4664 Kingsbury Dr - Inspection FormCity of Ea
Residential Sanitary Sewer Service
Compliance Inspection
Date ! 1 / 1 17 Time ''I •
Name , 1 // 1 . .a
PID Number
House Number /.,:%1 2 -e.- Street Name
Alternative Mailing Address
e.
/
4" to 6" Transition:
White Copy: Proper ty Owner
f
Disk #
OWner Si gnature
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
O
am
Pm
Phone f " c�f.i ` i f ").
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks Entered S. L,at
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
)e< < /"
Time
•
Obstruction
Unable to push past
feet .
o am
O pr
Inspector Signature
Anal Cleanout:
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
//761-0/-7 ,/ p) y
Pink Copy: SEH
Total
Notes
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City of Ea
Residential Sanitary Sewer Service
Compliance Inspection
Date ! 1 / 1 17 Time ''I •
Name , 1 // 1 . .a
PID Number
House Number /.,:%1 2 -e.- Street Name
Alternative Mailing Address
e.
/
4" to 6" Transition:
White Copy: Proper ty Owner
f
Disk #
OWner Si gnature
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
O
am
Pm
Phone f " c�f.i ` i f ").
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks Entered S. L,at
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
)e< < /"
Time
•
Obstruction
Unable to push past
feet .
o am
O pr
Inspector Signature
Anal Cleanout:
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
//761-0/-7 ,/ p) y
Pink Copy: SEH