4284 Amber Dr - Inspection FormResidential Sanitary Sewer Service
ortag.E1 Compliance Inspection
Date /? I
Name ) / 7iv mi. isk # i/5
PID Number
House Number
Alternative Mailing Address
For information call 651.47
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
7
Service Lateral Inspection Fin
Roots ✓ L 1
/ f
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
rd
White Copy: Pr operty Owner
r^�
Time •
in s
Street Name
Owner /Occupant Signatur
am
pm
-2E1 [
5
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
Number of stacks_
Poor Pipe Joints
Mineral Deposits
Record Number
Phone /rte ._ ] 2--fi ` 50
inspector Signature
Obstruction
Unable to push past
feet
Entered S. L at rr.9r!' /
/
Length of Service: / --� --
Yellow Copy: City of Eagan
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Nat OV
r
r
-2 4 - ,
Number
Discharged-
f ei5 -- ( ) 0()
'i /,' � ,
Correctly
Incorrectly Unknown
Sump pumps
(
-.
Foundation drains
J
Roof drains
�o • • ,
= !34
Residential Sanitary Sewer Service
ortag.E1 Compliance Inspection
Date /? I
Name ) / 7iv mi. isk # i/5
PID Number
House Number
Alternative Mailing Address
For information call 651.47
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
7
Service Lateral Inspection Fin
Roots ✓ L 1
/ f
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
rd
White Copy: Pr operty Owner
r^�
Time •
in s
Street Name
Owner /Occupant Signatur
am
pm
-2E1 [
5
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
Number of stacks_
Poor Pipe Joints
Mineral Deposits
Record Number
Phone /rte ._ ] 2--fi ` 50
inspector Signature
Obstruction
Unable to push past
feet
Entered S. L at rr.9r!' /
/
Length of Service: / --� --
Yellow Copy: City of Eagan
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
City o '. a ,ai
Residential Sanitary Sewer Service
Compliance inspection
Date / 41 /
Name(-cc.?: tCr (t 44/.
PID Number
House Number
Alternative Mailing Addr'ess
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
11/
�.
7 % Street Name
White Copy; Pr oper ty Owner
Time /6 • ' -- pm
:-
oix#011—m
`/
Owner /Occupant Signature
For information calf 65
Service Lateral inspection Findings
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
Number of stacks
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan i
Record Number
Time
, f f
Phone
Obstruction
Unable to push past
feet
Entered S L. at
Inspector Signature
Final Cleanout:
O am
•
• O pm
No Access
O No one in
Access to service .
lateral needed
O Inspection
r efused
Pinsk Copy: S
/ J_
Notes — A/0 r r i}
4 I/171 r 01-50/ .
1
6
b
3ti 't"o
_ `
0 (5 ._
Number
Correctly
Dischar
Incorrectly
:Unknown
Total
Sump pumps
Foundation drains
Roof drains
City o '. a ,ai
Residential Sanitary Sewer Service
Compliance inspection
Date / 41 /
Name(-cc.?: tCr (t 44/.
PID Number
House Number
Alternative Mailing Addr'ess
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
11/
�.
7 % Street Name
White Copy; Pr oper ty Owner
Time /6 • ' -- pm
:-
oix#011—m
`/
Owner /Occupant Signature
For information calf 65
Service Lateral inspection Findings
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
Number of stacks
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan i
Record Number
Time
, f f
Phone
Obstruction
Unable to push past
feet
Entered S L. at
Inspector Signature
Final Cleanout:
O am
•
• O pm
No Access
O No one in
Access to service .
lateral needed
O Inspection
r efused
Pinsk Copy: S
/ J_