4652 Kingsbury Dr - Inspection Form41 city of boo
Residential Sanitary Sewer Service
Compliance Inspection
�.r
Date /7' 1
Name - \ ,` J ) Disk #
PID Number
House Number
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
1
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O Na sump pump
4" to b "Transition:
White Copy: Property Owner
J .2:73-- am
Time • Pm
Street Name
OwnerlOccupant 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
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection_
Damaged Pipe
Transition
Length of Service:
Record Number
Notes
Time
Entered S L.at
l
f
Phone( -.__, f _ W
Obstruction
Unable to push past
feet
o am
0 pm
Inspector Signature
For information call 651.470.2788
Final Cleanout:
1 i j
' 1 I_ s- .fir 't /f )am/
� c: f f
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH