4627 1_2 Penkwe Way - Inspection Form 2City f Papa
Residential Sanitary Sewer Service
Comphiance �nspeetion
l� 7• / i: am
Time • O pm
Date 0 l O /J
Name P. ,441 ( 2,,,4 [ii . F C ! , %• Disk # I •�
PID Number
Street Name ' •° 41,1
House Number
Alternative Mailing Addr ess
;
For information call 651.470.2788
Compliance
0 No foundation drain connection
0' No roof drain connection
ab Sump pit not connected to
sanitary sewer
�O Sump pump roperly-00d
0 No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
l''
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Sump pumps
Foundation drains
Roof drains
White Copy: property Owner
Owner /Occupant Signature
Total
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
Correctly
Record Number
Time
Obstruction
Unable to push past
feet
Number of stacks Entered S.L at
flY r
—. ?'_
Length of Service:
Number Discharged
Incorrectly
Unknown
Yellow Copy: City of Eagan
o
• _ o pm
Phongt
/ / /
r 4_i
Ins'pe Signature
Final Cleanout:
Notes
No Access
O No one in
O Access to service .
lateral needed
O inspection
refused
Pink Copy: SEH