1395 St Andrew Blvd - Inspection Form4 11. City of fo �a
Y p
Residential Sanitary Sewer Service
Compliance Inspection
r
Date i j
Name d ., J r� v'� r Disk #
PID Number
House Number :' `° ` " 'c Street Name
Alternative Mailing Address
/ r
i 3
/i
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
i
Time . •
/ bwnerlQccupant Signature
Service Lateral Inspection Findings
am
pm
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
,e
Obstruction
mow:
Obstruction
Unable to push past
feet.
Final Cleanout:
O am
•
O pm
Phone i�.� ^� I eq ir - ' � r
Inspector Signature {'
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L:at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
, ,.� -., -! l ,-7
- - ---- , },,,...._, , 74,1
....._ ,
Total
Sump pumps
o-^ /
REM
Foundation drains
IME
Roof drains
x
4 11. City of fo �a
Y p
Residential Sanitary Sewer Service
Compliance Inspection
r
Date i j
Name d ., J r� v'� r Disk #
PID Number
House Number :' `° ` " 'c Street Name
Alternative Mailing Address
/ r
i 3
/i
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
i
Time . •
/ bwnerlQccupant Signature
Service Lateral Inspection Findings
am
pm
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
,e
Obstruction
mow:
Obstruction
Unable to push past
feet.
Final Cleanout:
O am
•
O pm
Phone i�.� ^� I eq ir - ' � r
Inspector Signature {'
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L:at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH