1576 Sherwood Way - Inspection FormCity of tap
Residential ;Sanitary Sewer Service
Compliance Inspection
Date ,/
Name
Disk #
4" to 6 "Transition:
PID Number
House Number ,) � fF ) Street Name
Alternative Mailing Address
—�.
,
Lk), 0� �\ k
Owner /Occupant Signature
Compliance
O No foundation drain connection
l No roof drain connection
Sump pit not connected to
' sanitary sewer
_q Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipef oints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition
Sump pumps
Foundation drains
Roof drains
Total
White Copy: Property Owner
'7�`
,1� .�. J em
Time I` :' pm
LLi-LI _1
Length of Service:
Number Discharged
Incorrectly
Yellow Copy: City of Eagan
Record Number ' 7
Time
•
O
/\ / ;
/" Jw 1
Phone 4/ 1.
For information call 651:470.2788
Obstruction
Unable to push past
feet
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
Number of stacks _ Entered 5 L at
Notes
) / \j :
Inspector Signature
Final Cleanout:
0 a
O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
-
Pink Copy: SEH