4702 Beacon Hill Rd - Inspection FormCity of to p
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name .,C'�rs�° Disk#
House Number
Compliance
O No foundation drain connection
• No roof drain connection
!:
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6 "Transition:
White Copy: Pr operty Owner
• . foam
Time ct
MD Number
Pm
a �r
-LE-
n .
,/,,,,,.. Name > f .- f, ;� / I
Alternative Mailing Address Phone
Owner/Occupant Signature
For information call 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
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks Entered S . at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
n Time
Obstruction
Unable to push past
feet
•
Inspector Signature
Final Cleanout:
0 am
• O Pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
I
Foundation drains
Roof drains
l 11
' •
City of to p
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name .,C'�rs�° Disk#
House Number
Compliance
O No foundation drain connection
• No roof drain connection
!:
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6 "Transition:
White Copy: Pr operty Owner
• . foam
Time ct
MD Number
Pm
a �r
-LE-
n .
,/,,,,,.. Name > f .- f, ;� / I
Alternative Mailing Address Phone
Owner/Occupant Signature
For information call 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
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks Entered S . at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
n Time
Obstruction
Unable to push past
feet
•
Inspector Signature
Final Cleanout:
0 am
• O Pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH