2078 Quartz Lane - Inspection FormResidential Sanitary Sewer Service
City Oiliapit Compliance Inspection
Dat -' / /0
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Name i - - 2 2 2
PID Number
House Number 20 7 Street Name
6
— ';Phone � � '� „ " C1 iC" ��
Alternative MailingAddr•ess __ - --- -- — - - - --�
For information call 651 470.2188
Compliance
O 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
Roots 771f'1__. /
Poor Pipe Joints
Mineral Deposits 7
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Sump pumps
Foundation drains
Roof drains
White Copy: Property Owner
Total
0 a
Time J�_stpm
Disk #
Owner /Occupant Signature
IVY 7
Correctly
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 Discharged
LLB
Length of Service:
incorrectly
Unknown
Record Number
0
i
Time
inspector Signature
•
Obstruction
Unable to push past
feet
Number of stacks Entered S.L.at
No Access
O No one in
O Access to service
Lateral needed
O Inspection
r efused
Final Cleanout:
Notes C 0
3 .. .
if
C.�
Yellow Copy: City cif Pink Copy: SF