2010 Emerald Lane - Inspection FormCity Fagan
Residential Sanitary Sewer Service
Compliance inspecti ®n
Date
Name
(2 2 /2
J
0
Time
) ` / (} Disk#
P1D Number
House Number � � )( Street Name _
/4 / i )74
Alternative Mailing Address
Phone
( c�
Owner /Occupant Signature
For information. call 651A70.27
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump 0 Flexible sump pump piping
Service Lateral lnspectiti Findings Number of stacks
Roots ✓ , -
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Length of Service: 4.- Final Cleanout:
Total
r
0
Sump pumps
Foundation drains
Roof drains
White Copy: Property Owner
l am
pm
7,
Correctly
Incorrectly
Unknown
Yellow Copy. City of Fagan
Record Number
14
Notes
•
Time s_ o --
Inspector Signature
Obstruction
Unable to push past
feet
Entered S.L.at
am
o pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH