4650 Kingsbury Dr - Inspection FormCity of t,a
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 / /
}
Name Ai4 t 4171
House Number
Roots
4" to 6 "Transition:
. -
White Copy: Pr operty Owner
2% o am
Time . • pm
Disk #
PID Number
r 97
Alternative Mailing Address Phone r';: 2-r#-'r "°'
OwnerIOccupant Signature
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
, Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
7 7 3..
Poor Pipe Joints.
c)
Street Name s'
For information call 651.470.2788
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
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe • . �/ a' .,
Transition i
• 1
Length of Service: a 2T
1 ✓
Record Number
. • ?---) o am
Time . • i Pm
{ Inspector Signature
Obstruction
Unable to push past
feet
Number of stacks Entered S. at
Notes
Na Access
O No one in
O Access to service
lateral needed
O inspection
refused
r) 1)
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
Unknown
Sump pumps
('
Foundation drains
ti
Roof drains
City of t,a
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 / /
}
Name Ai4 t 4171
House Number
Roots
4" to 6 "Transition:
. -
White Copy: Pr operty Owner
2% o am
Time . • pm
Disk #
PID Number
r 97
Alternative Mailing Address Phone r';: 2-r#-'r "°'
OwnerIOccupant Signature
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
, Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
7 7 3..
Poor Pipe Joints.
c)
Street Name s'
For information call 651.470.2788
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
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe • . �/ a' .,
Transition i
• 1
Length of Service: a 2T
1 ✓
Record Number
. • ?---) o am
Time . • i Pm
{ Inspector Signature
Obstruction
Unable to push past
feet
Number of stacks Entered S. at
Notes
Na Access
O No one in
O Access to service
lateral needed
O inspection
refused
r) 1)
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH