4793 Beacon Hill Rd - Inspection Form''
Number
Correctly
Discharged
Incorrectly Unknown
Notes
r
A' ,I.-..--.--,, " r -- ,;. 3 :;
j , j ,, a -
s - C (f , / ; :2
e - ! '`
s ,. ?
i '
Total
Sump pumps
°
+
Jai
r !
- i i r
3
'
Foundation drains
Roof drains
,,
4 City of Fa oo
Residential Sanitary Sewer Service
Compliance Inspection
-
Date ! ./ 1 l Time
1
Name r' r i , ' fir' Disk #
PID Number
)_ )
House Number ! -- Street Name
Alternative Mailing Address
Roots
Poor Pipe Joints
Mineral Deposits
4" to 6" Transition:
White Copy: Property Owner
pyrnt Signature
Compliance
O r No foundation drain connection
No roof drain connection
;
d Sump pit riot connected t
sanitary sewer !
Sump pump pr•operlypiped
O No sump pun — /
Service Lateral Inspection Findings
),4
BM
pm
Sag /Pipe Deflection
Damaged Pipe
Transition
LE LE
Non- Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
0,, Defective manholes
Sump pump connected to sanitary
sewer ` ;'' /
Flexible su pump pipin
Number of stacks
Length of Service:
Record Number
Phone
Time
Yellow Copy: City of Eagan,.,. -
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
•
•
o am
O pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S Lat.
Pink Copy: SEH