1458 Wellington Way - Inspection Form4 111111 ' City f to p
Y �
Residential Sanitary Sewer Service
Compliance Inspection
Date
I
Name r%,/ I -41 ) ! c_ Disk #
PID Number
House Number .. Street Name
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
•� -/ j o' em
Time • t j' p
1
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
?' p Sump pit not connected to
sanitary sewer
O/ Sump pump properly piped
O No sump pump
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
•
o am
• - o pm
? A �, `
Phone /�
Obstruction
Unable to push past
feet
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Notes
Discharged
Total
Incorrectly
Unknown
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Sump pumps
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Foundation drains
Roof drains
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4 111111 ' City f to p
Y �
Residential Sanitary Sewer Service
Compliance Inspection
Date
I
Name r%,/ I -41 ) ! c_ Disk #
PID Number
House Number .. Street Name
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
•� -/ j o' em
Time • t j' p
1
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
?' p Sump pit not connected to
sanitary sewer
O/ Sump pump properly piped
O No sump pump
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
•
o am
• - o pm
? A �, `
Phone /�
Obstruction
Unable to push past
feet
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH