1443 Wellington Way - Inspection FormCity of hp
Residential Sanitary Sewer Service
Compliance Inspection
H f } /
Date i } l 'r / ;ir` .✓
J
Name
4, 7,) .t2-4 Disk #
PID Number'
House Number ; ) L) . .. . Street Name
r,r
CerlOccupant Signature
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
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
g am
Time • — jo pm
}
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
Alternative Mailing Address Phone r`J
177
Obstruction
Unable to push past
feet.
• O am
• O Pm
Inspector Signature
For information call 651.470.2788
Final Cleanout:
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
jy Notes
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Total
Sump pumps
,
num
Foundation drains
Roof drains
` �/ `
A MIN
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
H f } /
Date i } l 'r / ;ir` .✓
J
Name
4, 7,) .t2-4 Disk #
PID Number'
House Number ; ) L) . .. . Street Name
r,r
CerlOccupant Signature
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
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
g am
Time • — jo pm
}
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
Alternative Mailing Address Phone r`J
177
Obstruction
Unable to push past
feet.
• O am
• O Pm
Inspector Signature
For information call 651.470.2788
Final Cleanout:
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