4619 1_2 Penkwe Way - Inspection FormCity of Ea as
p
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 -.1 /(3 Time
Name
4" to 6" Transition:
Sump pumps
Foundation drains
Roof drains
White Copy: Ptoper ty Owner
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 PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Total
1
• 00
l —• /• pm
Disk #
PID Number
House Number - } � Street Name
OwnerlOccupant Signature
Correctly
I J
Alterative Mailing Address
/
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O f=lexible sump pump piping
•
i
Number Discharged
Incorrectly Unknown
Record Number.
• ✓ am
Time • pm
Service Lateral Inspection Findings Number of stacks Entered S. at . "� ;-
Roots
Phone . - `° -�
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
- Length- GiServira,, I / 4 Final Cleanout:_ l✓ i i_
Notes ,
' ✓� —-
f
Yellow Copy: City of Eagan Pink Copy: SEH