2091 Shale Lane - Inspection Form - -
d-
I Ir Compliance Inspection
Dated i 1_ Time a Pm Record Number
t ~
G~oam
Disk# f f ,1 D Time ~..~7pm
PID Number
ouse Number Street Name
House
Alternative MaiiingAddress__ Phone 42,
OwnerlOccupa t Signature - Inspector Signature
For information call 651.470.2788
Compliance Non-Compliance Obstruction No Access
No foundation drain connection O Clear water connections to Unable to push past O No one in
No roof drain connection sanitary sewer, _ feet. O Access to service
O Service lateral defects lateral needed
O Sump pit not connected to O Defective manholes
sanitary sewer O Inspection
O Sump pump connected to sanitary
O Sump pump properly piped sewer, refused
No sump pump O Flexible sump pump piping
Service Later~aInspection indi~f s Number of statics Entered S.L. at
- -
Roots -.L
Poor Pipe)oints
Mineral Deposits
Sag/Pipe Deflection _
Damaged Pipe
Transition
4" to 6"Transition: Length of Service: / Final Cleanout:~~C J
Notes
Number Discharged
Total Correctly Incorrectly Unknown
Sump pumps 0
Foundation drains
Roof drains
White Copy: Property Owner Yellow Copy: City of Eagan Pink Copy: SEH