4711 Hazeltine Lane - Inspection FormResidential Sanitary Sewer Service
Compliance Inspection
Date a, ) q1 13
Name
PID Number
House Number
Alternative Mailing Address Phone ) "A;- ))
f
For information call 651.470.2788
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
S anitary sewer
ump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner.
Total
4. o am
Time o Jo
Disk # 9
J LI-
Street Name
Ownerl0ccupant Signature
Non - Compliance
O Clear water connections to Unable to push past
sanitary sewer. feet
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: J72
Sump pumps
Foundation drains
Roof drains
Number Discharged
Correctly Incorrectly Unknown
Record (lumber 'I
7 • o am
me • Clpm
7 T"
� r
Inspector Signature
Obstruction
Notes
i1
A
r.
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: Y
Yellow Copy: City of Eagan Pink Copy: SEH