4623 Kingsbury Dr - Inspection Form1, 111 . Cit of ha ii
City �
Residential Sanitary Sewer Service
Compliance Inspection
Date ,�l / J; }
Name f
PID Number.
House Number
Alternative Mailing Address
Compliance
Owne'rl0ccupant Signature
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
•C ;C„/ „-- am
Time T• p
▪ Disk #
> f") °"2
''' Name
Service Lateral Inspection Findings
Number of stacks
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
10 Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
1
Phone >e =°
Inspector Signature
obstruction
Unable to push past
feet
Final Cleanout:
•
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L.at
Roots
Poor Pipe joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
ii n,-- i . <. C - % ! �a ) , 1,
m t .�..,. r _ A . r r)
Total
Sump pumps
i
r ➢
i Viz'
,.,- r ?
,r2--
F -
Foundation drains
P ,4. 1 �
Roof drains
// /
MEM
1, 111 . Cit of ha ii
City �
Residential Sanitary Sewer Service
Compliance Inspection
Date ,�l / J; }
Name f
PID Number.
House Number
Alternative Mailing Address
Compliance
Owne'rl0ccupant Signature
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
•C ;C„/ „-- am
Time T• p
▪ Disk #
> f") °"2
''' Name
Service Lateral Inspection Findings
Number of stacks
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
10 Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
1
Phone >e =°
Inspector Signature
obstruction
Unable to push past
feet
Final Cleanout:
•
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L.at
Roots
Poor Pipe joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH