1528 Sherwood Way - Inspection Formon
•Residerdial. Sanitary ,Sewer Service
C ompliance , Compflance Inspedtion
Date CP / a,
Name
PID Number
House Number /
Alternate Mailing Address
• 6
Compliance
id
Sump pit not connected to
sanitary sewer
o Sump Pump properly piped
No sump pump
Transition
White Copy: Property Owner
r
�F f J
Owner /Occupant Signature
No foundation drain connection
No roof drain connection
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe.. Deflection. � I
Damaged Pipe
J I
4" to 6" Transition:
Time S
Disk #
am
. Jl (0 0 pm
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
Street Name
Yellow Copy: City of Eagan
Record Number ,17 /1,4 I
Obstruction
Time
Phone
For Information call 651.470.2788
Unable to push past
feet
Number of stacks Entered S L. at
Length of Service: a c∎
Inspector Signature
O am
o pm
No Access
o No one in
O Access to service lateral
needed
o Inspection refused
c I t� •
Final Cleanout: )9t.
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
Total
Notes
4
C %7e
r ' r !I
S 3. -
i
col<.,
/C.7,
C, 0 -
I
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
Foundation Drains
Roof Drains
on
•Residerdial. Sanitary ,Sewer Service
C ompliance , Compflance Inspedtion
Date CP / a,
Name
PID Number
House Number /
Alternate Mailing Address
• 6
Compliance
id
Sump pit not connected to
sanitary sewer
o Sump Pump properly piped
No sump pump
Transition
White Copy: Property Owner
r
�F f J
Owner /Occupant Signature
No foundation drain connection
No roof drain connection
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe.. Deflection. � I
Damaged Pipe
J I
4" to 6" Transition:
Time S
Disk #
am
. Jl (0 0 pm
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
Street Name
Yellow Copy: City of Eagan
Record Number ,17 /1,4 I
Obstruction
Time
Phone
For Information call 651.470.2788
Unable to push past
feet
Number of stacks Entered S L. at
Length of Service: a c∎
Inspector Signature
O am
o pm
No Access
o No one in
O Access to service lateral
needed
o Inspection refused
c I t� •
Final Cleanout: )9t.
Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551