1613 Norwood Dr - Inspection Form4 City tit hp
Residential Sanitary Sewer Service
Compliance Inspection
Date ill 1
Name ' °71. 3'" /
PID Number
House Number
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit riot connected to
sanitary sewer
O,Sump pump properly piped
No sump pump
OwnerlOccupant J� ignature
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Proper ty Owner
n
% •✓� am
Time Ir i • O pm
Street Name
O Flexible sump pump piping
Number of stacks
Length of Service:
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Number Discharged
Total
Sump pumps
Foundation drains
Roof drains
Correctly Incorrectly !Jnknovyn
Record Number
1
-, t L.
Obstruction
Unable to push past
feet
Notes
Time
Inspe
ctor Signature
Final Cleanout:
• O am
• o pm
Phone-
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SEH