1486 Thomas Lane - Inspection Form4 City or Eagan
Compliance Inspection
Sanitary Sewer Service
• Date di/ (6 / 0,
Name 'L4 4 h. J(
House Number /t
Alternative Mai i gAddres
Ej
erlOcc • ant Signature
Service Lateral Inspection Findings
Time / :Oo
daf
DVD #
Street Name 2'ip1 f
4" to b" Transition:
Sump Pumps and Foundation Drains
Sump Pum Foundation Drains
Number: Number:
Number Discharged: Number Discharged:
Correctly _ Correctly
_ Incorrectly __ Incorrectly
Unknown __, Unknown ___-
Further Investigation _.
0 No one home — left notice on door
O Access to Service Lateral needed
Q Cover replaced Time
O Obstruction
O Review Video
White Copy: Property Owner
Inspection Number
ine
Notes
Yellow Copy: City of Eagan
o e
Q Compliant
Non- Compliant —° ( Ol/T _ / C C, 1 .
Incomplete Inspection C YA-
Number of stacks / Entered S . at
For Appointments call
612.219.423!
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection _
Damaged Pipe — - _ --
Noes/Other
A'J 4711 (/, 1/",
3 , pc/c 2 _ s - f _ �(/Tv r'( f'
,r L , # : r17 (//ltd &. CAP N c Tb xi;
Lt, /7.., _ �' 1 p .' (4am low /Of
r
Length of Service: / 7 Final Ckeanout:�✓
t .1 4
inspector Signature
-
2S ( _ 7
Time /7•1am
prn
Phone f) /-.1/2Z
Pink Copy: SEH