3713 South Hills Lane - Inspection Form.City of Pa go
Residential Sanitary Sewer Service
Compliance Inspection
'2 )//) ),-",' . •(.93 +¥ am
Date` �1 /a.` I 1 : T ime : i o pm
Name e J7 ) /.t',` % , „-- 1 Disk #
A
PFD Number r�
" )
House Number f� / Th Street Name
Roots
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: Property Owner
OwnerlOccupant Signature
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 {
Yellow Copy: City of Eagan
7J)
Record Number
Alternative Mailing Address Phone
7. am
Time / t / . O pm
inspector Signature
For information call 651.470.2788
Obstruction
Una Fexp push past
feet
Entered S L at
No Access
O No one in
O Access to service
lateral needed
D Inspection
refused
Poor. ipeJ ints y ) 1 !1 ^ 7 ) -7 . " 1; - -�' - ",: -�I/� ) 11 <..._ - 7 '! / =_�' t
Miner eposits Y �. f1 /� C /° /7?- �- r 3 �. /I� ] � i
/ 1( .,+/ i
5aglP Deflection e-:--/ '.( fc" 4 -- ,,- "' 7 1 = ,f"
Damaged Pipe . - ' �� J j � � 1/ J /jam e- "— ` % lie" 4 '1;14 - J
Transition
Length of Service:
Final Cleanout:
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
71
Foundation drains
Roof drains
/
r-,
�1
.City of Pa go
Residential Sanitary Sewer Service
Compliance Inspection
'2 )//) ),-",' . •(.93 +¥ am
Date` �1 /a.` I 1 : T ime : i o pm
Name e J7 ) /.t',` % , „-- 1 Disk #
A
PFD Number r�
" )
House Number f� / Th Street Name
Roots
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: Property Owner
OwnerlOccupant Signature
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 {
Yellow Copy: City of Eagan
7J)
Record Number
Alternative Mailing Address Phone
7. am
Time / t / . O pm
inspector Signature
For information call 651.470.2788
Obstruction
Una Fexp push past
feet
Entered S L at
No Access
O No one in
O Access to service
lateral needed
D Inspection
refused
Poor. ipeJ ints y ) 1 !1 ^ 7 ) -7 . " 1; - -�' - ",: -�I/� ) 11 <..._ - 7 '! / =_�' t
Miner eposits Y �. f1 /� C /° /7?- �- r 3 �. /I� ] � i
/ 1( .,+/ i
5aglP Deflection e-:--/ '.( fc" 4 -- ,,- "' 7 1 = ,f"
Damaged Pipe . - ' �� J j � � 1/ J /jam e- "— ` % lie" 4 '1;14 - J
Transition
Length of Service:
Final Cleanout:
Pink Copy: SEH