4663 Penkwe Way - Inspection FormCity o hp]
Residential Sanitary Sewer Service
Compliance Inspection
Date / ) /2)
/ ( Time.,..7: am
W Pm
Name
Disk #
PID Number
House Number.
Street Name
Alternative Mailing Address
Owner/Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer.
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
Non-Compliance
_LI FE
.7 1 -----
1
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number 2-- r
o am
•
Time • 0 pm
Phorie9.7.1(.376
inspector Signature /1/7.z.4
For information call 651.470.2788
Obstruction
Unable to push past
feet.
Entered S L at
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Notes
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
/ - . - _.,_--,..
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:::::::.' ) ()
1
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Q ''
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Foundation drains
1
Roof drains
---)
City o hp]
Residential Sanitary Sewer Service
Compliance Inspection
Date / ) /2)
/ ( Time.,..7: am
W Pm
Name
Disk #
PID Number
House Number.
Street Name
Alternative Mailing Address
Owner/Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer.
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
Non-Compliance
_LI FE
.7 1 -----
1
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number 2-- r
o am
•
Time • 0 pm
Phorie9.7.1(.376
inspector Signature /1/7.z.4
For information call 651.470.2788
Obstruction
Unable to push past
feet.
Entered S L at
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH