1655 Sherwood Way - Inspection FormNotes
Number
Correctly
Discharged
Incorrectly Unknown
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Total
Sump pumps
p
A /
-9 1
% 'l
/
rains�"�
Foundation drains
/
Roof drains
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---
41110- City or n
Residential Sanitary Sewer Service
Compliance Inspection
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Date / / 1 / Time . '• p
Name l 1 OF Disk #
PID Number
House Number
Alternative Mailing Address
j :
)6;;;;---c.___, Street Name
Owner /Occupant Signature
For information call 651 .470.2788
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
4" to 6 "Transition:
White Copy: Pr operty Owner
0
O
O
0
0
j
4
Non - Compliance
Sag /Pipe Deflection
Damaged Pipe
Transition ,i
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 St at
Length of Service: 1 (
Yellow Copy: City of Pagan
Record Number
2 . 2
Time
r�
Phone :2
Inspector Signature
Final Cleanout:
__. 9,ram
pm
Obstruction No Access
Unable to push past 0 No one in
feet
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH