1432 Rebecca Lane - Inspection FormCit y of Jag.au
Residential Sanitary Sewer Service
Compliance Inspection
Date OJ'1 2' 1 /d
Narne /, ^ 137 s i`r. i Disk #
fA 9
PID Number
House Number Z
f : .
Owner/Occup Signature
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
LO Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
/
White Copy: Property Owner
A-
Time i .
e arn
0 pm
Record Number
0
Street Name'. s°�.d`"
Alternative Mailing Address
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
Length of Service:
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
f ; am
Time /' • f ' p pm
Phone 1 ? ='.1 e','.-'
''Inspector Signature
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
r
Roots
Poor Pi pe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe ✓ {
Transition l / / r a T/ t J ,' � I A i ihil- ✓
Final Cleanout:'L/l t
Pink Copy: SEH
Total
Number
Correctly
Discharged
Incorrectly Unknown
Notes - Mill Vc.: 4/ („ . - - -- ;;7 7
f , _ ;
( /r T 4 /J 7-' ✓. e- (r,�}' _A � ,V
i � "1/42(,--7—e, 2 e J— ,-a� t.1.,
1
Sump pumps
Foundation drains
MI
1111
Roof drains
M1111111111111111111
Cit y of Jag.au
Residential Sanitary Sewer Service
Compliance Inspection
Date OJ'1 2' 1 /d
Narne /, ^ 137 s i`r. i Disk #
fA 9
PID Number
House Number Z
f : .
Owner/Occup Signature
Compliance
0 No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
LO Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
/
White Copy: Property Owner
A-
Time i .
e arn
0 pm
Record Number
0
Street Name'. s°�.d`"
Alternative Mailing Address
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
Length of Service:
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
f ; am
Time /' • f ' p pm
Phone 1 ? ='.1 e','.-'
''Inspector Signature
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
r
Roots
Poor Pi pe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe ✓ {
Transition l / / r a T/ t J ,' � I A i ihil- ✓
Final Cleanout:'L/l t
Pink Copy: SEH