4697 Penkwe Way - Inspection Form4 City d Cap
Residential Sanitary Sewer Service
Compliance Inspection
L )
Date,
Name ; ,
House Number
PID Number
Alternative Mailing Address
7.
/V V(./(
Owner/Occupant Signature
For information call 651.470.2788
Compliance
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
•
Time • o pm
Disk
am
Service Lateral Inspection Findings Number of stacks
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
....••■•■■■
Street Name A L--/ V I .
Time
Obstruction
Unable to push past
feet
Entered St at
Final Cleanout:
12
0 am
•
• _0 pm
r
11 .11"
1 /7 • 7
Phone .7
-
•-•./
'1
Inspector Signature 1 2
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
V
Number
Correctly
Discharged
Notes
f . ,---- 1 ,-, ...-----)., , '" -- .> •-- 2...,;.,=•:---- , / - 1
-..-„ 2 .--,
,/c 5 c .: - / ...- ,:
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.„/
i„_. ...., ) __,...„ ,
/ / 4 /7bi:• 3 , ---- ,
"2 ._,
• '''2,' --/— , ,,„/---1.
,-_____-----,-::. 1
Incorrectly
Unknown
Sump pumps
/ Total
f
( / •-
,,-----• ;._,°•:'•
.
),:--- , ?"
L.- ' ' '
r ,..-
....-/'-r .).'
/ -' .`, 1 . - - i IT—
,--).--
:,,,----
Foundation drains
Roof drains
IL)
V
4 City d Cap
Residential Sanitary Sewer Service
Compliance Inspection
L )
Date,
Name ; ,
House Number
PID Number
Alternative Mailing Address
7.
/V V(./(
Owner/Occupant Signature
For information call 651.470.2788
Compliance
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
•
Time • o pm
Disk
am
Service Lateral Inspection Findings Number of stacks
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
....••■•■■■
Street Name A L--/ V I .
Time
Obstruction
Unable to push past
feet
Entered St at
Final Cleanout:
12
0 am
•
• _0 pm
r
11 .11"
1 /7 • 7
Phone .7
-
•-•./
'1
Inspector Signature 1 2
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
V