4617 Kingsbury Dr - Inspection Form1 6 1 . •
Ctty oF Eaggi
Residential Sanitary Sewer Service
Compliance Inspection
„
Date)) / )
Name
Disk # M
PID Number
,,. V i A
House Number ) i 7 Street Name // r .--'-c r ''ii 2
, , ,
,./ /
Alternative Mailing Addr ess Phone,
For information call 651.470.2788
Compliance Non-Compliance
O No foundation drain connection 0 Clear water connections to
sanitary sewer
O Service lateral defects
OiSump pit not connected to
0 Defective manholes
sanitary sewer
O Sump pump connected to sanitary
O Sump pump properly piped sewer
O No sump pump 0 Flexible sump pump piping
O No roof drain connection
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6"Transition:
White Copy: Property Owner
O am
Time Pm
Owner/Occupant Signature
Length of Service:
Yellow Copy: City of Eagan
-FT]
Record Number 1 —
Time
Obstruction
Unable to push past
feet
m
• a
• 0 prn
Final Cleanout:
Inspector Signature /
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
%
...,
, L----:-"
,:::::....?
,,...,) l' i ,,, y - i .. /".)
',- , .-,.:..... :::- -7
Total
Sump pumps
/
- --
_..4..._. 4...)::
-. <- / 4
' 1 7 ; I
• - 7 1'72-
i C,-
i
-t:I
I-
Foundation drains
I.
Roof drains
___...)
,,
1 6 1 . •
Ctty oF Eaggi
Residential Sanitary Sewer Service
Compliance Inspection
„
Date)) / )
Name
Disk # M
PID Number
,,. V i A
House Number ) i 7 Street Name // r .--'-c r ''ii 2
, , ,
,./ /
Alternative Mailing Addr ess Phone,
For information call 651.470.2788
Compliance Non-Compliance
O No foundation drain connection 0 Clear water connections to
sanitary sewer
O Service lateral defects
OiSump pit not connected to
0 Defective manholes
sanitary sewer
O Sump pump connected to sanitary
O Sump pump properly piped sewer
O No sump pump 0 Flexible sump pump piping
O No roof drain connection
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6"Transition:
White Copy: Property Owner
O am
Time Pm
Owner/Occupant Signature
Length of Service:
Yellow Copy: City of Eagan
-FT]
Record Number 1 —
Time
Obstruction
Unable to push past
feet
m
• a
• 0 prn
Final Cleanout:
Inspector Signature /
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH