4731 Beacon Hill Cir - Inspection FormCity of Evan
Residential Sanitary Sewer Service
Compliance Inspection
Date)) 1 / /11
)
Name l "
PID Number
House Number - / ) Street Name
Alternative Mailing Address
)
Owner/Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
z1 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
• & am
Time - • %O pm
Disk #
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
Length of Service:
Yellow Copy: City of Eagan
Record Number T
• O am
Time • O pm
Phone - c / .
Number of stacks Entered S L at
Obstruction
Unable to push past
feet,
inspector Signature { rr ,�r
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
Total
Notes
i
W
-' _J_-
'
1/2
'"4-!J
/
y. ,'"
._..
/
,
4:::-..:2- ,/
r
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
i
1 '�.
l'%
^ �
Foundation drains
Roof drains
City of Evan
Residential Sanitary Sewer Service
Compliance Inspection
Date)) 1 / /11
)
Name l "
PID Number
House Number - / ) Street Name
Alternative Mailing Address
)
Owner/Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
z1 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
• & am
Time - • %O pm
Disk #
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
Length of Service:
Yellow Copy: City of Eagan
Record Number T
• O am
Time • O pm
Phone - c / .
Number of stacks Entered S L at
Obstruction
Unable to push past
feet,
inspector Signature { rr ,�r
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