768 Elrene Ct - Inspection FormResidential Sanitary Sewer Service
Compliance Inspection
Date ;' 1
Roots
Name
PID Number
House Number
Poor Pipe Joints
Mineral Deposits
4" to 6" Transition:
Compliance
O No foundation drain connection
. 0 No roof drain connection
QI Sump plc not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
White Copy: Property Owner
Time ` .
Disk #
Street Name
Alternative Mang "dd ress
ff
; Owner /Occupant Signature
Service Lateral inspection Findings
am
/D pm
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
Sag /Pipe Deflection ._
Damaged Pipe - ' w' /7 - y 1
Transition `� �� �._ �r� � R .._
Yellow Copy: City of Fagan
Record Number
Length of Service:
1 pam
Time - -
Phone r� .. .
r
Obstruction
Unable to push past
feet
Notes
Inspector Signature
For, information call 651 A70.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S. at
Final Cleanout: 1 '
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
C
' -) <-..4
A f ry
-
Foundation drains
Roof drains
}
Residential Sanitary Sewer Service
Compliance Inspection
Date ;' 1
Roots
Name
PID Number
House Number
Poor Pipe Joints
Mineral Deposits
4" to 6" Transition:
Compliance
O No foundation drain connection
. 0 No roof drain connection
QI Sump plc not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
White Copy: Property Owner
Time ` .
Disk #
Street Name
Alternative Mang "dd ress
ff
; Owner /Occupant Signature
Service Lateral inspection Findings
am
/D pm
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
Sag /Pipe Deflection ._
Damaged Pipe - ' w' /7 - y 1
Transition `� �� �._ �r� � R .._
Yellow Copy: City of Fagan
Record Number
Length of Service:
1 pam
Time - -
Phone r� .. .
r
Obstruction
Unable to push past
feet
Notes
Inspector Signature
For, information call 651 A70.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S. at
Final Cleanout: 1 '
Pink Copy: SEH