4676 Cambridge Dr - Inspection FormCity of n
Residential Sanitary Sewer Service
Compliance Inspection
Dated / 1 ; ,
i
Name
House Number
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
4 Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
4" to 6 "Transition:
White Copy: Property Owner
Time
Disk #
PID Number
1 4 ""7. Street Name
Owner /Occupant Signature
0
O
O
O
0
Service Lateral Inspection Findings
• .-' O, am
• pm
For information call 651.470.2788
Non - Compliance
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe_
1
Transition
/ /) /
Number of stacks //
Length. of Service:
Yellow Copy: City of E agan
Record Number
Phone
a rm
O am
Time • - O pm
•
'N1
Inspector Signature
Obstruction
Unable to push past
feet
Entered S
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout
r,
:: = Copy: SEH
Number Discharged.
Unknown
:N otes n
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a -'' ' , ' ,. :2 - . , e.„- r 7 ra ` s.
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— ` " �'
Total
Correctly
Incorrectly
Sump pumps
,f!
Foundation drains,a
'
Roof drains
City of n
Residential Sanitary Sewer Service
Compliance Inspection
Dated / 1 ; ,
i
Name
House Number
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
4 Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
4" to 6 "Transition:
White Copy: Property Owner
Time
Disk #
PID Number
1 4 ""7. Street Name
Owner /Occupant Signature
0
O
O
O
0
Service Lateral Inspection Findings
• .-' O, am
• pm
For information call 651.470.2788
Non - Compliance
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe_
1
Transition
/ /) /
Number of stacks //
Length. of Service:
Yellow Copy: City of E agan
Record Number
Phone
a rm
O am
Time • - O pm
•
'N1
Inspector Signature
Obstruction
Unable to push past
feet
Entered S
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout
r,
:: = Copy: SEH