1365 Grace Dr - Inspection FormCity of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date 24-1 q / ; y
Name ),//✓ ' 3l1
3
PFD Number
House Number 1 f. Street Name
OwnerlOccupant 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
Time
7 Disk #
Service Lateral Inspection Findings
Transition
4" to 6 "Transition:
White Copy: Property Owner
6._3( y am
• O pm
i
1
Yellow Copy: City of Eagan
C)
Alternative Mailing Address Phone 4.-7 i ,=
f
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
Record Number
Li-
° Time
Il
•
Inspector Signature
Obstruction
Unable to push past
feet .
of am
0 pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks Entered S,L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
ifs
Length of Service:{ - -Final Cleanout•
. —`
Sump pumps
Foundation drains
Roof drains
Total
Correctly
Number Discharged
Fncor r•ectly
Unknown
Notes
Pink Copy: SEH