2231 Liberty Lane - Inspection FormCif o
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Residential Sanitary Sewer Service
Compliance Inspection
Datell Time )
Name 7 g 5(/ b Disk #
PID Number
House Number
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
I Street Name
Owner /Occupant 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
t
O, am
pm
�1
For information call 65 1.470.2788
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
Record Number
412-'
Phone
Service Lateral Inspection Findings Number of stacks] Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
I
Transition ;, i
t
ir
L- engtfr~of-Ser-vlee:- r
Yellow Copy: City of Eagan
1
m�•wn
Time r •
Inspector Signature
Obstruction
Unable to push past
feet
am
Pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout:
/1
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
Total
Sump pumps
— i-
=' T y)s' I( ... �, ). `
d ) / i ° y
Foundation drains
gIIIIIIMIIIII
Roof drains
MIN
Cif o
�
Residential Sanitary Sewer Service
Compliance Inspection
Datell Time )
Name 7 g 5(/ b Disk #
PID Number
House Number
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
I Street Name
Owner /Occupant 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
t
O, am
pm
�1
For information call 65 1.470.2788
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
Record Number
412-'
Phone
Service Lateral Inspection Findings Number of stacks] Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
I
Transition ;, i
t
ir
L- engtfr~of-Ser-vlee:- r
Yellow Copy: City of Eagan
1
m�•wn
Time r •
Inspector Signature
Obstruction
Unable to push past
feet
am
Pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout:
/1
Pink Copy: SEH