4723 Beacon Hill Rd - Inspection Form4 City of Cap
Residential Sanitary Sewer Service
Compliance Inspection
Date / / / )(:?)
-.
Name
PID Number
House Number
Compliance
O No foundation drain connection
O No roof drain connection
sanitary sewer
\ d Sump pump properly piped
O No sump pump
Sump pit not connected to
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: PI oper ty Owner
C) BM
Time
. •
Disk #
2--4 9 2
treet Name
Owner/Occupant Signature
Pm
1
Length of Service:
Alternative Mailing Addr ess
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
Number of stacks
Yellow Copy: City of Eagan
Time
Entered S L at
Record Number
Obstruction
Unable to push past
feet
•
o am
• 0 pm
pi?.
Phone
Inspector Signature 7.
= r‘
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number
Correctly
Discharged
Notes
..1
;.C.--ze.-- i / ' '
)
-7-7-.,2 --------_-.- ... 7 1,..) -
f /
'''''' Li ,..„...7-4-7---•-,--,, '
,:,.;'-i ,--__'...• : - lik,,, 4
Total
Incorrectly
Unknown
Sump pumps
,----
.) „,,,,
-.-',
Foundation drains
Roof drains
t._ _
--;
4 City of Cap
Residential Sanitary Sewer Service
Compliance Inspection
Date / / / )(:?)
-.
Name
PID Number
House Number
Compliance
O No foundation drain connection
O No roof drain connection
sanitary sewer
\ d Sump pump properly piped
O No sump pump
Sump pit not connected to
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: PI oper ty Owner
C) BM
Time
. •
Disk #
2--4 9 2
treet Name
Owner/Occupant Signature
Pm
1
Length of Service:
Alternative Mailing Addr ess
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
Number of stacks
Yellow Copy: City of Eagan
Time
Entered S L at
Record Number
Obstruction
Unable to push past
feet
•
o am
• 0 pm
pi?.
Phone
Inspector Signature 7.
= r‘
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH