Occupant Signature
Time / :_ 6/ g"
v
f
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
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
Length of Ser vice: ' --
Record Number
Notes
r�T Oam
Time / ® '• 3 pm
Phon -r!".� o . .
') Spector Signature
For information call 651 A70 2788
Obstruction
Unable to push past
feet
Number of stacks 1 Entered S,L,at 7e
Final Cleanout:
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Yellow Copy: City of pagan { ,' Pink Copy SEH
Number
Correctly
Discharged
Incorrectly Unknown
Total
Sump pumps
_�
Foundation drains
-----°
`
Roof drains
Residential Sanitary Sewer Service
City of lia it Compliance Inspection
Date I0e/
Name C��/I. #
PID Number
House Number [ Street Name _�' �' /Ft
Alternative Mailing Address
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots i r S
4" to 6" Transition:
White Copy: Owner
Owner /Occupant Signature
Time / :_ 6/ g"
v
f
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
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
Length of Ser vice: ' --
Record Number
Notes
r�T Oam
Time / ® '• 3 pm
Phon -r!".� o . .
') Spector Signature
For information call 651 A70 2788
Obstruction
Unable to push past
feet
Number of stacks 1 Entered S,L,at 7e
Final Cleanout:
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Yellow Copy: City of pagan { ,' Pink Copy SEH
Residential Sanitary Sewer Service
City of lia it Compliance Inspection
Date I0e/
Name C��/I. #
PID Number
House Number [ Street Name _�' �' /Ft
Alternative Mailing Address
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots i r S
4" to 6" Transition:
White Copy: Owner
Owner /Occupant Signature
Time / :_ 6/ g"
v
f
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
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
Length of Ser vice: ' --
Record Number
Notes
r�T Oam
Time / ® '• 3 pm
Phon -r!".� o . .
') Spector Signature
For information call 651 A70 2788
Obstruction
Unable to push past
feet
Number of stacks 1 Entered S,L,at % n1
Final Cleanout:
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Yellow Copy: City of pagan { ,' Pink Copy SEH
Number
Correctly
Discharged
Incorrectly Unknown
Total
Sump pumps
_�
Foundation drains
-----°
`
Roof drains
Residential Sanitary Sewer Service
City of lia it Compliance Inspection
Date I0e/
Name C��/I. #
PID Number
House Number [ Street Name _�' �' /Ft
Alternative Mailing Address
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots i r S
4" to 6" Transition:
White Copy: Owner
Owner /Occupant Signature
Time / :_ 6/ g"
v
f
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
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
Length of Ser vice: ' --
Record Number
Notes
r�T Oam
Time / ® '• 3 pm
Phon -r!".� o . .
') Spector Signature
For information call 651 A70 2788
Obstruction
Unable to push past
feet
Number of stacks 1 Entered S,L,at % n1
Final Cleanout:
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Yellow Copy: City of pagan { ,' Pink Copy SEH