4760 Penkwe Cir - Inspection FormCity of bra n
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 /1`_f I :( r _
ii
t t
E f
Name {VI:. (1 W)Disk#
PID Number
House Number r .' r >( .J Street Name
Alternative Mailing Address
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
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
Time, •
g Owner /Occupant Signature
p, am
Pm
L
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
Record Number
Time
• 0 am
• O Pm
Phone C - >- •� �./ % 2.
Inspector Signature 11).6i J
f
For information call 651.470.2788
Obstruction
Unable to push past
feet
Length of Service: Final Cleanout:
Notes
r i
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S. at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
.r
' L �,
-, ;' 7
/ /)
.w.
R- ''V
Foundation drains
, -
? I
Roof drains
-._'
City of bra n
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 /1`_f I :( r _
ii
t t
E f
Name {VI:. (1 W)Disk#
PID Number
House Number r .' r >( .J Street Name
Alternative Mailing Address
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
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
Time, •
g Owner /Occupant Signature
p, am
Pm
L
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
Record Number
Time
• 0 am
• O Pm
Phone C - >- •� �./ % 2.
Inspector Signature 11).6i J
f
For information call 651.470.2788
Obstruction
Unable to push past
feet
Length of Service: Final Cleanout:
Notes
r i
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S. at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SEH