4654 Cambridge Dr - Inspection FormSump pumps
4
Foundation drains
Roof drains
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4 1.
City of Fa all
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Residential Sanitary Sewer Service
Compliance Inspection
Date IL rl
1 4 r
Name ,� r l A dF Disk #
PID Number
House Number
udo
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AlterrIative Mai ing Address Phone
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For information call 651.470.2788
Compliance
O No foundation drain connection
I No roof+drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Proper ty Owner
Time / am
D � > ✓ ;
4 Pm
1 4 - 5_ treet Name
OwnerlOccupant Signature
7
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
Length of Service:
Number Discharged
Total Correctly Incorrectly Unknown
Record Number
Obstruction
Unable to push past
feet.
Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Notes
Time
•
•
Inspector Signature
Final Cleanout:
o em
O pm
7)i
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH