4658 Kingsbury Dr - Inspection Form4 41110—
City at hp
Residential Sanitary Sewer Service
Compliance Inspection
Date ) - / . _„/ am
Time
0 PM
)
Name 1 V Disk #
PID Number
House Number
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipejoints
Sag/Pipe Deflection
4" to 6"Transition:
White Copy: Proper ty Owner
Owner/OcEnpunt Signature
Eu-
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
1
Record Number )
Time
' .mreet. r.mame A YI )
Alternative Mailing Address
Phone . /
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Service Later al Inspection Findings Number of stacks Entered S L at
Roots
Mineral Deposits
Damaged Pipe
Transition
Final Cleanout:
Om
•
• 0 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Notes
.E... (
. / .
- iz-----
,--
--/ ; LI • - i ._--;› / L.-
....,y)
,---,
Number
Discharged
Correctly
'Incorrectly Unknown
Sump pumps
1
' . - 1 ,--
.1
-
:....-.„ 4 f ,
i I ( 2 - '
_ - i
- - -
, - i
' i
.., ii
Foundation drains
. ..._.,.
i
Roof drans
1
.4----,--
4 41110—
City at hp
Residential Sanitary Sewer Service
Compliance Inspection
Date ) - / . _„/ am
Time
0 PM
)
Name 1 V Disk #
PID Number
House Number
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipejoints
Sag/Pipe Deflection
4" to 6"Transition:
White Copy: Proper ty Owner
Owner/OcEnpunt Signature
Eu-
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
1
Record Number )
Time
' .mreet. r.mame A YI )
Alternative Mailing Address
Phone . /
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Service Later al Inspection Findings Number of stacks Entered S L at
Roots
Mineral Deposits
Damaged Pipe
Transition
Final Cleanout:
Om
•
• 0 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH