2129 Marble Lane - Inspection Formr City of > ,a pi
Residential ;Sanitary Sewer Service
Compliance Inspection
Date ''' 1 ° > / /,
Name J 7"/ tom'
PID Number
House Number
Alternative Mailing Address
Compliance
No foundation drain connection
(No roof drain connection
O Sump pit not connected to
sanitar y sewer
O Sump pump properly piped
No sump pump
Sag /Pipe Deflection
Damaged Pipe r r '
r y.C. Transition
4" to 6 "Transition:
White Copy: Property Owner
• _ p C� p`_am
Time O pm
Disk #
1 67. 7 Street Name
Owner /Occupant Signature
For information calf 65
Service Lateral Inspection Findin s Number of stacks
Roots (( ?-
Poor Pipe Joints
r F
Mineral Deposits � r � �� y � �` � � �7e)
fl0
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
r
C {. 7
C)
7
LLi -HH
;.Length of Service:
Yellow Copy: City of Fagan
Record Number
o am
Time • — -o pm
Phone . t
A
Obstruction
Unable to push past
feet
Entered S L at
7
•
i' ,inspector Signature
No Access
O No one in
Final Cleanout: ✓ -
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps]
_- . -
w —_...
Foundation drains
i�
--
_____
Roof drains
.:�
_. _ .
r City of > ,a pi
Residential ;Sanitary Sewer Service
Compliance Inspection
Date ''' 1 ° > / /,
Name J 7"/ tom'
PID Number
House Number
Alternative Mailing Address
Compliance
No foundation drain connection
(No roof drain connection
O Sump pit not connected to
sanitar y sewer
O Sump pump properly piped
No sump pump
Sag /Pipe Deflection
Damaged Pipe r r '
r y.C. Transition
4" to 6 "Transition:
White Copy: Property Owner
• _ p C� p`_am
Time O pm
Disk #
1 67. 7 Street Name
Owner /Occupant Signature
For information calf 65
Service Lateral Inspection Findin s Number of stacks
Roots (( ?-
Poor Pipe Joints
r F
Mineral Deposits � r � �� y � �` � � �7e)
fl0
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
r
C {. 7
C)
7
LLi -HH
;.Length of Service:
Yellow Copy: City of Fagan
Record Number
o am
Time • — -o pm
Phone . t
A
Obstruction
Unable to push past
feet
Entered S L at
7
•
i' ,inspector Signature
No Access
O No one in
Final Cleanout: ✓ -
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH