4671 Kingsbury Dr - Inspection Form" City area ao
Residential Sanitary Sewer Service
Compliance Inspection
Date".I )1
Name «. f ' )„ Disk # jJ
PID Number.
House Number.
Alternative Mailing Address
-., ,.=.-- . ...___))46
Owner /Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral tose Findings
Number of of stacks
Roots 4
Poor Pipef oints
Mineral Deposits 1) I
Sag /Pipe Deflectio
Damaged Pipe
Transition
+J
4" to 6" Transition:
White Copy: Property Owner
Street Name � � �t' �� � �/. _D/
Phone .. ✓
g5"
Time.
At-75
//
/4
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
• ✓C 0 am
• X pm
1
er , (0).
Length of Service:
Yellow Copy: City of Eagan
Record Number
4/
Time
• Q am
• O pm
✓
Inspector Signature
Obstruction
Unable to push past
feet.
1 -
Entered S. it at
1
Final Cleanout:
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknow
Notes
i� _ --; ' ~ r / n , : 3
) i f . ' :, d -r' f
�� r
": 1 . l/' - t / - ! - 77, - .1--
f r � {{ j r >, „
Total
Sump pumps
Foundation drains
--
Roof drains
" City area ao
Residential Sanitary Sewer Service
Compliance Inspection
Date".I )1
Name «. f ' )„ Disk # jJ
PID Number.
House Number.
Alternative Mailing Address
-., ,.=.-- . ...___))46
Owner /Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral tose Findings
Number of of stacks
Roots 4
Poor Pipef oints
Mineral Deposits 1) I
Sag /Pipe Deflectio
Damaged Pipe
Transition
+J
4" to 6" Transition:
White Copy: Property Owner
Street Name � � �t' �� � �/. _D/
Phone .. ✓
g5"
Time.
At-75
//
/4
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
• ✓C 0 am
• X pm
1
er , (0).
Length of Service:
Yellow Copy: City of Eagan
Record Number
4/
Time
• Q am
• O pm
✓
Inspector Signature
Obstruction
Unable to push past
feet.
1 -
Entered S. it at
1
Final Cleanout:
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
-
Number
Correctly
Discharged
Incorrectly
.
Unknown
Total
Sump pumps
" may
Foundation drains
t`
Roof drains
-tom
City of tgan
Residential Sanitary Sewer Service
Compliance Inspection
Date f7_1 / 1
alp - i
Narne t 1� Disk#
PID Number'
House Number f 7) Street Name 1. / ? .< Jr: • 1
Phone r � f "' � - --- > � 2-)--,2
Alternative Mailing Address
For information call 651.470.2788
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to b "Transition:
'`OwnerlOccupant Signature
1 e( r
White Copy: Pi operty Owner
Time l
— L1] - G
am
pm
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
1
Yellow Copy: City of Eagan
Record Number
inspector Signature
Obstruction
Unable to push past
feet
4
® C._,/ 0 am
• pm
(f
(2 f1
Length of Service: Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Not
("?
f ff (2, - -`7=-?"--)1 � r
/ r1
Pink Copy: SEH