1928 Carnelian Lane - Inspection FormsCity of }4 d1
Residential Sanitary Sewer Service
Compliance inspection
Date (6 1 1 i L)
- }� )• 1 r 47� f) 2 Disk #
Name ,..
PlD Number
House Number 1 _ ) Street Name
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
1 y i
Transition
4" to b" Transition:
White Copy: Proper ty Owner
�
1
Time •
4
t� = am
O pm
OwnerIOccupant Signature
LLd
Length of Service:
Record Number
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 Eriered S.L at
Yellow Copy: City of Fagan
7
it
• • am
Time r ® pm
Phone ,i °� 1 ` ).
Inspector Signature
Obstruction
Unable to push past
feet
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Nursber
Correctly
Discharged
Incorrectly
Notes
Total
Unknown
Sump pumps
G.
? t )
1 '
F oundation drains
1
Roof drains
/ '
City of }4 d1
Residential Sanitary Sewer Service
Compliance inspection
Date (6 1 1 i L)
- }� )• 1 r 47� f) 2 Disk #
Name ,..
PlD Number
House Number 1 _ ) Street Name
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
1 y i
Transition
4" to b" Transition:
White Copy: Proper ty Owner
�
1
Time •
4
t� = am
O pm
OwnerIOccupant Signature
LLd
Length of Service:
Record Number
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 Eriered S.L at
Yellow Copy: City of Fagan
7
it
• • am
Time r ® pm
Phone ,i °� 1 ` ).
Inspector Signature
Obstruction
Unable to push past
feet
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
City of }4 d1
Residential Sanitary Sewer Service
Compliance inspection
Date (6 1 1 i L)
- }� )• 1 r 47� f) 2 Disk #
Name ,..
PlD Number
House Number 1 _ ) Street Name
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
1 y i
Transition
4" to b" Transition:
White Copy: Proper ty Owner
�
1
Time •
4
t� = am
O pm
OwnerIOccupant Signature
LLd
Length of Service:
Record Number
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 Eriered S.L at
Yellow Copy: City of Fagan
7
it
• • am
Time r ® pm
Phone ,i °� 1 ` ).
Inspector Signature
Obstruction
Unable to push past
feet
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Nursber
Correctly
Discharged
Incorrectly
Notes
Total
Unknown
Sump pumps
G.
? t )
1 '
F oundation drains
1
Roof drains
/ '
City of }4 d1
Residential Sanitary Sewer Service
Compliance inspection
Date (6 1 1 i L)
- }� )• 1 r 47� f) 2 Disk #
Name ,..
PlD Number
House Number 1 _ ) Street Name
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
1 y i
Transition
4" to b" Transition:
White Copy: Proper ty Owner
�
1
Time •
4
t� = am
O pm
OwnerIOccupant Signature
LLd
Length of Service:
Record Number
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 Eriered S.L at
Yellow Copy: City of Fagan
7
it
• • am
Time r ® pm
Phone ,i °� 1 ` ).
Inspector Signature
Obstruction
Unable to push past
feet
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH