1607 Sherwood Way - Inspection FormCitoian
Residential Sanitary Sewer Service
Compliance Inspection
Date ' / 1 .
Name /
Compliance
O No foundation drain connection
y
No roof drain connection
O Sump pit not connected to
sanitary sewer
Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Proper Own er
:E '4 am
Time• o pm
Disk #
PID Number
House Number / �2 • ✓ Street Name
Owner /Occupant Signature
MOM
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
Length of Service:
Yellow Copy: City of Eagan
Record Number / ` •
Alternative Mailing Address
0 am
•
Time • o pm
Phone / ' "� � ./� 77
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
Number of stacks Entered S . at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH
Notes
_
Nuriber
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
'y-
;{{
/ (/
i,
(
1
f i r / 2r
/' ;
.--:'
Foundation drains
Roof drains -
�7
---".--.
I
Citoian
Residential Sanitary Sewer Service
Compliance Inspection
Date ' / 1 .
Name /
Compliance
O No foundation drain connection
y
No roof drain connection
O Sump pit not connected to
sanitary sewer
Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Proper Own er
:E '4 am
Time• o pm
Disk #
PID Number
House Number / �2 • ✓ Street Name
Owner /Occupant Signature
MOM
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
Length of Service:
Yellow Copy: City of Eagan
Record Number / ` •
Alternative Mailing Address
0 am
•
Time • o pm
Phone / ' "� � ./� 77
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
Number of stacks Entered S . at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH