4853 WellingtonCt - Inspection Form--".~
Residential Sanitary Sewer Service
Inspection
�-
ity of
Date � / V ' / /l Time /[) :
Name / - � f// 7 '~��w Disk #
PO Number
House Number
Alternate Mailing Address
9
Roots
Compliance
mL No foundation dram connection
mL No roof dram connection
V Sump pit not connected to
sanitary sewer
^u/m
uxxu�x.
Sump Pump properly piped
0 No sump pump
Poor Pipe Joints _------
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
a am
0 pm
L i c( S Lki e /'' 4 up Name
~=~_�
�
°
Signature
Service Lateral Inspection Findings
Non-Compliance
o Clear water corinections to
sanitary sewer
o Service lateral defects
o Defective manholes
n Sump pump connected to
sanitary sewer
o
Flexible sump pump piping
Number of stacks
Yellow Copy: City of Eagan
Record Number
Obstruction
/
4^|oO^Transition: ~----- Length of Service: / ' y'
Time
Phone
For Information call 651.470.2788
Unable to push past
feet
Signature
n am
O pm
No Access
o Noonein
o Access 10 service lateral
needed
o Inspection refused
�^� ��`
En��dSLok wv�«. . c _~�
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing
Total
Notes
« /
,
�' ..,/
_
'"r r�, , (�c,-`-
L/`~�r'�, _'-
^
.:*—
'
��
.
--~,
,
�_
~ ' .. /� /y
. R�
�`~�^�^ _ `^�
//
'�—L//l/«~
Number
Discharged
Correctly
Incorrectly
Unknown
Sump Pumps
`
l/
�^
Foundation Drains
��
L^
Roof Drains
/
`~-
--".~
Residential Sanitary Sewer Service
Inspection
�-
ity of
Date � / V ' / /l Time /[) :
Name / - � f// 7 '~��w Disk #
PO Number
House Number
Alternate Mailing Address
9
Roots
Compliance
mL No foundation dram connection
mL No roof dram connection
V Sump pit not connected to
sanitary sewer
^u/m
uxxu�x.
Sump Pump properly piped
0 No sump pump
Poor Pipe Joints _------
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
a am
0 pm
L i c( S Lki e /'' 4 up Name
~=~_�
�
°
Signature
Service Lateral Inspection Findings
Non-Compliance
o Clear water corinections to
sanitary sewer
o Service lateral defects
o Defective manholes
n Sump pump connected to
sanitary sewer
o
Flexible sump pump piping
Number of stacks
Yellow Copy: City of Eagan
Record Number
Obstruction
/
4^|oO^Transition: ~----- Length of Service: / ' y'
Time
Phone
For Information call 651.470.2788
Unable to push past
feet
Signature
n am
O pm
No Access
o Noonein
o Access 10 service lateral
needed
o Inspection refused
�^� ��`
En��dSLok wv�«. . c _~�
Final Cleanout:
Pink Copy: Benjamin Franklin Plumbing