4851 Sheffield Cir - Inspection FormCit of l a an
Residential Sanitary Sewer Service
Compliance Inspection
.7; t = /
Date �� ...il / / / (• / Time
Name, `f�
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O 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
4" to 6 "Transition:
White Copy: Property Owner
Disk #
# Street Name
Ownerldccupant Signature
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
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
Obstruction
Unable to push past
feet
Entered S.L at
•
•
1 ' F
Inspector Signature
Final Cleanout:
o am
.D pm
!
Ph --) (f . 37 - ' ) ,.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
>' ./' t } C ]� %' i - -' /
< . �' _::i L ' ice 7 c- 77
/`�1 !; ` ;f�` , i Yf
"� .. ' �- - - 7
Total
Sump pumps
�T..
�� jt
, r„
1
Foundation drains
Roof drains
Cit of l a an
Residential Sanitary Sewer Service
Compliance Inspection
.7; t = /
Date �� ...il / / / (• / Time
Name, `f�
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O 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
4" to 6 "Transition:
White Copy: Property Owner
Disk #
# Street Name
Ownerldccupant Signature
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
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
Obstruction
Unable to push past
feet
Entered S.L at
•
•
1 ' F
Inspector Signature
Final Cleanout:
o am
.D pm
!
Ph --) (f . 37 - ' ) ,.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH