4616 Kingsbury Dr - Inspection FormCity of Fa an
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
PID Number
!/ )
( /1
) ') /Disk #
Compliance
0 No foundation drain connection
O No roof drain connection
x�F
Sump pit not connected to
sanitary sewer
I
Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
f n am
Time f pm
/7
House Number 4"- Street Name
Owner /Occupant Signature
-L
V
1) ) I
/ O
Alternative Mailing Address ✓ Phone. T / I
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:
Record Number !}
Notes
Time
• O am
• O pm
Obstruction
Unable to push past
feet
Final Cleanout:
l
inspector Signature �� ,wa ) 141 n
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
-
Foundation drains
Roof drains
City of Fa an
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
PID Number
!/ )
( /1
) ') /Disk #
Compliance
0 No foundation drain connection
O No roof drain connection
x�F
Sump pit not connected to
sanitary sewer
I
Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
f n am
Time f pm
/7
House Number 4"- Street Name
Owner /Occupant Signature
-L
V
1) ) I
/ O
Alternative Mailing Address ✓ Phone. T / I
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:
Record Number !}
Notes
Time
• O am
• O pm
Obstruction
Unable to push past
feet
Final Cleanout:
l
inspector Signature �� ,wa ) 141 n
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SEH