Sewer Lateral Inspection

• Property Owner's Name:

• Property Address:

• Contractor Name:

• Inspector's Name:

• Conducted on:

  Date

• Prepared on:

  Date

• Prepared by:

• Location
  Address

Sewer Lateral Inspection

• Is cleanout accessible outside of building?

  Yes

  No

  N/A

• Is there a sewer ejector pump at this property?

  Yes

  No

  N/A

• Where is the connection point?

  Sewer Main

  Manhole

• If connection point is at the manhole, has drop in been installed?

  Yes

  No

  N/A

• Does private sewer lateral crosses neighboring private property?

  Yes

  No

  N/A
• Where is the location of the tap?
  Address

• Is there a cleanout at the property line?

  Yes

  No

  N/A

• Is the sewer pipe type the same as approved by MCSD?

  Yes

  No

  N/A

• Is there more than one structure at this address served by the private sewer lateral?

  Yes

  No

  N/A

• Has property been verified as having a working back-flow prevention device?

  Yes

  No

  N/A

• Has property been verified as having no illegal connections including sump pumps, roof gutters, foundation <br>drains, heat pumps, etc?

  Yes

  No

  N/A

• Provide a drawing showing buildings, structures and roadways, water lines, and the directional path of the proposed lateral sewer connection.

  Drawing

CORRECTIVE ACTIONS

• Comments

INSPECTION COMPLETED BY

• Name:

  Sign

• Date and Time

  Date