4301 Amber Dr - Inspection FormCity of Ca ap
Residential Sanitary Sewer Service
Compliance Inspection
Date d
Name
: .< 3f Disk
PO Number
House Number •( _ / Street Name
•
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
y o No foundation drain connection
Q No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Propeity Owner
f -,.3
• -q am
Time „�.� • # Pm
fi
Poor Pipe joints
Mineral, Deposits
,fi'ipe Deflection / 7
Damaged Pipe
Transition
Length of Service:
{
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
Record Number
2
For information call 651.470.2788
Roots
Number of stacks / Entered S,L.at
Phone 2 ' 9 � e
Time — 9 am
— • Pm
Obstruction
Unable to push past
feet
inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
final Cleanout,��
Notes
- � L )c, I _ - i o n ..
1
I T
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Correctly
Discharged
Incorrectly
Unknown
Sump pumps
Foundation drains
f j
\ %
MIMI=
/ � )
,'
Roof drains
City of Ca ap
Residential Sanitary Sewer Service
Compliance Inspection
Date d
Name
: .< 3f Disk
PO Number
House Number •( _ / Street Name
•
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
y o No foundation drain connection
Q No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Propeity Owner
f -,.3
• -q am
Time „�.� • # Pm
fi
Poor Pipe joints
Mineral, Deposits
,fi'ipe Deflection / 7
Damaged Pipe
Transition
Length of Service:
{
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
Record Number
2
For information call 651.470.2788
Roots
Number of stacks / Entered S,L.at
Phone 2 ' 9 � e
Time — 9 am
— • Pm
Obstruction
Unable to push past
feet
inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
final Cleanout,��
Notes
- � L )c, I _ - i o n ..
1
I T
Yellow Copy: City of Eagan Pink Copy: SEH