4637 Penkwe Way - Inspection Form41* City of a Ji
Y �.
Residential Sanitary Sewer Service
Compliance Inspection
Date 1
I
Name Ai, ! /I/4 " 724 Disk #
PhD Number
House Number . . "?ti. ` '� Street Name
Alternative Mailing Address
Owner /Occupan 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
0 am
Time • X pm
i
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
Service Lateral Inspection Findings Number of stacks_
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to b" Transition:
White Copy: Property Owner
2
Yellow Copy: City of Eagan
Record Number
Time
• O am
• —pm
Phone , /
Inspector Signature
Obstruction No Access
Unable to push past 0 No one in
feet.
.�i
Entered S L at
O Access to service
lateral needed
O Inspection
refused
f.Serv i-- 4 Final Cleanout: ,.,. r �' L
Pink Copy: SEH
Total
Notes
� I
1
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(
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s/ ' i '
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` A -,--,,---:71 r:-a-.----(-- .
I
Number
Discharged
Correctly
Incorrectlly
Unknown
Sump pumps
"^�
/.
I /
° �
Foundation drains
Roof drains
L%
41* City of a Ji
Y �.
Residential Sanitary Sewer Service
Compliance Inspection
Date 1
I
Name Ai, ! /I/4 " 724 Disk #
PhD Number
House Number . . "?ti. ` '� Street Name
Alternative Mailing Address
Owner /Occupan 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
0 am
Time • X pm
i
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
Service Lateral Inspection Findings Number of stacks_
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to b" Transition:
White Copy: Property Owner
2
Yellow Copy: City of Eagan
Record Number
Time
• O am
• —pm
Phone , /
Inspector Signature
Obstruction No Access
Unable to push past 0 No one in
feet.
.�i
Entered S L at
O Access to service
lateral needed
O Inspection
refused
f.Serv i-- 4 Final Cleanout: ,.,. r �' L
Pink Copy: SEH