4064 Beryl Rd - Inspection FormSump pumps
(
Foundation drains
i '
Roof drains
Cit of liap,ao.
Residential Sanitary Sewer Service
Compliance Inspection
Date / / .1 11/ Time
v
Name 1 I , i4 Disk # .".
PID Number f�
House Number )(i? Street Name
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
Ownerl0ccupant Signature
Compliance
No foundation drain connection
GP No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
0 No sump pump
am
pm
For information call 651.470.2788
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
Service Lateral Inspection Findings 1 i/ Number of stacks Entered S.L.at
Roots 1 ,!�
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition ,Z-42 ! / (, / r' lam' . ' f %" 1 -
n
Length of Service:
Number Discharged
Total Correctly Incorrectly
Unknown
Record Number 7
Time
•
Obstruction
Unable to push past
feet
Notes
•
P°r
Phone 5) T i j ,: 5 1
Inspecto Signature
// ,)
o 5 ���Final Cleanout:
w�^�L✓
am
O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH