4269 Amber Dr - Inspection Form4 111110 .
City of
Residential Sanitary Sewer Service
Compliance Inspection
Date /({--;
Name L „ 77/ - 1• if 4isk#
A j
PO Number
"-
House Number .2-,1„4 Street Name
Alternative Mailing Addr ess
(
For information call 651.4701788
Compliance
0 No foundation drain connection
No roof drain connection
(' Q Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe t
Transition
4” to 6" Transition:
Owner/Occupant Signature
'.13
White Copy: Pt °petty Ownei
Time
Non-Compliance
0
am
t pm
FJ[
'1)74 DI
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Noter
Time
Inspector Signature
Obstruction
Unable to push past
feet
'
• am
• pm
Entered S L at - 7)
• . —rFinal Cleanout:
No Access
O No one in
0
1.E
;(9
Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
/ (2 /2 .
r
•
Number
Correctly
Discharged.
Incorrectly
.
Unknown
Total
Sump pumps
C„7 )
..---'
Foundation drains
.,..---),
Roof drains
( ")
4 111110 .
City of
Residential Sanitary Sewer Service
Compliance Inspection
Date /({--;
Name L „ 77/ - 1• if 4isk#
A j
PO Number
"-
House Number .2-,1„4 Street Name
Alternative Mailing Addr ess
(
For information call 651.4701788
Compliance
0 No foundation drain connection
No roof drain connection
(' Q Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe t
Transition
4” to 6" Transition:
Owner/Occupant Signature
'.13
White Copy: Pt °petty Ownei
Time
Non-Compliance
0
am
t pm
FJ[
'1)74 DI
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Noter
Time
Inspector Signature
Obstruction
Unable to push past
feet
'
• am
• pm
Entered S L at - 7)
• . —rFinal Cleanout:
No Access
O No one in
0
1.E
;(9
Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
/ (2 /2 .
r