1373 Camelback Dr - Inspection FormCity or hap
Residential Sanitary Sewer Service
Compliance Inspection
Date ' / /
) e )
PED Number
House Number / 4 ") Street Name )
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
c i No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Disk #
Time - •
OwnerlOccUpant
1
0 am
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
Obstruction
Unable to push past
feet
_7
am
•
• Opm
V- -
°'" I /7:
Phone _ "") -)
Inspector Signature )i/
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at
Pink Copy: SEH
Total
Notes
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Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
. .
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-
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Foundation drains
Roof drains
, ? ,
, /'. / '
1 ----/
City or hap
Residential Sanitary Sewer Service
Compliance Inspection
Date ' / /
) e )
PED Number
House Number / 4 ") Street Name )
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
c i No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Disk #
Time - •
OwnerlOccUpant
1
0 am
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
Obstruction
Unable to push past
feet
_7
am
•
• Opm
V- -
°'" I /7:
Phone _ "") -)
Inspector Signature )i/
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at
Pink Copy: SEH