3665 Windtree Cir - Inspection Form4 City
Residential Sanitary Sewer Service
Compliance Inspection
Date / / 1 1 1 /
Names` d d,' Disk #
PID Number
House Number
Alternative Mailing Address
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
Mineral Deposits
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe joints
Sag /Pipe Deflection
Damaged Pipe
Transition
I �
4" to 6 "Transition:
White Copy: Property `Owr der
Time iL/• '0 pm
L
Owner /Occupant Signature
/,'
Length of Service:
Record Number
(^; ° T Street Name ) t /�!/
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
Obstruction
Unable to push past
feet
T
inspector Signature
Entered S L at
Phone
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
,. Final Cleanout: ''
Notes
✓/ ?•X40
f 1,, ,
Yellow Copy: City - of Fagan Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
-
d
l�.
Foundation drains
Roof drains
%f
4 City
Residential Sanitary Sewer Service
Compliance Inspection
Date / / 1 1 1 /
Names` d d,' Disk #
PID Number
House Number
Alternative Mailing Address
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
Mineral Deposits
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe joints
Sag /Pipe Deflection
Damaged Pipe
Transition
I �
4" to 6 "Transition:
White Copy: Property `Owr der
Time iL/• '0 pm
L
Owner /Occupant Signature
/,'
Length of Service:
Record Number
(^; ° T Street Name ) t /�!/
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
Obstruction
Unable to push past
feet
T
inspector Signature
Entered S L at
Phone
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
,. Final Cleanout: ''
Notes
✓/ ?•X40
f 1,, ,
Yellow Copy: City - of Fagan Pink Copy: SEH