4628 Kingsbury Dr - Inspection FormCity
Residential Sanitary Sewer Service
Compliance Inspection
Date 1-71--I
Name 4-z LA
House Number.
0 No sump pump
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
White Copy: Proper ty Owner
Time
i
i ... Disk #
PID Number
Street Name
owner /Occupant Signature
,- o am
• pm
Y
Alternative Mailing Address Phone
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
1
• ._ i 0 am
Time •
� "�� ^'- �"" ` �• - -_ -. �� � '�":
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Notes
" 11
No Access
O No one in
Roots / i
'-' i-'1-- =2 * :7 ..- ?- � -- ? =-1
- i t_
O Access to service
lateral needed
O Inspection
refused
Service Lateral inspection Findings Number of stacks ✓r Entered S L at _, y
i } r
Length of Service :6,. /( 4i') _`r Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
Unknown
Sump pumps
.
Foundation drains
Roof drains
City
Residential Sanitary Sewer Service
Compliance Inspection
Date 1-71--I
Name 4-z LA
House Number.
0 No sump pump
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
White Copy: Proper ty Owner
Time
i
i ... Disk #
PID Number
Street Name
owner /Occupant Signature
,- o am
• pm
Y
Alternative Mailing Address Phone
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
1
• ._ i 0 am
Time •
� "�� ^'- �"" ` �• - -_ -. �� � '�":
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Notes
" 11
No Access
O No one in
Roots / i
'-' i-'1-- =2 * :7 ..- ?- � -- ? =-1
- i t_
O Access to service
lateral needed
O Inspection
refused
Service Lateral inspection Findings Number of stacks ✓r Entered S L at _, y
i } r
Length of Service :6,. /( 4i') _`r Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH