2097 Marble Lane - Inspection FormCity of Fa a
Residential Sanitary Sewer Service
Compliance Inspection
ate"' :
Date.!
Name ----
M
• : are
Time °� �' ' 4' pm
Disk #
OwneriOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
7/7
PID Number
House Number 'fir )(:-' / Street Name ' / i i f; o=ff' ) w r'
/2,
Alternative Mailing Address Phone '
Service Lateral Inspection Findings Number of statkss
-) d
Roots /fifes— l .
Length of Service:
Yellow Copy: City of Eagan
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
Record Number f`
• i o am
Time • • ' pm
Obstruction
Unable to push past
feet
Entered S.L.at
Inspector Signature
Final Cleanout:
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor' Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition H (. 4" (,1."(f f • J
Notes
Pink Copy: SEH
Total
Number Discharged
Correctly
-
Incorrectly
-
Unknown
Ell
Sump pumps
'
Foundation drains
11.1
Roof drains
City of Fa a
Residential Sanitary Sewer Service
Compliance Inspection
ate"' :
Date.!
Name ----
M
• : are
Time °� �' ' 4' pm
Disk #
OwneriOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
7/7
PID Number
House Number 'fir )(:-' / Street Name ' / i i f; o=ff' ) w r'
/2,
Alternative Mailing Address Phone '
Service Lateral Inspection Findings Number of statkss
-) d
Roots /fifes— l .
Length of Service:
Yellow Copy: City of Eagan
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
Record Number f`
• i o am
Time • • ' pm
Obstruction
Unable to push past
feet
Entered S.L.at
Inspector Signature
Final Cleanout:
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor' Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition H (. 4" (,1."(f f • J
Notes
Pink Copy: SEH