4796 Beacon Hill Rd - Inspection FormCity of Ufa as
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 �'7 Time
Name /al. Disk #
PID Number
House Number 746 Street Name
Ownerldccupant Signature
am
pm
Alternative Mailing Address
Record Number.
{ l am
Time J(/ • o pm
Phone 6 'egg` g,77 L7
Inspector Signature
For information call 651.470.2788
Compliance
? No foundation drain connection
No roof drain connection
/ k Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Roof drains
White Copy: Property Owner
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
Number of stacks -I Entered S L at
f 1 a �
IIs .)f` ' 1 - !
Length of Service:
Number Discharged
Sump pumps
Foundation drains
Total
Correctly Incorrectly Unknown
Obstruction No Access
Unable to push past 0 No one in
feet
Notes
Final Cleanout:
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH