4665 Penkwe Way - Inspection Form4 111. City of �� a
Y �
Residential Sanitary Sewer Service
Compliance Inspection
Date l n1
Name
House Number
).,A1
4" to 6" Transition:
PID Number
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
White Copy: Property Owner
'� /2 /�c7 a
Time ,.
r-1- `Disk #
h Street Name
Owner /Occupant Signature
-L
1
f i .
/ I ), iA
For information call 651.470.2788
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
O am
•
Opm
w � ,
Phone
Obstruction
Unable to push past
feet.
Entered S . at
Inspector Signature A
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Notes
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7/2
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
/
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i
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'
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Foundation drains
Roof drains
..
4 111. City of �� a
Y �
Residential Sanitary Sewer Service
Compliance Inspection
Date l n1
Name
House Number
).,A1
4" to 6" Transition:
PID Number
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
White Copy: Property Owner
'� /2 /�c7 a
Time ,.
r-1- `Disk #
h Street Name
Owner /Occupant Signature
-L
1
f i .
/ I ), iA
For information call 651.470.2788
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
O am
•
Opm
w � ,
Phone
Obstruction
Unable to push past
feet.
Entered S . at
Inspector Signature A
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH