1615 Norwood Dr - Inspection Form4. 111. City of Ca au
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
P1D Number
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Poor PipeJoints
4" to 6 "Transition:
1
White Copy: Property Owner
s m
a
Time _ / Pm
Disk #
Owner /Occupant Signature
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 Number of stacks Entered SL ,at
Roots
Mineral Deposits
SaglPipe Deflection_
Damaged Pipe,
Transition
CD - f _n Time
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
O am
•
• O Pm
House Number ) ! ; ) Street Name ) \) (
Alternative Mailing Address
Phone : � . -•
Inspector Signature , y � �'sj ��
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SFH
Number Discharged
Notes
i
; ';', ) 7 ' ,' _ _ . ` r ' . -'I
4
; -1 _'' 1.• ?... -,=
----7 / ..� • � ` -- -- .. % c7--`
_
1
Total
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
__.p j
.i ...
4. 111. City of Ca au
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
P1D Number
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Poor PipeJoints
4" to 6 "Transition:
1
White Copy: Property Owner
s m
a
Time _ / Pm
Disk #
Owner /Occupant Signature
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 Number of stacks Entered SL ,at
Roots
Mineral Deposits
SaglPipe Deflection_
Damaged Pipe,
Transition
CD - f _n Time
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
O am
•
• O Pm
House Number ) ! ; ) Street Name ) \) (
Alternative Mailing Address
Phone : � . -•
Inspector Signature , y � �'sj ��
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SFH
