2073 Shale Lane - Inspection Form100—
City of ha an
Residential Sanitary Sewer Service
Compliance Inspection
• C?' m
Time • AN pm
Name \j 1�� • ? Disk #
Date .°* / ! J
rrr
Record Number
Time
PID Number
House Number 4 ! : Street Name f
O am
•
• O pm
Alternative Mailing Address Phone (
Owner /Occupant Signature
Inspector Signature
For information call 651.470.2788
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
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
Obstruction
Unable to push past
feet
No Access
O No one in
Access to service
lateral needed
O Inspection
r efused
Service Lateral Inspection Findings Number of stacks Entered St at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
Length of Service:
Final Cleanout:
Yellow Copy: City of Lagan v'
pis
SF Fl
< 7
C.
Number Discharged
Notes
_ " . '
,1 '::.� ,,
-
C f� 1
/ ,c✓ -� c � r
Sum um sC_
P pumps
Total Correctly Incorrectly Unknown
----
Foundation drains
Roof drains
100—
City of ha an
Residential Sanitary Sewer Service
Compliance Inspection
• C?' m
Time • AN pm
Name \j 1�� • ? Disk #
Date .°* / ! J
rrr
Record Number
Time
PID Number
House Number 4 ! : Street Name f
O am
•
• O pm
Alternative Mailing Address Phone (
Owner /Occupant Signature
Inspector Signature
For information call 651.470.2788
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
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
Obstruction
Unable to push past
feet
No Access
O No one in
Access to service
lateral needed
O Inspection
r efused
Service Lateral Inspection Findings Number of stacks Entered St at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
Length of Service:
Final Cleanout:
Yellow Copy: City of Lagan v'
pis
SF Fl
< 7
C.
City Ofl
Residential Sanitary Sewer Service
Compliance Is e ti
Date - 7
Name
PID Number
House Number
Alternate Mailing Address
t \il ' ?.
Compliance
Q/ No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
Sump Pump properly piped
6 No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe Transition
4" to 6" Transition:
White Copy: Property Owner
Time
Owner /Occupant Signature
Service Lateral Inspection Findings
Disk #
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
o am
o pm
Street Name
Length of Service:
Number Discharged
Sump Pumps
Foundation Drains
Roof Drains
Total
Correctly Incorrectly Unknown
Record Number
i
Obstruction
--7
Notes
Time
Phone
Unable to push past
(�, f feet.
L -."
Inspector Signature
o am
o pm
For Information call 651.470.2788
No Access
o No one in
o Access to service lateral
needed
o Inspection refused
Number of stacks 0 Entered S L at .., .
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: Benjamin Franklin Plumbing
651- 222 -1551
City of
Reel
ential Sanita
oni piance
Sewer se ice
nspectiorx
�7 p /0
Date / /
Name tel
PID Number
House Number
/Alternate Mailing Address '
\ [ U 1' r r i if ii L
White Copy: Property Owner
Time
Disk #
Owner /Occupant Signature
o am
O pm
Street Name
Yellow Copy: City of Eagan
Record Number V / / r 2 c 3
Time
Phone
Inspector Signature
Compliance
o No foundation drain connection
"0 No roof drain connection
O Sump pit not connected to
sanitary sewer
o Sump Pump properly piped
o No sump pump
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
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Number of stacks
Length of Service:
Entered S L. at
Final Cleanout:
For Information call 651.470.2788
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551
o am
o pm
/ 77c
Number
Correctly
Discharged
Incorrectly
Unknown
Not
t
` 1-r-.1--.
'�. i .
f_ ( ,,,,_.c,_, v7 ° 1
` r Ec
/- c ,-= r >__
Total
Sump Pumps
IIII
Foundation Drains
Roof Drains
EMMEN
City of
Reel
ential Sanita
oni piance
Sewer se ice
nspectiorx
�7 p /0
Date / /
Name tel
PID Number
House Number
/Alternate Mailing Address '
\ [ U 1' r r i if ii L
White Copy: Property Owner
Time
Disk #
Owner /Occupant Signature
o am
O pm
Street Name
Yellow Copy: City of Eagan
Record Number V / / r 2 c 3
Time
Phone
Inspector Signature
Compliance
o No foundation drain connection
"0 No roof drain connection
O Sump pit not connected to
sanitary sewer
o Sump Pump properly piped
o No sump pump
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
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Number of stacks
Length of Service:
Entered S L. at
Final Cleanout:
For Information call 651.470.2788
Pink Copy: Benjamin Franklin Plumbing
651 - 222 -1551
o am
o pm
/ 77c