4634 Summit Pass - Inspection Form
I WA_ City Residential Sanitary Sewer Service
ilr Compliance Inspection
Dacell t Time • ~p Pm Record Number l /
am
Name ! l,. Disk F7rT-Time > • Pm
PID Number
House Number J Street Name -
Alternative Mailing Address Phone
OwnerlOccupant Signature fnspector Signature
For information call 651.470.2788
Compliance Non-Compliance Obstruction No Access
X No foundation drain connection O Clear- water- connections to Unable to push past O No one in
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 O Inspection
O Sump pump connected to sanitary
O Sump pump properly piped sewer refused
O No sump pump O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks i Entered S.L.at -
Roots
Poor Pipe joints
Mineral Deposits
Sag/Pipe Deflection -
Damaged Pipe
Transition
4" to 6" Transition: Length of Service:, = Final Cleanout:
Notes
Number Discharged
Total Correctly Incorrectly Unknown
Sump pumps
i
Foundation drains
Roof drains
White Copy: Property Owner Yellow Copy: 04 of Eagan Pink Copy: SEH