4177 Topaz Dr - Inspection FormCity of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date C: / / .)' '
Alternative Mailing Address
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Mine I D posits
Sag /Pi Deflection
Damge Pipe
Tr' nsition
4" to 6" Transition:
White Copy: Property Owner
) • am
Time/ i. pm
PID Number
House Numbed ) 7 Street Name /J t~ I �" � �� /
Phone /�' �) — . {.% � Cr / '
OwnerlOccupant Signature
For information call 65
Compliance Non- Compliance
O No foundation drain connection 0 Clear water connections to
Poor'ipeJoi
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
•
Service Lateral Inspection Findings Number of stacks
Roots
D..Qi-W -CLI
747)1\ ,
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
•
•
Inspector
Obstruction
Unable to push past
feet .
o am
O pm
lat .l ,nry!eee�
O l =ttdfi
refused
No Access
0 No one in
Access to service
d
Entered S.L.at
Final Cleanout:
Pink Copy: SEH
Number.'
Correctly
Discharged
Incorrectly
Notes
.
Total
Unknown
Sump pumps
-.
Foundation drains
Roof drains
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date C: / / .)' '
Alternative Mailing Address
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Mine I D posits
Sag /Pi Deflection
Damge Pipe
Tr' nsition
4" to 6" Transition:
White Copy: Property Owner
) • am
Time/ i. pm
PID Number
House Numbed ) 7 Street Name /J t~ I �" � �� /
Phone /�' �) — . {.% � Cr / '
OwnerlOccupant Signature
For information call 65
Compliance Non- Compliance
O No foundation drain connection 0 Clear water connections to
Poor'ipeJoi
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
•
Service Lateral Inspection Findings Number of stacks
Roots
D..Qi-W -CLI
747)1\ ,
Length of Service:
Yellow Copy: City of Fagan
Record Number
Time
•
•
Inspector
Obstruction
Unable to push past
feet .
o am
O pm
lat .l ,nry!eee�
O l =ttdfi
refused
No Access
0 No one in
Access to service
d
Entered S.L.at
Final Cleanout:
Pink Copy: SEH