4625 1_2 Penkwe Way - Inspection Form4 °I *City of Eaiao
Residential Sanitary Sewer Service
Compliance Inspection
Date . 1 0 5 " / /0
Name 1j .'t/ 4 n' /afbisk #
i
PID Number
House Number
Alternative Mailing Address
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
Time •
o am
p pm
/ /(175 > Street Name
Owner /Occupant Signature
-r
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
Record Number
•
Time • o prn
Phone / ✓
Insp ector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
0 am
Access to service
lateral needed
O Inspection
refused
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 6 " Transition:
Notes �: %` /{"���r•�__�,z j
r- rte. a
C
_, . / ,� r '
White Copy: Property Owner
Length of Service:
Yellow Copy: City of Eagan
Final Cleanout:
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
MIN
--
Unknown
Sump pumps
MIN
MIN
Foundation drains
Roof drains
4 °I *City of Eaiao
Residential Sanitary Sewer Service
Compliance Inspection
Date . 1 0 5 " / /0
Name 1j .'t/ 4 n' /afbisk #
i
PID Number
House Number
Alternative Mailing Address
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
Time •
o am
p pm
/ /(175 > Street Name
Owner /Occupant Signature
-r
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
Record Number
•
Time • o prn
Phone / ✓
Insp ector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
0 am
Access to service
lateral needed
O Inspection
refused
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 6 " Transition:
Notes �: %` /{"���r•�__�,z j
r- rte. a
C
_, . / ,� r '
White Copy: Property Owner
Length of Service:
Yellow Copy: City of Eagan
Final Cleanout:
Pink Copy: SEH