1567 Sherwood Way - Inspection Form411 City or hp
Residential Sanitary Sewer Service
Compliance Inspection
Date ! / )
Name 4 //K 1) Disk #
WID Number
House Number Street Name
Alternative Mailing Address
Owner - Occupant Signature
For information call 651.970.2788
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
Service Lateral inspection Findings
4" to 6" Transition:
White Copy: Property Owner
i i •r_! am
Time r : • o pm
Non - Compliance
O
O
O
O
O
-m -m
J3 ' ✓'
3 A 1/'
f
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Record Number'
Time
Phone
,..-
Inspector Signature
Obstruction
Unable to push past
feet
• o am
• o p m
. � )
o Access
No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks _ Entered S. L_ at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Notes
•
Final Cleanout:
Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
411 City or hp
Residential Sanitary Sewer Service
Compliance Inspection
Date ! / )
Name 4 //K 1) Disk #
WID Number
House Number Street Name
Alternative Mailing Address
Owner - Occupant Signature
For information call 651.970.2788
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
Service Lateral inspection Findings
4" to 6" Transition:
White Copy: Property Owner
i i •r_! am
Time r : • o pm
Non - Compliance
O
O
O
O
O
-m -m
J3 ' ✓'
3 A 1/'
f
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Record Number'
Time
Phone
,..-
Inspector Signature
Obstruction
Unable to push past
feet
• o am
• o p m
. � )
o Access
No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks _ Entered S. L_ at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Notes
•
Final Cleanout:
Pink Copy: SEH