2074 Jade Lane - Inspection FormCity of Fa u
Residential Sanitary Sewer Service
Compliance Inspection
Date 1(4 qo' 1 4
Name : -1, l . '
PID Number
House Number
Compliance
No foundation drain connection
V No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copy: Property Owner
0 a
Time /—s pm
Disk #
7r) ✓ Street Name
, ..w_.- Owner /Occupant Signature
Service Lateral Inspection Findings/
/� Roots a_ 5,y,5 1 ° F
Alternative Mailing Address
w� L • j
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 I
Yellow Copy: City of Eagan
Record Number
Phone
S 9 am
��
Time � 5
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition L! v 1 t AJ / e ,. /
x
/ 2. Inspector Signature
Length of Service: 47 T""
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S at ,�7;4s
No Access
O No one in
Poor Pipe joints
1
O Access to service
lateral needed
O Inspection
refused
.f
Final Cleanout:
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
- rs = , _ - -? -�
,
Total
Sump pumps
j%Y'
Foundation drains
Roof drains
i ,
City of Fa u
Residential Sanitary Sewer Service
Compliance Inspection
Date 1(4 qo' 1 4
Name : -1, l . '
PID Number
House Number
Compliance
No foundation drain connection
V No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copy: Property Owner
0 a
Time /—s pm
Disk #
7r) ✓ Street Name
, ..w_.- Owner /Occupant Signature
Service Lateral Inspection Findings/
/� Roots a_ 5,y,5 1 ° F
Alternative Mailing Address
w� L • j
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 I
Yellow Copy: City of Eagan
Record Number
Phone
S 9 am
��
Time � 5
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition L! v 1 t AJ / e ,. /
x
/ 2. Inspector Signature
Length of Service: 47 T""
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S at ,�7;4s
No Access
O No one in
Poor Pipe joints
1
O Access to service
lateral needed
O Inspection
refused
.f
Final Cleanout:
Pink Copy: SEH