2029 Jade Lane - Inspection FormCity of Capo
Residential Sanitary Sewer Service
Compliance Inspection
Dat i . Time ,C • pm
Name
PID Number
House Number
Alternative Mailing Address
No sump pump
Sag /Pipe Deflection
Transition
r
4" to 6" Transition:
White Copy: Property Owner
Disk if
Owner /Occupant Signature
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
Service Lateral Inspection Findings
Roots `
Street Name f (-
Phone
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
Number of stacks Entered S. L at
Poor Pipe Joints
Mineral Deposits
Damaged Pipe
Length of Service:
Yellow Copy: City of Eagan
Record Number
}
am
•
Time 0 pm
Inspector Signat
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: A-
Pink Copy: SEH
Number Discharged
Unknown
Notes
Total
Correctly
Incorrectly
Sump pumps
Foundation drains
Roof drains
-
City of Capo
Residential Sanitary Sewer Service
Compliance Inspection
Dat i . Time ,C • pm
Name
PID Number
House Number
Alternative Mailing Address
No sump pump
Sag /Pipe Deflection
Transition
r
4" to 6" Transition:
White Copy: Property Owner
Disk if
Owner /Occupant Signature
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
Service Lateral Inspection Findings
Roots `
Street Name f (-
Phone
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
Number of stacks Entered S. L at
Poor Pipe Joints
Mineral Deposits
Damaged Pipe
Length of Service:
Yellow Copy: City of Eagan
Record Number
}
am
•
Time 0 pm
Inspector Signat
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: A-
Pink Copy: SEH