4767 London Lane - Inspection FormCity of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date..2 / / 1
Name f �.?
PID Number
House Number
4" to 6" Transition:
White Copy: Property Owner
, .. Street Name
Owner /Occupant Signature
Compliance
No foundation drain connection
No_roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
• 57' O r am
Time pm
Disk
Service Lateral Inspection Findings Number of stacks
Alternative: Mailing AcJdress
i s
For information call 651.470.2788
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
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Length of Service:
Number Discharged
Sump pumps
Foundation drains
Roof drains
Total
Correctly
Incorrectly Unknown
Notes
Yellow Copy: City of Eagan
Record Number
Time
Entered S L at
Obstruction
Unable to push past
feet
• 0 a
,
• , pm
Phone
inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout
,e. ev : � - ,s
Pink Copy: SEH