4622 Summit Pass - Inspection FormSump pumps
Foundation drains
Roof drains
.
T ! City of bpi
Residential Sanitary Sewer Service
Compliance Inspection
Date
? 1 1 1r''.
Name � 1 .� --* d -°�I t Disk #
PID Number
House Number
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
SagJPipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner
Total
I am
Time �� pm
f ! ' Street Name
Owner /Occupant Signature
Number Discharged
-m
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
Record Number
Time
Obstruction
Unable to push past
feet.
Entered S L at
Notes
Correctly Incorrectly Unknown
)
f;
p , i
inspector Signature
Length of Service: Final Cleanout:
r
0 a
O pm
Phone_.! , �� ' >7
For information call 651.470.2788
No Access
O. No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH