1474 Thomas Lane - Inspection Form4 111 . 1111. City Eaau
Residential Sanitary Sewer Service
Compliance Inspection
Date c4 t. 71 10 Time '?
Name °JbU'41,4f / t� /J ` kr-
PID Number
House Number
Alternative Mailing Address
�r 1
i Owner /Occupan Signature
f /f
Compliance
O No foundation drain connection
'ISR No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copy: Pr operty Ownex
/ Z 7 « Street Name
J
cjsam
0 pm
4r
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
1
Obstruction
Unable to push past
feet
4
am
Time ! O pm
Phone `'W 7 o ' / - (
40
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks i Entered S. L at . /r 7 . s ,
Roots
PoorPipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition ?^ ° A / ,'i,y /'t,c ( r -�
Final Cieanout:
Pink Copy: SEH
Total
Notes •_.viv/
t / 94 , -. /8 w (
/ c' ( J f - a " _ /U.4'
.5; c, ,.P
_ 3 : ;
, V61 , 4 ° --�-,.`:: ` = ,'
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7
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/.. 7
, -- ,ae 6/.w
r% s',:;.r
4, i" f'' ':;..'4
.
Number
Discharged
Correctly
incorrectly
Unknown
Sump pumps
~`
Foundation drains
Roof drains
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4 111 . 1111. City Eaau
Residential Sanitary Sewer Service
Compliance Inspection
Date c4 t. 71 10 Time '?
Name °JbU'41,4f / t� /J ` kr-
PID Number
House Number
Alternative Mailing Address
�r 1
i Owner /Occupan Signature
f /f
Compliance
O No foundation drain connection
'ISR No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copy: Pr operty Ownex
/ Z 7 « Street Name
J
cjsam
0 pm
4r
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
1
Obstruction
Unable to push past
feet
4
am
Time ! O pm
Phone `'W 7 o ' / - (
40
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks i Entered S. L at . /r 7 . s ,
Roots
PoorPipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition ?^ ° A / ,'i,y /'t,c ( r -�
Final Cieanout:
Pink Copy: SEH