4052 Mica Tr - Inspection FormCity or boo
Residential Sanitary Sewer Service
Compliance inspection
• W
Date 0// 7..i / /c Time • - p p
Name,44/ l t ' 141 ' Disk #
PID Number '
House Number
�-i
4" to 6" Transition:
/ Alter j ative Mailing Address
/ 1 r • . ...
No roof drain connection
0 Sump pit not connected to
sanitary sewer
Sump pump properly piped
No sump pump
White Copy: Property Owner
Street Name
v
OwnerlO ccupant Signature
6'
pliance Non- Compliance
No foundation drain connection 0 Clear water connections to
7
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service: ey
Yellow Copy: City of Fagan
Record Number
0
rte'
.46 am
• y1 Time • / o pm
Phone (-1 r'
X 1 / //..
;;-,- . i
( !pector Signature
For inform ation call 651.470.2788
Obstruction 1 No Access
Unable to push past 0 No one in
feet
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks ( Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes CO ( vC '' -7c' - c!
(. l i
;�
".�
Total
Sump pumps
=~
Foundation drains
„.0.,
.,,,,,.- .�-- �^v °�M
Roof drains
f
�~--
City or boo
Residential Sanitary Sewer Service
Compliance inspection
• W
Date 0// 7..i / /c Time • - p p
Name,44/ l t ' 141 ' Disk #
PID Number '
House Number
�-i
4" to 6" Transition:
/ Alter j ative Mailing Address
/ 1 r • . ...
No roof drain connection
0 Sump pit not connected to
sanitary sewer
Sump pump properly piped
No sump pump
White Copy: Property Owner
Street Name
v
OwnerlO ccupant Signature
6'
pliance Non- Compliance
No foundation drain connection 0 Clear water connections to
7
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service: ey
Yellow Copy: City of Fagan
Record Number
0
rte'
.46 am
• y1 Time • / o pm
Phone (-1 r'
X 1 / //..
;;-,- . i
( !pector Signature
For inform ation call 651.470.2788
Obstruction 1 No Access
Unable to push past 0 No one in
feet
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks ( Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH