4872 Richard Lane - Inspection Form11 1111' — Residential Sanitary Sewer Service
ol tap Compliance Inspection
/
Date_ /
/; V/V7
Name Disk #
ND Number
House Number
Alternative Mailing Addr ess
I ( f " •
/ - • ' 7-1 / -
OwnerlOccupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6"Transition:
White Copy: Pr operty Owner
,16 am
Time /
Pm
Street Name
Non-Compliance
Transition
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Obstruction
Unable to push past
feet
Number of stacks Entered S L at
Length of Service: / )
Yellow Copy: City of Eagan
Record Number
• X am
Time --=-/ • O pm
Phone
— •
Inspector Signature
"5-)
e"
_
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
&`;' / Y14 rcr
Final Cleanout:
Pink Copy: SE 11
Number
Correctly
Discharged
Incorrectly Unknown
Notes
, , ffin .-- - !.. y ff -- ji 7, / _• , 7 ,/` ......*--
)
r....,
Total
Sump pumps
1 i
7 -0':2
..",,
i K....
Foundation drains
ME
Roof drains
11 1111' — Residential Sanitary Sewer Service
ol tap Compliance Inspection
/
Date_ /
/; V/V7
Name Disk #
ND Number
House Number
Alternative Mailing Addr ess
I ( f " •
/ - • ' 7-1 / -
OwnerlOccupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6"Transition:
White Copy: Pr operty Owner
,16 am
Time /
Pm
Street Name
Non-Compliance
Transition
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Obstruction
Unable to push past
feet
Number of stacks Entered S L at
Length of Service: / )
Yellow Copy: City of Eagan
Record Number
• X am
Time --=-/ • O pm
Phone
— •
Inspector Signature
"5-)
e"
_
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
&`;' / Y14 rcr
Final Cleanout:
Pink Copy: SE 11