4633 Beacon Hill Rd - Inspection FormCif of Ea ao
Y i�
Residential Sanitary Sewer Service
Compliance Inspection
Date ) ) 1=
Name
W : r ~3r Disk #
PID Number
House Number _ �. Street Name
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
id 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
1., ;("
Time
Non - Compliance
O
O
O
O
O
i
am
pm
Number of stacks
- CLJ -fTl Time
•
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number —
� I
Phone
r I
STS
Final Cleanout:
o am
•
• O pm
lnspetctor Signature \�
For information call 651.470.2788
Obstruction No Access
Unable to push past 0 No one in
feet
O Access to service
lateral needed
O Inspection
refused
Entered St at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number
Correctly
Discharged
Notes
,- r- f _.-/ / ..--
11 r L
i r° )• f ft I 1
' Li ..J `t/ k.. -yam - 42,
'f ,,. t
1
jw/ '°4-
Total
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains _
--°> j N' . .'
Cif of Ea ao
Y i�
Residential Sanitary Sewer Service
Compliance Inspection
Date ) ) 1=
Name
W : r ~3r Disk #
PID Number
House Number _ �. Street Name
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
id 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
1., ;("
Time
Non - Compliance
O
O
O
O
O
i
am
pm
Number of stacks
- CLJ -fTl Time
•
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number —
� I
Phone
r I
STS
Final Cleanout:
o am
•
• O pm
lnspetctor Signature \�
For information call 651.470.2788
Obstruction No Access
Unable to push past 0 No one in
feet
O Access to service
lateral needed
O Inspection
refused
Entered St at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH