4680 Penkwe Way - Inspection Form4 City olla an
Residential Sanitary Sewer Service
Compliance Inspection
s
Date 1 ✓
Name
1 �
PD Number
House Number' 1 (Street Name
Alternative Mailing Address
L ' r / , � t
> �e, „
OwnerlOccupant Signature
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
' . 4 1 No sump pump
4" to 6" Transition:
White Copy: Property Owner
i a
Time I
r 1 :' 11,' Disk #
am
0 pm
�m-
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
z y
Phone _ ( 73 °<
Service Lateral Inspection Findings 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
Record Number
Time
Obstruction
Unable to push past
feet
Final Cleanout:
p am
•
• O pm
Inspector Signature ) \} a / / / l // j s "
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
Total
Sump pumps
' r'
MEM
Foundation drains
Roof drains
i )
4 City olla an
Residential Sanitary Sewer Service
Compliance Inspection
s
Date 1 ✓
Name
1 �
PD Number
House Number' 1 (Street Name
Alternative Mailing Address
L ' r / , � t
> �e, „
OwnerlOccupant Signature
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
' . 4 1 No sump pump
4" to 6" Transition:
White Copy: Property Owner
i a
Time I
r 1 :' 11,' Disk #
am
0 pm
�m-
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
z y
Phone _ ( 73 °<
Service Lateral Inspection Findings 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
Record Number
Time
Obstruction
Unable to push past
feet
Final Cleanout:
p am
•
• O pm
Inspector Signature ) \} a / / / l // j s "
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH