4635 1_2 Penkwe Way - Inspection Form`. City of 1a ate
Residential Sanitary Sewer Service
Compliance Inspection
Date14- 1 41 1(
Nam )1
PID Number
�� �� �/'ate
House Number --f5 i Street Name
Alternatixe Mailing Address,'
Owner /Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
ii
Transition .- Asp
4" to 6" Transition:
White Copy: Proper ty Owner
Time
1
Disk #
Non - Compliance
0
O
O
O
0
am
pm
Clear water. connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Roots
kertgt i Seevi -ee~
Yellow Copy: City of Eagan
Record Number
Lz Time
Phone
Inspector Signature
Obstruction
Unable to push past
feet
Entered S.L.at �'--
• oam
• /'
- a Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
N otes
/��jf�
J
f .
r /
r r^, -
�:;.-
3. ; ' �(
j
f
Number
Discharged
Correctly
incorrectly
Unknown
Sump pumps
L '
3 1 9
Foundation drains
Roof drains
.i
`. City of 1a ate
Residential Sanitary Sewer Service
Compliance Inspection
Date14- 1 41 1(
Nam )1
PID Number
�� �� �/'ate
House Number --f5 i Street Name
Alternatixe Mailing Address,'
Owner /Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
ii
Transition .- Asp
4" to 6" Transition:
White Copy: Proper ty Owner
Time
1
Disk #
Non - Compliance
0
O
O
O
0
am
pm
Clear water. connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Roots
kertgt i Seevi -ee~
Yellow Copy: City of Eagan
Record Number
Lz Time
Phone
Inspector Signature
Obstruction
Unable to push past
feet
Entered S.L.at �'--
• oam
• /'
- a Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH