West Mifflin Sanitary Sewer Municipal Authority
Roof, Driveway, and Area Drain Connection Survey
DYE TESTING REPORT
Testing & Report by:						Date:
Property Address
Owner's Name						Dye Test
DIAGRAM OF PROPERTY
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Rear Property Line
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Building Line
						Street Line
						Street Line
Description of Violation (show location by number on the sketch)
Downspout in Sanitary Sewer					Driveway and Other Drains in Sanitary Sewer
				Legend
#1				Item	Results	#1
				ss- sanitary sewer	v-violation
#2				mh-manhole	?-undeterminable	#2
				st-storm drain	x-cross connection
#3				cr-creek	o-observed visually	#3
				cb-catch basin	t-sound out tapping
#4				ve-vent	r-road	#4
				rl-roof leader	s-surface
Final Result:  Pass or Fail				sd-stairwell drain	e-elevated	Additional Notes:
(please circle one)				wd-walk drain	g-ground
				dd-driveway drain	c-clogged
If test failed please explain below				fd-foundation drain	m-maintenance
				ww-window well	a-abandoned
				ad-area drain
				co-clean out
				gc-ground conductor