4684 Kingsbury Dr - Inspection FormCity of Eg an
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 ) / . . / ; I( F . l
Name ) 4 ? ) .;P:77)
PID Number
House Number Street Name
Alternative Mailing Address Phone
4" to 6 "Transition:
White Copy: Property Owner
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
Time •
Ow er' /Qcc)lant Signature
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer'
'd
Flexible sump pump piping
Lengt, of Service:
Yellow Copy: City of Eagan
am
Pm
Record Number
y�-
Time
Inspeaor Signature
Obstruction
Unable to push past
feet
Final Cleanout:
O am
opm
No Access
O No one in
-
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered St at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Total
Notes
_
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v j r ;
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per .: r j "1 i .:
%2'
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lV
3
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-
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
41
. ! .
Foundation drains
Roof drains
4,"'""t-
City of Eg an
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 ) / . . / ; I( F . l
Name ) 4 ? ) .;P:77)
PID Number
House Number Street Name
Alternative Mailing Address Phone
4" to 6 "Transition:
White Copy: Property Owner
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
Time •
Ow er' /Qcc)lant Signature
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer'
'd
Flexible sump pump piping
Lengt, of Service:
Yellow Copy: City of Eagan
am
Pm
Record Number
y�-
Time
Inspeaor Signature
Obstruction
Unable to push past
feet
Final Cleanout:
O am
opm
No Access
O No one in
-
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered St at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH