4686 Penkwe Way - Inspection FormA Cit of Capp
Residential Sanitary Sewer Service
Compliance Inspection
, s %
Date ) /L— l
Name
- 2
PID Number
House Number
4" to 6" Transition:
White Copy: Pi* oper ty Owner
Time
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected ) , t � o ,
sanitary sewer — yr � V I L , /,/,i
O Sump pump properly piped
O No sump pump
f
Disk #
Owner /Occupant Signature
Service Lateral Inspection Findings
• am
• pm
- r r lf/; Street Name
Alternative Mailing Address .
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
Record Number `°' 17 1—
Time
• Oam
• O pm
) A Y
Phone ?� 2
For information call 651.470.2788
Obstruction
Unable to push past
feet
inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks Entered S L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Final Cleanout:
Pink Copy: SEH
Total
Notes`
�C�s
' ,?
f1G
? �
I �
i
(
C
'
Lam'
€— f`� ='..
.. �:.
1
✓
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
�
�,
i '/
} p
Foundation drains
`
'
Roof drains
7,--
u
IIIII
A Cit of Capp
Residential Sanitary Sewer Service
Compliance Inspection
, s %
Date ) /L— l
Name
- 2
PID Number
House Number
4" to 6" Transition:
White Copy: Pi* oper ty Owner
Time
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected ) , t � o ,
sanitary sewer — yr � V I L , /,/,i
O Sump pump properly piped
O No sump pump
f
Disk #
Owner /Occupant Signature
Service Lateral Inspection Findings
• am
• pm
- r r lf/; Street Name
Alternative Mailing Address .
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
Record Number `°' 17 1—
Time
• Oam
• O pm
) A Y
Phone ?� 2
For information call 651.470.2788
Obstruction
Unable to push past
feet
inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks Entered S L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Final Cleanout:
Pink Copy: SEH