4634 Kingsbury Dr - Inspection Form4 0 11 ' City of ,aa
Residential Sanitary Sewer Service
Compliance Inspection
/
Date jI
Name . )r .e. d r . " -:;) ,- 1 #
PID Number
House Number • Street Name
Alternative Mailing Address
td
.{?
k rr /f
i . ts.r t
0 No sump pump
4" to 6" Transition:
i Time i pm
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
r
sanitary sewer
l Sump pump properly piped
White Copy: Property Owner
0 ner /Occupant Signature
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:
Yellow Copy: City of Eagan
Record Number
Time
Phone 7� ` ) —
Notes i}
Obstruction
Unable to push past
feet
Inspector Signature
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
•
• 0 pm
For information call 651.470.2788
Service Lateral Inspection Findings Number of stacks Entered S L. at
Roots
Final Cleanout:
�✓', ✓, 'rr
0 am
NO Access
O No one in
O Access to service
lateral needed
O inspection
refused
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
� h
A
ill
Foundation drains
111111111111
Roof drains
I
A.---)
4 0 11 ' City of ,aa
Residential Sanitary Sewer Service
Compliance Inspection
/
Date jI
Name . )r .e. d r . " -:;) ,- 1 #
PID Number
House Number • Street Name
Alternative Mailing Address
td
.{?
k rr /f
i . ts.r t
0 No sump pump
4" to 6" Transition:
i Time i pm
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
r
sanitary sewer
l Sump pump properly piped
White Copy: Property Owner
0 ner /Occupant Signature
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:
Yellow Copy: City of Eagan
Record Number
Time
Phone 7� ` ) —
Notes i}
Obstruction
Unable to push past
feet
Inspector Signature
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
•
• 0 pm
For information call 651.470.2788
Service Lateral Inspection Findings Number of stacks Entered S L. at
Roots
Final Cleanout:
�✓', ✓, 'rr
0 am
NO Access
O No one in
O Access to service
lateral needed
O inspection
refused
Pink Copy: SEH