4647 1_2 Penkwe Way - Inspection Form1 City of Ca u
Residential Sanitary Sewer Service
Compliance Inspection
Date . /
Name
House Number
P!D Number
Alternative Mailing Address
/ i 1 /
1
7 / Owner/Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
�.1
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transitions- 1.7
-472 "� i .
4" to 6" Transition:
White Copy: Property Owner
Time I -
'1 Disk#
�l p , am
.�1J1� pm
/ ' - "estreet 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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
r'�
Number of stacks
Yellow Copy: City of Eagan
Record Number
Phone
Time
Obstruction
Unable to push past
feet
O am
pm
Inspector Signature
No Access
O No one in
O Inspection
refused
O Access to service
lateral needed
Entered S. L. at
Final Cleanout: r -
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
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2 r
Totes!
Sump pumps
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.W.7
Foundation drains
MEI
MI
Roof drains
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1 City of Ca u
Residential Sanitary Sewer Service
Compliance Inspection
Date . /
Name
House Number
P!D Number
Alternative Mailing Address
/ i 1 /
1
7 / Owner/Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
�.1
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transitions- 1.7
-472 "� i .
4" to 6" Transition:
White Copy: Property Owner
Time I -
'1 Disk#
�l p , am
.�1J1� pm
/ ' - "estreet 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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
r'�
Number of stacks
Yellow Copy: City of Eagan
Record Number
Phone
Time
Obstruction
Unable to push past
feet
O am
pm
Inspector Signature
No Access
O No one in
O Inspection
refused
O Access to service
lateral needed
Entered S. L. at
Final Cleanout: r -
Pink Copy: SEH