4608 Penkwe Way - Inspection Form:City oI CI U
Residential Sanitary Sewer Service
Compliance Inspection
Date_ g 1 23 / /0
Name Yv /
House Number
Alternative Mailing Address
No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Compliance
O No foundation drain connection
R)No roof drain connection
f
Iv Sump pit not connected to
sanitary sewer
O Sump pump properly piped
Service Lateral Inspection Findings
Sag /Pipe Deflection
Damaged Pipe
Transition :AK
4" to 6" Transition:
White Copy: Property Owner
l am
Time _• O p
PID Number
Owner /Occupant Signature
Disk # [ jJ
Street Name r ' /~ Gv /Irk
Phone (
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
1
Record Number
A
Time
i • (2C)
•
V. / inspector Signature
f r / o em
0 pm
Number of stacks
r: :AA/ t &
!
Length of Service: -<
Yellow Copy: City of Eagan
Obstruction No Access
Unable to push past 0 No one in
feet
Entered S . at 7 AZ
4
O Access to service
lateral needed
O Inspection
refused
1 4 CA/
Final Cleanout:,�;{�
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
J'
!
} J _.L r
!emu ,, }` . ;: j
Total
Sump pumps
�
Foundation drains
MEM
Roof drainsr
/ t
r
:City oI CI U
Residential Sanitary Sewer Service
Compliance Inspection
Date_ g 1 23 / /0
Name Yv /
House Number
Alternative Mailing Address
No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Compliance
O No foundation drain connection
R)No roof drain connection
f
Iv Sump pit not connected to
sanitary sewer
O Sump pump properly piped
Service Lateral Inspection Findings
Sag /Pipe Deflection
Damaged Pipe
Transition :AK
4" to 6" Transition:
White Copy: Property Owner
l am
Time _• O p
PID Number
Owner /Occupant Signature
Disk # [ jJ
Street Name r ' /~ Gv /Irk
Phone (
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
1
Record Number
A
Time
i • (2C)
•
V. / inspector Signature
f r / o em
0 pm
Number of stacks
r: :AA/ t &
!
Length of Service: -<
Yellow Copy: City of Eagan
Obstruction No Access
Unable to push past 0 No one in
feet
Entered S . at 7 AZ
4
O Access to service
lateral needed
O Inspection
refused
1 4 CA/
Final Cleanout:,�;{�
Pink Copy: SEH