1339 St Andrew Blvd - Inspection Form4 1111 0 .
City of tap
Residential Sanitary Sewer Service
Compliance Inspection
C)) )/)
Date
Name V< » #
PD Number
House Number
r?" /
4" to 6" Transition:
White Copy: Property Owner
Compliance
O No foundation drain connection
O No roof drain connection
tkitt • Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
oc 2(1,-
oam
Time •
pm
Street Name
PPYAIL,
Owner/Occupant Signature
Non
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Alternative Mailing Address
Time
Dam
•
• 0 Pm
.)
Phone = )
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
ef:
No Access
O No one in
O Inspection
refused
Entered S L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
For information call 651.470.2788
O Access to service
lateral needed
Pink Copy: SEH
Total
Notes
/ Ti-
..
,_ • i
,.
--
, 4
(
,4". --
,
D -
1
),
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
j i -t
1 -- it -
q,.. f t- -
• i •
Foundation drains
Roof drains
1-- 1
\ /
,
4 1111 0 .
City of tap
Residential Sanitary Sewer Service
Compliance Inspection
C)) )/)
Date
Name V< » #
PD Number
House Number
r?" /
4" to 6" Transition:
White Copy: Property Owner
Compliance
O No foundation drain connection
O No roof drain connection
tkitt • Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
oc 2(1,-
oam
Time •
pm
Street Name
PPYAIL,
Owner/Occupant Signature
Non
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
Alternative Mailing Address
Time
Dam
•
• 0 Pm
.)
Phone = )
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
ef:
No Access
O No one in
O Inspection
refused
Entered S L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
For information call 651.470.2788
O Access to service
lateral needed
Pink Copy: SEH