4879 Richard Lane - Inspection FormsResidential Sanitary Sewer Service
Compliance Inspection
Date 3 1 /6 /
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
Transition
4" to 6 "Transition:
White Copy: Pr operty Owner
r 7 O am
Time • O pro
Name t *v/ /6
PID Number
Disk #
OwnerlOccupant Signature
House Number L Z Sri Street Name
Alternative Mailing Address Phone ( C,% `':
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacks Entered S L.at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
� I
Length of Service:
Yellow Copy: City of Eagan
Time
/`' Inspector Signature
✓
Obstruction
Unable to push past
feet.
tf
7
Record Number
Final Cleanout:
O am
•
• O pm
No Access
v
No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
g
Incorrectly Unknown
Notes Pi,/ i i t lie ;_ Go, , ,.
4:`'.+'cam :�,+�.. ' '._jJ ;,• riL,
9(47 , `
/
Total
Sump pumps
1111
: _.." „.... ) .... ,,,
� � —� l
Foundation drains
MI
-
Roof drains
ilf
Residential Sanitary Sewer Service
Compliance Inspection
Date 3 1 /6 /
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
Transition
4" to 6 "Transition:
White Copy: Pr operty Owner
r 7 O am
Time • O pro
Name t *v/ /6
PID Number
Disk #
OwnerlOccupant Signature
House Number L Z Sri Street Name
Alternative Mailing Address Phone ( C,% `':
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacks Entered S L.at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
� I
Length of Service:
Yellow Copy: City of Eagan
Time
/`' Inspector Signature
✓
Obstruction
Unable to push past
feet.
tf
7
Record Number
Final Cleanout:
O am
•
• O pm
No Access
v
No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
city of hp
Residential Sanitary Sewer Service
Compliance Inspection
Date t '/l /5 I Jc'.
Name PAW /) I 2 I J / Disk #
PID Number
House Number
)
u i rr°�- - it
Compliance
r
i - No foundation drain connection
No roof drain connection
r ' Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
ig No sump pump
L /S 7' Street Name
Owner /Occupant Signature
Service Lateral Inspection Findings
Roots
4" to 6" Transition:
White Copy: Property Owner
1 4
• (2 � am
Time • o pm
O
O
O
O
O
0
L?
Non - Compliance
MINIM
0
)(3/44-,e) L , . / 1/
Alternative Mailing Address
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number Discharged
Yellow Copy: City of Eagan
Record Number
• � 4-am
* .' pm
Phone
///
— 1:s L) /
Length of Service: 125
r
Sump pumps
Foundation drains
Roof drains
Total
�f
Correctly Incorrectly Unknown
6 / Inspector Signature
Obstruction
Unable to push past
feet
Ji
For information call 651.470.2788
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks Z Entered S.L. . at teZ— .6 _._ � C
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection / 11 ) 2 /Fr -
Damaged Pipe
Transition Li 3n! Pti# I1 �, n� i� r,� r �
Notes . , i D p, n
r' U ^
a 1o - 73 i '✓TTk
Pink Copy: 5E11