4737 Westminster Cir - Inspection Forms411111 -
City ai to n
Residential Sanitary Sewer Service
Compliance Inspection
r s
Date -/ , 1� 1 It % Time •
Narne`2,
r
(/) `` J ?' Disk #
PID Number
am
0 pm
/72
House Number
i Street Name
l3
Record Number 4„
Alternative MailingAddress
Owner/Occupant Signature
Time
• i am
•• Opm
Phonew f 7 .'
Inspector Signature
For information call 651.470.2788
Compliance
0 No foundation drain connection
/4, No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
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
Obstruction
Unable to push past
feet.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Number of stacks
Entered S. L at
,,11
Sag/Pipe Deflection 1
Damaged Pipe
Transition- �r!
�! J
4" to 6"Transition:
Length of Service:
24
Final Cleanout:
White Copy: Property Owner
Yellow Copy: City of Eagan
Pink Copy: SEH
Notes
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Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps'"
4`._..-e:::
- r /!
,f`
'�f� .
p
Foundation drains
1 /
Roof drains
,1
`' 4
White Copy: Property Owner
Yellow Copy: City of Eagan
Pink Copy: SEH
/
Date /
Name ,,,;/,:PV)
Residential Sanitary Sewer Service
Compliance Inspection
Time
Disk #
o, am
9 pm
PID Number
H 11-
House
Number. ` . ,/ Street Name f
Record Number /
Time
•
•
o am
o pm
Alternative Mailing Address Phone
`----`Owner/Occupant Signature
inspector Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
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
Obstruction
Unable to push past
feet
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints ",;:, "
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
I , f
/
e.
Transition - 1.` rr,.
4" to 6"Transition:
Length of Service: Final Cleanout:
Notes
f
•
{
White Copy: Property Owner
Yellow Copy: City of Eagan Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown ,
Total
Sump pumps
Foundation drains
Roof drains
--�-
Notes
f
•
{
White Copy: Property Owner
Yellow Copy: City of Eagan Pink Copy: SEH