4703 Penkwe Way - Inspection FormCity of i;a as
Residential Sanitary Sewer Service
Compliance Inspection
Date
Y
Name ) r 1
PlD Number
House Number f Street Name
i
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits_
Sag /Pipe Deflection__
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Propel ty Owner
,.- ,V) /) 'Y? Disk #
• �ii" p, am
Time T• R pm
Owner /Occupant 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
Number of stacks ____ Entered S. at
Length of Service:
-Q7
Yellow Copy: City of Eagan
Record Number ?
Time
•
•
Obstruction
Unable to push past
feet
Final Cleanout:
o am
o pm
Phone
Inspector Signature �� j 1 /ri r"
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Notes
Total
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City of i;a as
Residential Sanitary Sewer Service
Compliance Inspection
Date
Y
Name ) r 1
PlD Number
House Number f Street Name
i
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe joints
Mineral Deposits_
Sag /Pipe Deflection__
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Propel ty Owner
,.- ,V) /) 'Y? Disk #
• �ii" p, am
Time T• R pm
Owner /Occupant 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
Number of stacks ____ Entered S. at
Length of Service:
-Q7
Yellow Copy: City of Eagan
Record Number ?
Time
•
•
Obstruction
Unable to push past
feet
Final Cleanout:
o am
o pm
Phone
Inspector Signature �� j 1 /ri r"
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Sump pumps
7
i
/ -
-
/
)0> ..
T1
f
-- _
1 �--
Foundation drains
�7
1 )
Roof drains
.Y
City of Ea au
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
Alternative Mailing Address
firs /2
/7 i( ,
Compliance
O No foundation drain connection
O No roof drain connection
Sump pic not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Ownet
rfri
•
Time
am
m
Disk # FT—
Owner /Occupant 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
Number of stacks
Number Discharged
Total Correctly Incorrectly Unknown
Record Number <
J .
Time
PID Number �} g j l
House Number 2 47/ Street Name Phone 7!
Inspector Signature
Obstruction
Unable to push past
feet
Entered S.L. at
Notes
• 0 a
• O pm
Length of Service: Final Cleanout:
J 1
} /,'
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor PipeJoints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
I t `.:
! - _ r 7 / C -' - � - 7 :�. -. - f
r7?
Yellow Copy: City of Eagan Pink Copy: SEH