1617 Sherwood Way - Inspection Form40- •
City of Nan
Residential Sanitary Sewer Service
Compliance Inspection
1
Date / /;
Name 2
` "om- /1") ' i71
PID Number
/7
House Number /1`':2
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
Time ''° • • • : o pm
Disk #
/
.�.p f S �-
Street Name
/Owner /Occupant Signature
Phone i
r
For information call 651.470.2788
Non- Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
sewer
9 Flexible sump pump piping
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet
r ,-
Final Cleanout:
1./
o am
•
• p Pm
Inspector Signature -,
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at
Pink Copy: SEH
Total
f
Notes
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
z
Foundation drains
-
Roof drains
40- •
City of Nan
Residential Sanitary Sewer Service
Compliance Inspection
1
Date / /;
Name 2
` "om- /1") ' i71
PID Number
/7
House Number /1`':2
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
Time ''° • • • : o pm
Disk #
/
.�.p f S �-
Street Name
/Owner /Occupant Signature
Phone i
r
For information call 651.470.2788
Non- Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
sewer
9 Flexible sump pump piping
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet
r ,-
Final Cleanout:
1./
o am
•
• p Pm
Inspector Signature -,
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at
Pink Copy: SEH