4683 Kingsbury Dr - Inspection FormCityo11aau
Residential Sanitary Sewer Service
Compliance Inspection
Date r/ / 7 /
Name k M
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
O 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
Tra nsition I
(/ 1./c,
4" to 6" Transition:
White Copy: Copy: Property Owner
vci
// • 7, 9 am
Time '6 • i'pm
Disk #
Owner/Occupant Signature
0
7
Number of stacks
,
Street Name
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
sewer
O Flexible sump pump piping
,
n'St1:6 1z 4;/(-- /iv(
Length of Service:
Yellow Copy: City of Eagan
Record Number
D
Phone —
/7 4
,
inspector Signature
Obstruction
Unable to push past
feet
Entered S L at
Time
2 '
/ /f; • o ar2
• A-Pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
10'
Final Cleanout:
k"
Pink Copy: SEH
Number
Correctly
Discharged
incorrectly Unknown
Notes S, .,....„ 7 f)„,....,-.)..<7 j)„,
- / / --- .7- ,— ic -
/
1 .. 7c- im, . >
, ...'
Total
Sump pumps
,
Foundation drains
PatAirdF, 4-(Z. -S6;g2
Roof drains
7 -V--
)
Cityo11aau
Residential Sanitary Sewer Service
Compliance Inspection
Date r/ / 7 /
Name k M
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
O 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
Tra nsition I
(/ 1./c,
4" to 6" Transition:
White Copy: Copy: Property Owner
vci
// • 7, 9 am
Time '6 • i'pm
Disk #
Owner/Occupant Signature
0
7
Number of stacks
,
Street Name
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
sewer
O Flexible sump pump piping
,
n'St1:6 1z 4;/(-- /iv(
Length of Service:
Yellow Copy: City of Eagan
Record Number
D
Phone —
/7 4
,
inspector Signature
Obstruction
Unable to push past
feet
Entered S L at
Time
2 '
/ /f; • o ar2
• A-Pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
10'
Final Cleanout:
k"
Pink Copy: SEH