4765 Penkwe Cir - Inspection Form41111
Ca of flap
Residential Sanitary Sewer Service
Compliance Inspection
Date / / 2 /i kg
Name
PID Number
House Number -. 7 treet Name
Alternative Mailing Address
f Oviner/Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
• sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6"Transition:
White Copy: Proper ty Owner
/.
Time
Disk #
am
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
Record Number
Obstruction
Unable to push past
feet
o am
Time • 0 pm
Phone 4-7
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered 5 L. at
Roots
Poor joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Final Cleanout:
Yellow Copy: City of Fagan
Pink Copy: SEH
.//),.."-). )27
Number
Correctly
Discharged
Incorrectly Unknown
N otes
4. . ,...,
(C, /a 1/7 °1
— '
Total
Sump pumps
'
Foundation drains
Roof drains
.„-----,
.----"
------,
.__-----
41111
Ca of flap
Residential Sanitary Sewer Service
Compliance Inspection
Date / / 2 /i kg
Name
PID Number
House Number -. 7 treet Name
Alternative Mailing Address
f Oviner/Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
• sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6"Transition:
White Copy: Proper ty Owner
/.
Time
Disk #
am
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
Record Number
Obstruction
Unable to push past
feet
o am
Time • 0 pm
Phone 4-7
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered 5 L. at
Roots
Poor joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Final Cleanout:
Yellow Copy: City of Fagan
Pink Copy: SEH
.//),.."-). )27