4629 Summit Pass - Inspection Form
Residential Sewer City I rlr Compliance Inspection
401~
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Date Time , pm Record Number.
„0 Disk# s ~ Time 0 ~ pm
Name '`t
1}'" i j , A aM
t
PID Number
House Number'? treet Name, , 1ti ,~v c
Alternative Mailing Address Phone
OugndrlOccupant Signature Inspector Signature
For information call 651.470.2788
Compliance Non-Compliance Obstruction No Access
O No foundation drain connection O Clear water connections to Unable to push past O No one in
Q/ No roof drain connection sanitary sewer feet O Access to service
O Service lateral defects lateral needed
Sump pit not connected to O Defective manholes
sanitary sewer
f O Sump pump connected to sanitary O Inspection
refused
,Q Sump pump properly piped sewer
O No sump pump O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks Entered S.L at Roots -
Poor Rpejoints _ T
Mineral Deposits - -
SaglPipe Deflection
Damaged Pipe
Transition
~i
7
4" to 6"Transition: Length of Service: Final Cleanout: ` , . {
Notes
Number Discharged
Total Correctly Incorrectly Unknown
-vl
Sump pumps f! _
Foundation drains
Roof drains-
Pink
White Copy: Propeity Ownei Yellow Copy: City of Eagan f l Copy SE H