4665 Kingsbury Dr - Inspection Form4 City of Ea aH
Residential Sanitary Sewer Service
Compliance Inspection
11/_
Alternative Mailing Address
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner
Compliance
O No foundation drain connection
O No roof drain connection
O am
Time "`s • pm
Date P
Name/ C-7 Disk #
MD Number
S her /Occuiant Signature
-L1J
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
0 Defective manholes
0( Sump pump connected to sanitary
sewer
Flexible sump pump piping
Yellow Copy: City of Eagan
Record Number
Time
• O am
• o pm
House Number .2. 1 -Th Street Name i/ / V O
Phone /
Obstruction
Unable to push past
feet.
Service Lateral Inspection Findings Number of stacks Entered S L.at
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Inspector Signature \
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
r -I� ii �1.~°
t _ z_ ,)
Length of Service:
Final Cleanout:
Pink Copy: SEH
1 /
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
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Total
Sump pumps
1.J
Foundation drains
®
1111
Roof drains
i
111/1
4 City of Ea aH
Residential Sanitary Sewer Service
Compliance Inspection
11/_
Alternative Mailing Address
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner
Compliance
O No foundation drain connection
O No roof drain connection
O am
Time "`s • pm
Date P
Name/ C-7 Disk #
MD Number
S her /Occuiant Signature
-L1J
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
0 Defective manholes
0( Sump pump connected to sanitary
sewer
Flexible sump pump piping
Yellow Copy: City of Eagan
Record Number
Time
• O am
• o pm
House Number .2. 1 -Th Street Name i/ / V O
Phone /
Obstruction
Unable to push past
feet.
Service Lateral Inspection Findings Number of stacks Entered S L.at
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Inspector Signature \
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
r -I� ii �1.~°
t _ z_ ,)
Length of Service:
Final Cleanout:
Pink Copy: SEH
1 /