4641 Kingsbury Dr - Inspection Form4 City of ba an
Residential Sanitary Sewer Service
Compliance Inspection
Date 1. it 1( 1
Name: sar/' y /il Disk #
PID Number
I -louse Number
Alternative Mailing Address
i 1
i
J V Il Owner /Occupant Signature
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
ai No sump pump
4" to 6" Transition:
}
White Copy: Property Owner
pm
1 -W
V
Street Name _ , 1' J -) /-.`I 1 /'�
v r�
7 -
(-?)
Phone f -
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
Inspector Signature
Obstruction
Unable to push past
feet.
Final Cleanout:
O em
•
O pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
71
i
5 r:4--
OIL d iLi
&-✓mil,
If
.s aI f
Foundation drains
Roof drains
4 City of ba an
Residential Sanitary Sewer Service
Compliance Inspection
Date 1. it 1( 1
Name: sar/' y /il Disk #
PID Number
I -louse Number
Alternative Mailing Address
i 1
i
J V Il Owner /Occupant Signature
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
ai No sump pump
4" to 6" Transition:
}
White Copy: Property Owner
pm
1 -W
V
Street Name _ , 1' J -) /-.`I 1 /'�
v r�
7 -
(-?)
Phone f -
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
Inspector Signature
Obstruction
Unable to push past
feet.
Final Cleanout:
O em
•
O pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH