4618 Summit Pass - Inspection FormCity al bag]
Residential Sanitary Sewer Service
Compliance Inspection
Date ) ) / )71 1
Name
Disk #
PID Number
House Number 2— ; ' )-A Street Name
•
Alternatiive- failing Address
/ 3 S
1
i •
}
J 2fwnerloccupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
f Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
7---° • Vic' am
Time • pm
-m�
Phone r.s
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
[1
Time
Obstruction
Unable to push past
feet
Entered S.L,at
q am
•
• q pm
Inspector Signature \
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
Final Cleanout:
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
r,
✓ " .— � '; -,,.-
,
% -
_l `= ° � a ,f ,
Total
Sump pumps
1
Foundation drains
Roof drains
'
®
City al bag]
Residential Sanitary Sewer Service
Compliance Inspection
Date ) ) / )71 1
Name
Disk #
PID Number
House Number 2— ; ' )-A Street Name
•
Alternatiive- failing Address
/ 3 S
1
i •
}
J 2fwnerloccupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
f Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
7---° • Vic' am
Time • pm
-m�
Phone r.s
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
[1
Time
Obstruction
Unable to push past
feet
Entered S.L,at
q am
•
• q pm
Inspector Signature \
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
Final Cleanout:
Pink Copy: SEH