4058 Beryl Rd - Inspection Form41110. �City of 1 a n
Residential Sanitary Sewer Service
Compliance Inspection
Date / (` _1 t
Name
PID Number
House Number ; /_ "" Street Name
Alternative Mailing Address
OwnerlOccupant Signature
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
Mineral Deposits
Sag /Pipe Deflection _
Damaged Pipe
Transition —,: :); Vie
4" to 6" Transition:
White Copy: Property Owner
f •(
Time f'. 2 • o pm
Disk #
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 Nu mb'erof stacks
Roots
r - --- •
Poor Pipe Joints
Length of Service:
Yellow Copy: City of Eagan
Record Number
1
Tr 1.
p Time
!'T
Phone r." _.
Entered S.L. at
I t j • j-- _-
• opm
Inspector Signature
Obstruction No Access
Unable to push past 0 No one in
feet
am
Final Cleanout: /
. = "
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number Discharged
Unknown
Notes
Total
Correctly
incorrectly
Sump pumps
i f
>.
Foundation drains
r
Roof drains
41110. �City of 1 a n
Residential Sanitary Sewer Service
Compliance Inspection
Date / (` _1 t
Name
PID Number
House Number ; /_ "" Street Name
Alternative Mailing Address
OwnerlOccupant Signature
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
Mineral Deposits
Sag /Pipe Deflection _
Damaged Pipe
Transition —,: :); Vie
4" to 6" Transition:
White Copy: Property Owner
f •(
Time f'. 2 • o pm
Disk #
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 Nu mb'erof stacks
Roots
r - --- •
Poor Pipe Joints
Length of Service:
Yellow Copy: City of Eagan
Record Number
1
Tr 1.
p Time
!'T
Phone r." _.
Entered S.L. at
I t j • j-- _-
• opm
Inspector Signature
Obstruction No Access
Unable to push past 0 No one in
feet
am
Final Cleanout: /
. = "
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH