2196 Liberty Lane - Inspection Formcity or kan
Residential Sanitary Sewer Service
Compliance Inspection
Date/6 1 ( Time
Name
,, ! /% �r� f`_;
PID Number
House Number 4 Street Name
Alternative Flailing Address
Compliance
O No foundation drain connection
W No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
4" to 6" Transition:
Owner /Occupant Signature
White Copy: property Owner
Disk #
O
am
pm
•
Length of Service:
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible ▪ sump pump piping
Record Number
f • p am
Time f Cr pm
EFC-in
Phone ! — 2 7 7q
Yellow Copy: City of Eagan
For information calf 651.470.278$
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
i�
1. ' t ?
fi- Final Cleanout:
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
! y�
Roof drains
77)
city or kan
Residential Sanitary Sewer Service
Compliance Inspection
Date/6 1 ( Time
Name
,, ! /% �r� f`_;
PID Number
House Number 4 Street Name
Alternative Flailing Address
Compliance
O No foundation drain connection
W No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
4" to 6" Transition:
Owner /Occupant Signature
White Copy: property Owner
Disk #
O
am
pm
•
Length of Service:
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible ▪ sump pump piping
Record Number
f • p am
Time f Cr pm
EFC-in
Phone ! — 2 7 7q
Yellow Copy: City of Eagan
For information calf 651.470.278$
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
i�
1. ' t ?
fi- Final Cleanout:
Pink Copy: SEH