4659 Kingsbury Dr - Inspection FormHouse Number
CifafFau
Residential Sanitary Sewer Service
Compliance Inspection
a
Date '`�� % 1�
Name
PID Number
Alternative Mailing Address
4" to 6" Transition:
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O <N.o sump pump
Service Lateral Inspection Findings
White Copy: Proper ty Owner
�
Time. • `pm
isk #
Street Name
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
Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet.
0 a
•
• O pm
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L. at
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
Total
Sump pumps'-
%�f # "
Foundation drains
-�
Roof drains
� � � �`
House Number
CifafFau
Residential Sanitary Sewer Service
Compliance Inspection
a
Date '`�� % 1�
Name
PID Number
Alternative Mailing Address
4" to 6" Transition:
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O <N.o sump pump
Service Lateral Inspection Findings
White Copy: Proper ty Owner
�
Time. • `pm
isk #
Street Name
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
Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet.
0 a
•
• O pm
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L. at
Pink Copy: SEH