4259 Sandstone Dr - Inspection FormCity of Palau
Residential Sanitary Sewer Service
Compliance Inspection
Date ,l r r 1 Time • pm
Name r , / - 1= . r i_.-- Disk #
PID Number
House Number
Alternative Mailing Address
For information call 651:470.2788
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Sag /Pipe Deflection
Damaged Pipe
Transition ()/ - 4
4" to 6" Transition:
White Copy: Property Owner
Owner /Occupant Signature
Non - Compliance
Street Name
Record Number
Time
Obstruction
Inspector Signature
O Clear water connections to Unable to push past
sanitary sewer feet.
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks -i
Roots _ . I/
.--
Poor Pipe Joints
Mineral Deposits
Length of Service: 22-
Yellow Copy: City of Eagan
f {
Phone
• _ 0 a
• pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S..L.at 1 : ! - .��
�.
Final Cleanout: 7 , ?
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
Total
Sump pumps
r
Foundation drains
/1.
Roof drains
f
t 1
gym✓ = I•M72
City of Palau
Residential Sanitary Sewer Service
Compliance Inspection
Date ,l r r 1 Time • pm
Name r , / - 1= . r i_.-- Disk #
PID Number
House Number
Alternative Mailing Address
For information call 651:470.2788
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Sag /Pipe Deflection
Damaged Pipe
Transition ()/ - 4
4" to 6" Transition:
White Copy: Property Owner
Owner /Occupant Signature
Non - Compliance
Street Name
Record Number
Time
Obstruction
Inspector Signature
O Clear water connections to Unable to push past
sanitary sewer feet.
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks -i
Roots _ . I/
.--
Poor Pipe Joints
Mineral Deposits
Length of Service: 22-
Yellow Copy: City of Eagan
f {
Phone
• _ 0 a
• pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S..L.at 1 : ! - .��
�.
Final Cleanout: 7 , ?
Pink Copy: SEH