3735 South Hills Dr - Inspection FormCity of E as
Residential Sanitary Sewer Service
Compliance Inspection
(fl
Date" / /�_1
rf
Name ./ l
MD Number
House Number
Alternative Mailing Address
� ,
For information call 651.470.2788
Compliance
fern
Owner /Occupant Signature
o foundation drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
�r ,
O No sump pump
No roof drain connection
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
4
Transition
r
4" to 6" °Transition
White Copy: Property Owner
r:,'1 Disk #
Time 1 •" Pm
tr
Street Name
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
Number of stacks
7. -,
1 7‘ d , . / . " . . ; "; a - r
Length of Service: (k . 1 ) Final Cleanout:
Yellow Co City of E a
Copy: t5'' �ki ra
f
1
Record Number !
r
)
Phone !i
Inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at
i.1
Pink 4Sppy: SEH
r
Number
Correctly
Discharged
Incorrectly
Unknown
Not
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,/ -`'
Total
� Surnp pumps
1111
Foundation drains
MIN
Roof drains
City of E as
Residential Sanitary Sewer Service
Compliance Inspection
(fl
Date" / /�_1
rf
Name ./ l
MD Number
House Number
Alternative Mailing Address
� ,
For information call 651.470.2788
Compliance
fern
Owner /Occupant Signature
o foundation drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
�r ,
O No sump pump
No roof drain connection
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
4
Transition
r
4" to 6" °Transition
White Copy: Property Owner
r:,'1 Disk #
Time 1 •" Pm
tr
Street Name
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
Number of stacks
7. -,
1 7‘ d , . / . " . . ; "; a - r
Length of Service: (k . 1 ) Final Cleanout:
Yellow Co City of E a
Copy: t5'' �ki ra
f
1
Record Number !
r
)
Phone !i
Inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at
i.1
Pink 4Sppy: SEH
r
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date d / / /
Name j
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
!' I : Disk#
PID Number
It >� 0V am
Time It
//, /i3 pm
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
House Number Street Name r
Alternative Mailing Addr ess
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
Record Number
Notes
0 am
Time • o pm
Phone '= ?
•
inspector Signature
Obstruction
Unable to push past
feet
Length of Service: Final Cleanout:
No Access
No one in
O Inspection
refused
For information call 651.470.2788
r.�
„. Access to service
lateral needed
Service Lateral Inspection Findings Number of stacks Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
Foundation drains
Roof drains
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date d / / /
Name j
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
!' I : Disk#
PID Number
It >� 0V am
Time It
//, /i3 pm
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
House Number Street Name r
Alternative Mailing Addr ess
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
Record Number
Notes
0 am
Time • o pm
Phone '= ?
•
inspector Signature
Obstruction
Unable to push past
feet
Length of Service: Final Cleanout:
No Access
No one in
O Inspection
refused
For information call 651.470.2788
r.�
„. Access to service
lateral needed
Service Lateral Inspection Findings Number of stacks Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SEH