4751 Beacon Hill Rd - Inspection FormCity of to au
Residential Sanitary Sewer Service
Compliance Inspection
Date i 1 7' / 21 er
PID Number
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
4" to 6 "Transition:
Alternative Mailing Address
White Copy: Property Owner
Time � .
Name / '''. k
House Number }} `
,- � - ... :� Street Name
Owner/Occupant Signature
Compliance
O No foundation drain connection
A l : No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
0 am
pm
Transition
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe joints
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
Length of Service:
Sump pumps
Foundation drains
Roof drains
Nurtiher Discharged
Total
/ A/,-)0
P3:
Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Entered S L,at
Notes
Time
Record Number
I
Obstruction
Unable to push past
feet
Final Cleanout:
O am
•
- • O pm
"
f ..
Phone --�
Pink Copy: SEH
Inspector Signature 1 j R}, ,/
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O inspection
refused