1592 Norwood Cir - Inspection Formit CA of Eau
Residential Sanitary Sewer Service
Compliance Inspection
Date f r -
Name .! y c - ''a ,'. Disk #
PID Number
House Number
�k l
Compliance
O No foundation drain connection
O No roof drain connection
O Surnp pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Sag /Pipe Deflection
4" to 6 "Transition:
White Copy: Property Owner
i
2 ( am
Time tr O pm
Owner /Occupant Signature
O
O
O
O
O
Street Name
Alternative Mailing Address
For information call 651.0'0.27n
Non - Compliance
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks Entered 5 L at
Mineral Deposits `° >`1/ _�
fr fir-; !.J
Damaged Pipe
Transition
Length of Service:
Yellow Gopy: City of Eagan
Record Number
Time • •
1
! � ! 1 .. - -1 1
Phone `a
•
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
`/ Xam
0 pm
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Notes
Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
EMI
Unknown
Sump pumps
IIII
MI
Foundation drains
Roof drains
it CA of Eau
Residential Sanitary Sewer Service
Compliance Inspection
Date f r -
Name .! y c - ''a ,'. Disk #
PID Number
House Number
�k l
Compliance
O No foundation drain connection
O No roof drain connection
O Surnp pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Sag /Pipe Deflection
4" to 6 "Transition:
White Copy: Property Owner
i
2 ( am
Time tr O pm
Owner /Occupant Signature
O
O
O
O
O
Street Name
Alternative Mailing Address
For information call 651.0'0.27n
Non - Compliance
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks Entered 5 L at
Mineral Deposits `° >`1/ _�
fr fir-; !.J
Damaged Pipe
Transition
Length of Service:
Yellow Gopy: City of Eagan
Record Number
Time • •
1
! � ! 1 .. - -1 1
Phone `a
•
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
`/ Xam
0 pm
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Notes
Pink Copy: SEH