1567 Sherwood Way - Inspection Forms41 City o1bpi]
Residential Sanitary Sewer Service
Compliance Inspection
Date :y5 /
Name
PID Number
1 -louse Number
Alternative Mailing Address
4" to 6 "Transition:
White Copy: Property Owner
• =} l rw )q am
Time f • O pm
-":). Disk#
7 Street Name
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewe r
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks___ Entered S at
Roots
Poor Pipejoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Time
F }
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
• O am
• O pm
O Inspection
refused
co
No Access
:Q No one in
O Access to service
lateral needed
Pink Copy: SEH
Total
Notes
7
- i : � !
l
1 ' '. , � i
f
/
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
41 City o1bpi]
Residential Sanitary Sewer Service
Compliance Inspection
Date :y5 /
Name
PID Number
1 -louse Number
Alternative Mailing Address
4" to 6 "Transition:
White Copy: Property Owner
• =} l rw )q am
Time f • O pm
-":). Disk#
7 Street Name
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewe r
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks___ Entered S at
Roots
Poor Pipejoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Time
F }
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
• O am
• O pm
O Inspection
refused
co
No Access
:Q No one in
O Access to service
lateral needed
Pink Copy: SEH
4 it city of hp
Residential Sanitary Sewer Service
Compliance Inspection
- r2 j r"
Date --
)7>"71)( Name=� <474(1 Disk #
PID Number'
Compliance
No foundation drain connection
No roof drain connection
White Copy: Pr operty Owner
/
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 4,. -4-- f'. 4-7-1
j
4" to 6" Transition:
• (3.2...-J
h/ . 1 • pm
House Number } 7 Street Name
OwnerlOccupant Signature
Alternative Mailing Address
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
Service Lateral Inspection Findings N mber of stacks
Roots C = ; r!
r
Length of Ser vice:
Yellow Copy: City of Hagan
Record Number
r � � • f (yam
Time /. - • o pm
Phone } ,
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L.at
Final Cleanout:
Notes
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
1 /
�:
. /�)• l
} -
7 rL,
f'
;+ ,
/
r 2,
Foundation drains
/ J
'
Roof drains
A
4 it city of hp
Residential Sanitary Sewer Service
Compliance Inspection
- r2 j r"
Date --
)7>"71)( Name=� <474(1 Disk #
PID Number'
Compliance
No foundation drain connection
No roof drain connection
White Copy: Pr operty Owner
/
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 4,. -4-- f'. 4-7-1
j
4" to 6" Transition:
• (3.2...-J
h/ . 1 • pm
House Number } 7 Street Name
OwnerlOccupant Signature
Alternative Mailing Address
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
Service Lateral Inspection Findings N mber of stacks
Roots C = ; r!
r
Length of Ser vice:
Yellow Copy: City of Hagan
Record Number
r � � • f (yam
Time /. - • o pm
Phone } ,
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L.at
Final Cleanout:
Notes
Pink Copy: SEH