4758 Cypress Pt - Inspection Form11 11111
City of Cap]
Residential Sanitary Sewer Service
Compliance Inspection
11 2 )
Date
r
Name
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 surrip pump
4" to 6"Transition:
White Copy: Property Owner
) • 0/
Time
Disk #
PID Number
I 77 "-
House Number " Street Name
-• ,
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
0 am
•
• 0 pm
)
Phone )
A ,1
Inspector Signature I I /Vie,/
For information call 651.470.2788
Obstruction
Unable to push past
feet.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SE H
-7)
Total
Notes
i -
l''"). --- 2,,-:, —
,,,„
,• . - : < •:." --- )Ef: 1 :73- . 7 ) ,
____ • a
---
i ' /
(,./.•
...___.
c (..--
) V L •
,,,," .(:-; -- 7 t_. -
,1 " 1
-, 1 ," --
,2-----' ,,,,--'‹. .•,-
---•-7"1
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
--- (....„--.
-/----
7) ,r ,
' -v
---"4..„.?-1/17,72'
-1.- :..
Foundation drains
Roof drains
,
11 11111
City of Cap]
Residential Sanitary Sewer Service
Compliance Inspection
11 2 )
Date
r
Name
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 surrip pump
4" to 6"Transition:
White Copy: Property Owner
) • 0/
Time
Disk #
PID Number
I 77 "-
House Number " Street Name
-• ,
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
0 am
•
• 0 pm
)
Phone )
A ,1
Inspector Signature I I /Vie,/
For information call 651.470.2788
Obstruction
Unable to push past
feet.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SE H
-7)