1661 Sherwood Way - Inspection Form•
4 11111 1 P - • •
City ol tap
Residential Sanitary Sewer Service
Compliance Inspection
9 am
Date,, / / ( Time
Pm
Name
ND Number
House Number
Alternative Mailing Address
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Poor PipeJoints
Mineral Deposits
4" to 6" Transition:
White Copy: Proper ty Owner
Disk #
/2
Street Name
z
Owner/Occupant Signature
Compliance
O No foundation drain connection
Service Lateral inspection Findings
Non-Compliance
Number of stacks
— 1
Sag/Pipe Deflection_
Damaged Pipe
„;» (7 /-
Transition ; ,--)
Yellow Copy: City of Eagan
Record Number
Phone
Obstruction
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Entered SL at
/
ime
ea.sPolvisVe•
• e pAaM
• pm
(-112 ij •
•-9
inspector Signature
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
ikr)(f?
Length of Service:
H Final Cleanout:
fpri -- r 6
Pink Copy: SEH
Number Disch
ged
Unknown
Notes / /
..." -- I", f,5 ,,,...",
--'' / ' "--- ,. -
--- ./.--1-•-i i , ,---, ,- ..--
—.L.- ,./-) „..- ....-' / '
7 ) ''
i (:)/ 1 L.- (---"L l
- 3':---, - /(7) ,,...--
,
Total
Correctly
Incorrectly
Sump pumps
-1 .,
,......-, ,--...
o /
..,,, / ,.
/-
--,
.
.., •
.., ---- ...).
1 '
--- 4.
Foundation drains
.
/
Roof drains
( ;
,.._...-
•
4 11111 1 P - • •
City ol tap
Residential Sanitary Sewer Service
Compliance Inspection
9 am
Date,, / / ( Time
Pm
Name
ND Number
House Number
Alternative Mailing Address
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Poor PipeJoints
Mineral Deposits
4" to 6" Transition:
White Copy: Proper ty Owner
Disk #
/2
Street Name
z
Owner/Occupant Signature
Compliance
O No foundation drain connection
Service Lateral inspection Findings
Non-Compliance
Number of stacks
— 1
Sag/Pipe Deflection_
Damaged Pipe
„;» (7 /-
Transition ; ,--)
Yellow Copy: City of Eagan
Record Number
Phone
Obstruction
O Clear water connections to Unable to push past
sanitary sewer feet
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Entered SL at
/
ime
ea.sPolvisVe•
• e pAaM
• pm
(-112 ij •
•-9
inspector Signature
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
ikr)(f?
Length of Service:
H Final Cleanout:
fpri -- r 6
Pink Copy: SEH