4709 Covington Cir - Inspection Form4111
Cif ai' Ea pt
y
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
PID Number
House Number ' (./ Street Name
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
4" to 6" Transition:
Sump pumps
Foundation drains
Roof drains
Total
Correctly Incorrectly Unknown
White Copy: Property Owner
) • 06) am
Time / / • pm
Disk 14
771
OwnerlOccupant Signature
LU
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:
Number Discharged
Yellow Copy: City of Eagan
Record Number
Time
�~ 4 2 f'
Phone' --
•
Obstruction
Unable to push past
feet.
For information call 651.470.2788
Service Lateral Inspection Findings Number of stacks Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Notes
Final Cleanout:
0 am
• 0 pm
Inspector Signature ✓• -� :`, �, 3
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH