4734 Westminster Cir - Inspection FormSump pumps
4
Foundation drains
Roof drains
t ,� "
it ofIa p
Residential Sanitary Sewer Service
Compliance Inspection
Date /( /(
Names
4" to 6" Transition:
J ' /�i
White Copy: Property Owner
PLO Number
House Number j 7" :? Name
Alternative Mailing Address
!4 'pam
Time i • pm
Disk -
r r.
4
Owner /Occupant Signature
For information call 651.470.2788
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
1
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
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Number Discharged
Total Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Record Number
Notes
Time
Phone i h ; � � -f— � ] 'c' i' R 7
•
Inspector Signature
Obstruction
Unable to push past
feet
Entered S Lai
Final Cleanout:
Q am
•
• O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH