689 Stonewood Rd - Inspection FormCity of'.Capri
Residential Sanitary Sewer Service
Compliance Inspection
Date 0 K1 Q 1
Name
PID Number
House Number
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition /r/
PVC- e4S r ...
4" to 6" Transition:
ri
Compliance
O No foundation drain connection
3X" No roof drain connection
X Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
/
At/ ,1 A .
Time � 6 • ( O am
• c-pm
Disk #
Street Name
Alternative Mailing Address
OwnerlOccupant Signature
For information tall 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
ewer _
Flexible sump pump piping i
Number of stacks t; .,,tered S L at
p a tsl:r
Length of Service:
White Copy: Property Owner Yellow Co City of Eagan
� . Copy:
0
Record Number.
Sump pumps
Foundation drains
Roof drains
Total
Number Discharged
Correctly Incorrectly Unknown
PFione fd`
,
•
lime •
Inspector Signature
Obstruction
Unable to push past
feet
m
0 pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
i r r Final Cleanout:
/
7 ,-
4' —t'A 9J Eer
Ci
1 �G. j/, ,j
c ),2-1-
Pink Copy: SEH