4641 Beacon Hill Rd - Inspection FormCity of hp
Residential Sanitary Sewer Service
Compliance Inspection
i /) F 1,, - /
Date - :'! } .; 1
Name ...."'9f1f:" Disk #
ate?
am
Time • pm
•
PID Number
House Number O 1 Street Name
Alternative Mailing Address
3^
4" to 6" Transition:
White Copy: Property Owner
f
Owner /Occupghf Signature
W-
Compuiance
O No foundation drain connection
e.
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
sewer
Flexible sump pump piping
Non - Compliance
O Clear. water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
Yellow Copy: City of Eagan
Record Number
Time
Phone /•
Obstruction
Unable to push past
feet
•
•
Inspector Signature i N
o am
o Pm
Transition 1 ; . ? - 2
y
Length of Servic ,,,,..:a..,. - `i �� j' F i a I' Cle aiout s s
,.I
No Access
O No one in
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Pink Copy: SEH
For information call 65 1.470.2788
O Access to service
lateral needed
O Inspection
refused
Total
t.
Notes
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
----
Roof drains
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
i /) F 1,, - /
Date - :'! } .; 1
Name ...."'9f1f:" Disk #
ate?
am
Time • pm
•
PID Number
House Number O 1 Street Name
Alternative Mailing Address
3^
4" to 6" Transition:
White Copy: Property Owner
f
Owner /Occupghf Signature
W-
Compuiance
O No foundation drain connection
e.
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
sewer
Flexible sump pump piping
Non - Compliance
O Clear. water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
Sump pump connected to sanitary
Yellow Copy: City of Eagan
Record Number
Time
Phone /•
Obstruction
Unable to push past
feet
•
•
Inspector Signature i N
o am
o Pm
Transition 1 ; . ? - 2
y
Length of Servic ,,,,..:a..,. - `i �� j' F i a I' Cle aiout s s
,.I
No Access
O No one in
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Pink Copy: SEH
For information call 65 1.470.2788
O Access to service
lateral needed
O Inspection
refused