4617 1_2 Penkwe Way - Inspection FormCity of Ira pU
Residential Sanitary Sewer Service
Compliance Inspection
Dat 1 1 /K'
Name Al ie ( - 1 ' 7 "Pr"V)
PID Number
House Number
Alternative Mailing Address
Transition
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
^,Q No sump pump
Poor Pipe joints
4" to 6" Transition:
✓9,,. f '
Street Name %if3 s l L»�' / • r
1. f j .. j 1l L/ f i _ \,7- r il S
I - Phone ° I� r
-2 1
Time
Disk #
OwnerlOccupant Signature
• ,✓ /,, 0 am • e fpm
For information call 651.470.2788
Compliance
} / No foundation drain connection
1 6 No roof drain connection
Service Lateral Inspection Findings
Mineral Deposits
SaglPipe Deflection
Damaged Pipe i
}
White Copy: Property Owner
Non - Compliance
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks _ /
1
3
1
f l
Length of Service:
1
Record Number {�
Entered S.L. at
Yellow Copy: Cit of Fagan
f7 •- Oam
Time 13 • tpm
Inspector Signature
Obstruction
No Access
O No one in
O Access to service.
lateral needed
O Inspection
r efused
Roots
Final Cleanout: ''r�fl/
Pink Copy: SEH
Total
Notes _._ ,$ /r i 4/1 4,/, '_ '-:: --' ..� -_.f�
r
1 J C{ ,
I C B /-1-77:;9,( f:,i '
-
,.
Number.;
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
= `
f --
Foundation drains
,
Roof drains
,
"
- �___.�- _
City of Ira pU
Residential Sanitary Sewer Service
Compliance Inspection
Dat 1 1 /K'
Name Al ie ( - 1 ' 7 "Pr"V)
PID Number
House Number
Alternative Mailing Address
Transition
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
^,Q No sump pump
Poor Pipe joints
4" to 6" Transition:
✓9,,. f '
Street Name %if3 s l L»�' / • r
1. f j .. j 1l L/ f i _ \,7- r il S
I - Phone ° I� r
-2 1
Time
Disk #
OwnerlOccupant Signature
• ,✓ /,, 0 am • e fpm
For information call 651.470.2788
Compliance
} / No foundation drain connection
1 6 No roof drain connection
Service Lateral Inspection Findings
Mineral Deposits
SaglPipe Deflection
Damaged Pipe i
}
White Copy: Property Owner
Non - Compliance
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacks _ /
1
3
1
f l
Length of Service:
1
Record Number {�
Entered S.L. at
Yellow Copy: Cit of Fagan
f7 •- Oam
Time 13 • tpm
Inspector Signature
Obstruction
No Access
O No one in
O Access to service.
lateral needed
O Inspection
r efused
Roots
Final Cleanout: ''r�fl/
Pink Copy: SEH
; e.V.04 '1. /
Number D
Discharged z
z ,
Notes -- ( //rr ;
r City !t }ajar
Residential Sanitary Sewer SerV Ce
Compliance Inspection
Date 1 2 0
Name //C
Q' Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Transition 1!Ai /
4" to 6 "Transition:
'White Copy: Properiy Owner
s Time
t re-7/1 Disk #
PID Number
•07 C. am
• ? T p
House Number -;�.'� 2'' Street Name /6 -`. .^-/ - 1
J a do G /,,,rat i; }jr /
Alternative MailingAddress - . (n ..' A a ' Phon¢ ` ( J f` ?
,1
OwnerlOccupont .Signature
For information call 651.470.2788
Compliance
No foundation drain connection
10 No roof drain" connection
Ser vice Lateral Inspection Findings
Sag /Pipe Deflection
Damaged Pipe
3 i 1111 r*
Non - Compliance
t / ;
O
O
O
0
0
1 N r
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks _ t
f �
/'r-v ltl
Length of Service:
Yellow Copy: City of Fagan
f
Record Number
Obstruction
Unable to push past
feet
Entered S L. at
f • �,� o am
Time , J • ' o am
.4 Inspector Signature
�I$
'/6
Final Cleanout: ! ' '
r
i 3 � v _ . o rs 1; /L£. ` / ✓ %'t C . , �
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH