4071 Beryl Rd - Inspection FormCity of •liaR ,aa
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name f°
PID Number
House Number
4" to 6 "Transition:
I I( .
White Copy: Property Owner
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
0 No sump pump
r
Time
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection �J
Damaged Pipe
Transition
Disk ##
24. 7! Street Name
OwnerlOccupant Signature
am
pm
For information caH 65
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 inspecti Findings Number of stacks 4 Entered S L. at
Roots
L.
Length of Service:
Record Number
F
1 J • . jC ca
Time d- ¢ • — � V ,
Phone !�> _ 1 ° (-- ?
Inspector Signature
Obstruction
Unabje push past
7 (-? feet
1
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Final Cleanout: /
•
Yellow Copy: City of Eagan Pink C SEH
C � c t J 5 7
Number.
Correctly
Discharged
Notes # 1
/ f /C — f ; ;; 7c,j -`
1__ �, 1 r
..-_" ,--� fl �� .:=
)¢` ` ` ()''&'.
' � s 0
Total
Incorrectly
Unknown
Sump pumps
'7-,
Foundation drains
7)
Roof drains
7)
City of •liaR ,aa
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name f°
PID Number
House Number
4" to 6 "Transition:
I I( .
White Copy: Property Owner
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
0 No sump pump
r
Time
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection �J
Damaged Pipe
Transition
Disk ##
24. 7! Street Name
OwnerlOccupant Signature
am
pm
For information caH 65
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 inspecti Findings Number of stacks 4 Entered S L. at
Roots
L.
Length of Service:
Record Number
F
1 J • . jC ca
Time d- ¢ • — � V ,
Phone !�> _ 1 ° (-- ?
Inspector Signature
Obstruction
Unabje push past
7 (-? feet
1
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Final Cleanout: /
•
Yellow Copy: City of Eagan Pink C SEH
C � c t J 5 7