2036 Shale Lane - Inspection FormCite of EaPH
Residential Sanitary Sewer Service
Compliance Inspection
• s o am
Dated �rl' 1 1 � Time � �pm
Name 2)./..:44../AC
Disk #
PID Number
House Number 2 J76/ Street Name _ -1 e - 4A/
Alternative Mailing Address
White Copy: Property Owner
e
1,/^
is
OwnerfOccupant Signature
Compliance
0-No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Non - Compliance
0
O
O
0
0
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
4" to 6" Transition: 74/1„,
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
Service Lateral Inspection Findings Number of stacks / Entered S,L,at
•
o am
P pm
Phone 7, �' r,. . az-,/
ilnspecto Signature
Obstruction
Unable to push past
feet
For information call 65 „470.2788
No Access
O No one in
JC
Final Cleanout:
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Nriinber
Correctly
Discharged
Notes
Total
Incorrectly
Unknown
Sump pumps
__,_
_ ___..__
._.__ .�.____.
Foundation drains..
Roof drains
T
Cite of EaPH
Residential Sanitary Sewer Service
Compliance Inspection
• s o am
Dated �rl' 1 1 � Time � �pm
Name 2)./..:44../AC
Disk #
PID Number
House Number 2 J76/ Street Name _ -1 e - 4A/
Alternative Mailing Address
White Copy: Property Owner
e
1,/^
is
OwnerfOccupant Signature
Compliance
0-No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Non - Compliance
0
O
O
0
0
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
4" to 6" Transition: 74/1„,
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
Service Lateral Inspection Findings Number of stacks / Entered S,L,at
•
o am
P pm
Phone 7, �' r,. . az-,/
ilnspecto Signature
Obstruction
Unable to push past
feet
For information call 65 „470.2788
No Access
O No one in
JC
Final Cleanout:
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH