4616 Cambridge Dr - Inspection Form4 City of Cagan
Residential Sanitary Sewer Service
Compliance Inspection
,rte
Date ,; �1 f — Time M •
5 f 1
Name , i 6. �" � r Disk#
�w m
PID Number
House Number f (-2 Street Name
Owner /Occupant Signature
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
am
pm
Alternative Mailing Address
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
Transition
4" to 6" Transition:
White Copy: Pr oper ty Owner
Length of Service:
Yellow Copy: City of Eagan
Record Number.
Phone
Obstruction
Unable to push past
feet
N otes
Time
•
•
o am
o pm
inspector Signature
Final Cleanout:
n
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L_at
■
v 1/
f
! L ✓ r L� d '�✓ b f.A���'�' ��
Pink Copy: SEH
Nunsber
Discharged
Total
Correctly
Incorrectly
Unknown
Sump pumps
el
/1
Foundation drains
Roof drains
4 City of Cagan
Residential Sanitary Sewer Service
Compliance Inspection
,rte
Date ,; �1 f — Time M •
5 f 1
Name , i 6. �" � r Disk#
�w m
PID Number
House Number f (-2 Street Name
Owner /Occupant Signature
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
am
pm
Alternative Mailing Address
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
Transition
4" to 6" Transition:
White Copy: Pr oper ty Owner
Length of Service:
Yellow Copy: City of Eagan
Record Number.
Phone
Obstruction
Unable to push past
feet
N otes
Time
•
•
o am
o pm
inspector Signature
Final Cleanout:
n
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L_at
■
v 1/
f
! L ✓ r L� d '�✓ b f.A���'�' ��
Pink Copy: SEH