4657 Beacon Hill Rd - Inspection Form•
Residential Sanitary Sewer Service
City ot Iii Compliance Inspection
„
Date ,)(_// /
Name lordi Disk #
, ...
PID Number
House Number --',' .:::‘ / Street Name
Alternative Mailing Address
4/7
4" to 6" Transition:
White Copy: Pi °petty Owner
• AV., am
Time LL ._ /e b pm
r •
,•• / /
Owner/Occupant Signature
For information call 651A70.2788
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Non-Compliance
0
0
0
Service Lateral Inspection Findings
Roots
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
PoorPipeJoints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Record Number
Notes
Time
Phone
Number of stacks Entered S. L at
Obstruction
Unable to push past
feet
•
• O pm
Inspector Signature
Final Cleanout:
tD am
)
No Access
O No one in
O Access to service
-lateral needed
O Inspection
refused
-...---- , efe -...--1• ,,-, .,,
, 1
....--.
' I •i". C: ,•"'. _,-- ' 1„. ,..•) „ l '"-- '" C: ,
•r I
•/ ,• ' 127; '' 2 -• - -1. , " ) /2 - ---- i ..7---,-.>-_
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Yellow Copy: City of Eagan Pink Copy: SEH
!slumber
Discharged
Total
Correctly
Incorrectly
Unknown
Sump pumps
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/
) ' •
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--),...-
, I .,
..
.1 :,.
_.--7,
Foundation drains
, .:-7
Roof drains
._
•
Residential Sanitary Sewer Service
City ot Iii Compliance Inspection
„
Date ,)(_// /
Name lordi Disk #
, ...
PID Number
House Number --',' .:::‘ / Street Name
Alternative Mailing Address
4/7
4" to 6" Transition:
White Copy: Pi °petty Owner
• AV., am
Time LL ._ /e b pm
r •
,•• / /
Owner/Occupant Signature
For information call 651A70.2788
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Non-Compliance
0
0
0
Service Lateral Inspection Findings
Roots
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
PoorPipeJoints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Record Number
Notes
Time
Phone
Number of stacks Entered S. L at
Obstruction
Unable to push past
feet
•
• O pm
Inspector Signature
Final Cleanout:
tD am
)
No Access
O No one in
O Access to service
-lateral needed
O Inspection
refused
-...---- , efe -...--1• ,,-, .,,
, 1
....--.
' I •i". C: ,•"'. _,-- ' 1„. ,..•) „ l '"-- '" C: ,
•r I
•/ ,• ' 127; '' 2 -• - -1. , " ) /2 - ---- i ..7---,-.>-_
, ,,,' .,
,!.,„ ," • .'- '''-'
Yellow Copy: City of Eagan Pink Copy: SEH