4283 Amber Dr - Inspection Form4 f Ea a
Residential Sanitary Sewer Service
Compliance Inspection
Dater '// Z / //0
Name ./ ' .r -e'l ) #
PID Number
House Number
4" to 6" Transition:
White Copy: Property Owner
Time
• o am
• • gr pm
_ _._._� _cam
Owner /Occupant Signature
Compliance
No foundation drain connection
''No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
0
el
Street Name
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
Length of Service: i 1/V
Record Number.
Alternative Mailing Address Phone
For information call 651.470.2788
Obstruction
Unable to push past
Z feet
m0
Number of stacks 1 Entered S,L,at r7
Service Lateral Inspection Findings
Roots . )0. ,
t ' /
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition �! cr
• £ r oam
Time 7 m
Yellow Copy: City of Eagan
/ Pf
(0i °rf l f ew '�e e..z
Inspector S'ignature
e - ' . s -
Final Cieanout: J
6.-vixt/cr
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
N otes
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et
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Number
Discharged
Correctly
incorrectly Unknown
Sump pumps
(3,-;-- -
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-_
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Foundation drains
E/'`
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ME
Roof drains
4 f Ea a
Residential Sanitary Sewer Service
Compliance Inspection
Dater '// Z / //0
Name ./ ' .r -e'l ) #
PID Number
House Number
4" to 6" Transition:
White Copy: Property Owner
Time
• o am
• • gr pm
_ _._._� _cam
Owner /Occupant Signature
Compliance
No foundation drain connection
''No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
0
el
Street Name
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
Length of Service: i 1/V
Record Number.
Alternative Mailing Address Phone
For information call 651.470.2788
Obstruction
Unable to push past
Z feet
m0
Number of stacks 1 Entered S,L,at r7
Service Lateral Inspection Findings
Roots . )0. ,
t ' /
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition �! cr
• £ r oam
Time 7 m
Yellow Copy: City of Eagan
/ Pf
(0i °rf l f ew '�e e..z
Inspector S'ignature
e - ' . s -
Final Cieanout: J
6.-vixt/cr
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH