4059 Beryl Rd - Inspection FormSump pumps
Foundation drains
Roof drains
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City of Capri
Residential Sanitary Sewer Service
Compliance Inspection
Date 7 0 1 7 / / o
Name l 7 �> Disk #
PID Number
House Number
Alternative Mailing Address
For information call 651:470.2788
Compliance
O No foundation drain connection
, O'No roof drain connection
O Sump pit not connected to
sanitary sewer
p Sump pump properly piped
fcro sump pump
Service Lateral Inspection Findings
Roots r' ,r�_T 0 ry
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection h
Damaged Pipe
Transition 1; 1 / e-i ✓ %t//a csm..
4" to 6" Transition:
White Copy: Property Owner
Time • vc.✓ o Pm
'7 Street Name
Owner /Occupant Signature
Total
0
- LL'7 -[1J
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
Number of stacks t
7 Length of Service:
Number Discharged
Correctly Incorrectly
Unknown
Record Number
Notes
Time /0 • /S O pm
ftone
f /✓[�`� i
. /f �'�"'t
' Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanqut:
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Entered S L at
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Yellow Copy: City of Eagan Pink Copy: SFH