4646 Kingsbury Dr - Inspection FormCity off' 3a as
Residential Sanitary Sewer Service
Compliance Inspection
• am
Time � • pm
Name � ° '.' 'i/. Disk #
PID Number
Date l!
d
r ✓ 3 �.,p f
Alternative Mailing Address - '1F 'r'
i . f r atr � . It (f / ' /(r . i 1i C Phone
1
r ..�
House Number of / Street
Compliance
O No foundation drain connection
O 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
Owner /Occupant Signature
Service Lateral Inspection Findings
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
Length of Service:
Yellow Copy: City of Eagan
f� 7
Record Number
Time
r
Obstruction
Unable to push past
feet
Final Cleanout:
• o am
• ._ O pm
Inspector Signature )\) ' - ?) j
For information call 651.470.2788
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
Pink Copy: SEH
/1 ;fps.
Number
Correctly
Discharged
Incorrectly Unknown
Notes
i
6,, e"°} - _ { �
w / )
/2' lq _ 7. - '''' -`) r
' - - s,. / , LA '_ fi ' !
Total
Sump pump
Foundation drains
Roof drains
/ MIN
City off' 3a as
Residential Sanitary Sewer Service
Compliance Inspection
• am
Time � • pm
Name � ° '.' 'i/. Disk #
PID Number
Date l!
d
r ✓ 3 �.,p f
Alternative Mailing Address - '1F 'r'
i . f r atr � . It (f / ' /(r . i 1i C Phone
1
r ..�
House Number of / Street
Compliance
O No foundation drain connection
O 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
Owner /Occupant Signature
Service Lateral Inspection Findings
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
Length of Service:
Yellow Copy: City of Eagan
f� 7
Record Number
Time
r
Obstruction
Unable to push past
feet
Final Cleanout:
• o am
• ._ O pm
Inspector Signature )\) ' - ?) j
For information call 651.470.2788
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
Pink Copy: SEH
/1 ;fps.