4648 Cambridge Dr - Inspection Form4 110 1
City of liaaao
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name h
PID Number
House Number C )' Street Name
Alternative Mailing Address
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
Disk #
Owner /Occupant Signature
Compliance
O No foundation drain connection
l3
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
•L' oam
• pm
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
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe_
Length of Service:
Record Number
•
Time ,_ •
o am
o pm
Phone: ! °7 L- --
For information call 651.470.2788
Nantes
Obstruction
Unable to push past
feet
Entered S L at
Inspector Signature j \i 7 ) / V1 6 ;
Final Cleanout:
r
•
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
f
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Correctly
Discharged
Incorrectly
Unkno,
r // Ci )/
/1 fM'-
Sump pumps
P
C
T ,. I
'''
1
Foundation drains
J
Roof drains
4 110 1
City of liaaao
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name h
PID Number
House Number C )' Street Name
Alternative Mailing Address
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
Disk #
Owner /Occupant Signature
Compliance
O No foundation drain connection
l3
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
•L' oam
• pm
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
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe_
Length of Service:
Record Number
•
Time ,_ •
o am
o pm
Phone: ! °7 L- --
For information call 651.470.2788
Nantes
Obstruction
Unable to push past
feet
Entered S L at
Inspector Signature j \i 7 ) / V1 6 ;
Final Cleanout:
r
•
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
f
Yellow Copy: City of Eagan Pink Copy: SEH