2100 Shale Lane - Inspection FormCity of Eaiap,
Residential Sanitary Sewer Service
Compliance Inspection
Date/ "7 l
Name
PID Number
House Number f f ,' Street Name
Alternative Mailing Address
For information call 651.470.2788
Compliance
No foundation drain connection
hp No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Fin ingsf Number of stacks _
Roots s 7,fj)✓ -- t r
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 1 ✓� � � "� ;' ,- �`� ,/�
4" to 6" Transition: / ,
Sump pumps
Foundation drains
Roof drains
j7 i
White Copy: Property Owner
Time
I
ji � 1/ Disk #
/2
O /Occupant Signature
Total
f • am
• ; pm
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:
Number Discharged
Correctly
Incorrectly
Unknown
ff L
Phone
f --
0 am •
Time e ' pm
Record Number
-.
inspector Signature
Obstruction
Unable to push past
feet
Entered S. L at
Notes
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
r
Final Cleanout:
n
I (i - ✓r
Yellow Copy: City of Eagan Pink Copy: SEH