1371 St Andrew Blvd - Inspection FormCity of hp
Residential Sanitary Sewer Service
Compliance Inspection
/1
Date 1,! I )//
Name
PID Number
House Number 1 ' / Street Name
Alternative Mailing Address
4" to 6" Transition:
Compliance
O No foundation drain connection
O No roof drain connection
sanitary sewer
O Sump pump properly piped
O No sump pump
Sump pit not connected to
Time
OwnerlOccupant Signature
Service Lateral Inspection Findings
White Copy: Proper ty Owner
Disk #
A `lb
am
0 pm
m
Number of stacks
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
Time
Phone -2a ; 1
Obstruction
Unable to push past
feet
Final Cleanout:
• O am
• o pm
J
inspector Signature
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Roots
Poor PipeJoints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Total
Notes
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(4 (31 ). - e - 'ndi l
Number
Discharged
Correctly
Incorrectly Unknown
Sump pumps
. -" "'
�' ' `
I '
Foundation drains
Mil
Roof drains
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-, i
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
/1
Date 1,! I )//
Name
PID Number
House Number 1 ' / Street Name
Alternative Mailing Address
4" to 6" Transition:
Compliance
O No foundation drain connection
O No roof drain connection
sanitary sewer
O Sump pump properly piped
O No sump pump
Sump pit not connected to
Time
OwnerlOccupant Signature
Service Lateral Inspection Findings
White Copy: Proper ty Owner
Disk #
A `lb
am
0 pm
m
Number of stacks
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
Time
Phone -2a ; 1
Obstruction
Unable to push past
feet
Final Cleanout:
• O am
• o pm
J
inspector Signature
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Roots
Poor PipeJoints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH