4670 Kingsbury Dr - Inspection Form1.0. 111. City of f a a
y � u
Residential Sanitary Sewer Service
Compliance Inspection
.
r ) ” f ! ,99
'
Date `
Name
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
(Sump pit not connected to
f sanitary sewer
G)Sump pump properly piped
O No sump pump
4" to 6 "Transition:
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
" � •L/ i am
Time • pm
Street Name
Owner /Occupant Signature
Number of stacks
Non
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:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet
(
Phone ��a'' t �c° )
1) a /M»
Inspector Signature
Entered S L at
Final Cleanout:
0 am
•
• O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number Discharged
Correctly Incorrectly Unknown
Notes
tf % '1, - „,'.. , ; - .7 , �, - (. . � '
} .; :�.,�.
'e ,, � ' r �.
tt
Total
Sump pumps
Sum
/1 =MI
Foundation drains
M--
Roof drains
1.0. 111. City of f a a
y � u
Residential Sanitary Sewer Service
Compliance Inspection
.
r ) ” f ! ,99
'
Date `
Name
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
(Sump pit not connected to
f sanitary sewer
G)Sump pump properly piped
O No sump pump
4" to 6 "Transition:
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
White Copy: Property Owner
" � •L/ i am
Time • pm
Street Name
Owner /Occupant Signature
Number of stacks
Non
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:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet
(
Phone ��a'' t �c° )
1) a /M»
Inspector Signature
Entered S L at
Final Cleanout:
0 am
•
• O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH