1644 Sherwood Way - Inspection Formk.
City of bra ii
Residential Sanitary Sewer Service
Compliance Inspection
Date �' //,, / / f '
Lr
Nam_ �!i�.-= '/} 4Disk # L
PID Number
Alternative Mailing Address
�ry
Compliance
O No foundation drain connection
O No roof drain connection
c( Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
O
Time .j' • b
Owner /Occupant Signature
am
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
LTA E Time
•
House Number /"` Street Name ` " -- °? �' ? ,d/1
Obstruction
Unable to push past
feet
Final Cleanout:
O am
O pm
Phone ..r_"`d
l
Inspector Signature
j j ;
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
_ Entered 5.L. at
Pink Copy: SEH
r
Number
Correctly
Discharged
Notes
/ (..../ 1 / . 7 c-
/6 - e� // "'✓ °"a`
/ .mil " j "�
i. f r.,
c-:::._ r I H
Total
Incorrectly
Unknown
Sump pumps
Sum um s
r'
__f
, - � r
t l 10 r,_
3 I
-
Foundation drains
!
Roof drains
Z —_
_
��
k.
City of bra ii
Residential Sanitary Sewer Service
Compliance Inspection
Date �' //,, / / f '
Lr
Nam_ �!i�.-= '/} 4Disk # L
PID Number
Alternative Mailing Address
�ry
Compliance
O No foundation drain connection
O No roof drain connection
c( Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
O
Time .j' • b
Owner /Occupant Signature
am
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
LTA E Time
•
House Number /"` Street Name ` " -- °? �' ? ,d/1
Obstruction
Unable to push past
feet
Final Cleanout:
O am
O pm
Phone ..r_"`d
l
Inspector Signature
j j ;
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
_ Entered 5.L. at
Pink Copy: SEH
r