4767 Cypress Pt - Inspection FormNote
• Number
Correctly
Discharged
Incorrectly Unknown
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Total
Sump pumps
P P p
)i s:
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Foundation drains
Roof drains
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Residential Sanitary Sewer Service
Compliance Inspection
Date I i ,-7 71 /
Name
P1D Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
I
I j :9 �� i f l 'a
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection_
Damaged Pipe
Transition
4" to 6"Transition:
White Copy: Property Owner
ti
i 2. ri„ 0 am
Time • pm
/ { Disk #
/0'.2 Street Name
Owner /Occupant Signature
I
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
Length of Service:
Yellow Copy: City of Eagan
Record Number .
Phone
Time
Obstruction
Unable to push past
feet
t am o
1
• pm
inspector Signature
Entered S L. at
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: / ) /C__--f
Pink Copy: SEH