4614 Beacon Hill Rd - Inspection FormCity of Ulan
Residential Sanitary Sewer Service
Compliance Inspection
Date i' i -- l I / F
Name i�
/72,1-)--17)7Y? v ° Disk #
PID Number
House Number i - A' j Street Name / N r." ` t' `' I ; '~ ;
Alternative Mailing Addess Phone /..----). r
4" to b" Transition:
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
White Copy: Property Owner
Time m •
Owner /Occupant Signature
am
Pm
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service=faEer•al defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yetlow Copy: City of Eagan
Record Number
•
Time • p Pm
Obstruction
Unable to push past
feet
lnspeor Signature
Final Cleanout:
0 am
No Access
O No one in
t
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
` .,0
/ . " L& ! E
Total
Sump pumps
~ -. % "
5 i n -
Foundation drains
Roof drains
i
i. ^.r
f '
,
City of Ulan
Residential Sanitary Sewer Service
Compliance Inspection
Date i' i -- l I / F
Name i�
/72,1-)--17)7Y? v ° Disk #
PID Number
House Number i - A' j Street Name / N r." ` t' `' I ; '~ ;
Alternative Mailing Addess Phone /..----). r
4" to b" Transition:
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
White Copy: Property Owner
Time m •
Owner /Occupant Signature
am
Pm
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service=faEer•al defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yetlow Copy: City of Eagan
Record Number
•
Time • p Pm
Obstruction
Unable to push past
feet
lnspeor Signature
Final Cleanout:
0 am
No Access
O No one in
t
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH