1370 St Andrew Blvd - Inspection Form4 City of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 1 / W
.� ✓rte ,
Name
PED Number
House Number
Alternative Mailing Address
■
QwnerlOccupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
�1
a No roof drain connection
U Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transition 41. -
4" to 6" Transition:
White Copy: Property Owner
7 • 0 am
TimeYa pm
Disk #
Street Name
7 1.7-21/
' 1
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
Obstruction
Unable to push past
feet
Number of stacks + Entered S . at
Roots
Length of Service:
Yellow Copy: City of Eagan
Record Number
r - i , • , I- 0 a
T ime ! . • p pm
S
Phone „ i °�, l �l
r
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor Pipe Joints
Mineral Deposits
Sag / Pip_e Deflection ? - -
Damaged Pipe
Pink Copy: SEH
Number Discharged
Unknown
Notes
., �? ;; •� ' % -11„ ? � ?, :
j
`
1 , i
Total
Correctly
Incorrectly
Sump pumps
� , , 1 ' ' ✓''
r
�
Foundation drains
Roof drains
i f
."
4 City of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 1 / W
.� ✓rte ,
Name
PED Number
House Number
Alternative Mailing Address
■
QwnerlOccupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
�1
a No roof drain connection
U Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Transition 41. -
4" to 6" Transition:
White Copy: Property Owner
7 • 0 am
TimeYa pm
Disk #
Street Name
7 1.7-21/
' 1
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
Obstruction
Unable to push past
feet
Number of stacks + Entered S . at
Roots
Length of Service:
Yellow Copy: City of Eagan
Record Number
r - i , • , I- 0 a
T ime ! . • p pm
S
Phone „ i °�, l �l
r
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor Pipe Joints
Mineral Deposits
Sag / Pip_e Deflection ? - -
Damaged Pipe
Pink Copy: SEH