1415 Dolores Lane - Inspection FormCity of a ai
Residential Sanitary Sewer Service
Compliance Inspection
Date /a.. 1 .
Name 1) /A e7f 12p, Disk #
PID Number
House Number N/C Street Name
Alternative Mailing Address
e.?... it/
For information call 651.470.2788
Com pliance
i No foundation drain connection
i k(No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
k ' No sump pump
Service Lateral Inspection Findings Number of stacks 1 Entered S.L. at 1 ' C/ - (
Roots
PoorPipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 1 : - /? , ”
r ��
4" to 6 "Transition:
A1� .Y
Owner /Occupant Signature
White Copy: Property Owner
/ • 4 am
Time r - • • ['%wp m
T
C, %J 4 ( rt_c7- --
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: 1 /A . 7 C
Yellow Copy: City of Eagan
Record Number
_9
Phone's) /V
a
r m
Time ; • pm
Inspector Signature
Obstruction
Unable to push past
feet
Fi nal Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
f r
•
Pink Copy: SEH
Notes o _ (,�'rfi �� ,4 w , „
.. � Y _,� 0i
i ✓. C .
Number
Correctly
Y
Discharged
Incorrect) Y
Un known
Total
Sump pumps
Foundation drains
er
-- � ---'°
- -- °-°
Roof drains
City of a ai
Residential Sanitary Sewer Service
Compliance Inspection
Date /a.. 1 .
Name 1) /A e7f 12p, Disk #
PID Number
House Number N/C Street Name
Alternative Mailing Address
e.?... it/
For information call 651.470.2788
Com pliance
i No foundation drain connection
i k(No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
k ' No sump pump
Service Lateral Inspection Findings Number of stacks 1 Entered S.L. at 1 ' C/ - (
Roots
PoorPipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 1 : - /? , ”
r ��
4" to 6 "Transition:
A1� .Y
Owner /Occupant Signature
White Copy: Property Owner
/ • 4 am
Time r - • • ['%wp m
T
C, %J 4 ( rt_c7- --
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: 1 /A . 7 C
Yellow Copy: City of Eagan
Record Number
_9
Phone's) /V
a
r m
Time ; • pm
Inspector Signature
Obstruction
Unable to push past
feet
Fi nal Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
f r
•
Pink Copy: SEH