4290 Amber Dr - Inspection FormCity of apo
Residential .Sanitary Sewer Service
Compliance Inspection
Dater I
Name/ Disk #
PID Number
House Number ' -l-: a< `" _ . Street Name
Alternative Mailing Address
For information call 651:470.2788
Co pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lax_,.al-lnspection Findings
Roots — 6 r''
Poor Pipe Joints
4" to 6 "Transition:
Sump pumps
Foundation drains
Roof drains
White Copy: Property Owner
Owner /Occupant Signature
Total
,
Time
Correctly
am
pm
Incorrectly
� G
Unknown
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
i1
Length of Service:�
Number Discharged
Record Number
Time
I 27
Phone
j
Inspector ignature
Obstruction
Unable to push past
feet
Number of stacks Entered S L.at
Notes
!
3 1 final Cleanout:
m
pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
j l
Transition -.k �� ' 7 ( s 7 } -- = ' j ' ( - - , -
i
/1
Yellow Copy: City of Eagan Pink Copy: SEH