4640 Kingsbury Dr - Inspection FormCity of Ea as
Y �
Residential Sanitary Sewer Service
Compliance Inspection
f! !}.
Date if' ..// (-"7
Name,
House Number
•
!
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
(=' Sump pit not connected to
sanitary sewer
di Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
(2. 9 o am
Time • pm
Disk #
PID Number
i
Street Name
OwrierlOccupant Signature
1
sewer.
LU - ELi
For information call 651,470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
O Flexible sump pump piping
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 '� #
Jr �
Time
i
Phone f i
Obstruction
Unable to push past
feet
Oam
•
• O pm
Final Cleanout:
Inspector Signature A/„.„....7.-4 d � h 6 ,
1" s
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Notes
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.e.: -r 7 j ,%
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/
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
Foundation drains
Roof drains
/
City of Ea as
Y �
Residential Sanitary Sewer Service
Compliance Inspection
f! !}.
Date if' ..// (-"7
Name,
House Number
•
!
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
(=' Sump pit not connected to
sanitary sewer
di Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
(2. 9 o am
Time • pm
Disk #
PID Number
i
Street Name
OwrierlOccupant Signature
1
sewer.
LU - ELi
For information call 651,470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
O Flexible sump pump piping
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 '� #
Jr �
Time
i
Phone f i
Obstruction
Unable to push past
feet
Oam
•
• O pm
Final Cleanout:
Inspector Signature A/„.„....7.-4 d � h 6 ,
1" s
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH