2097 Carnelian Lane - Inspection FormCity of to
Residential Sanitary Sewer Service
Compliance Inspection
Date 11
I
Name Disk #
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
/ No sump pump
Service Lateral lnspectionj`indin'gs Number of stacks / Entered S L at " >" '-:k - r *
Roots - "
-
PoorPipe joints
Mineral Deposits
; /S i /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
1 ti < 777:
White Copy: Property Owner
v am
Time • O p
Street Name
Owner /Occupant Signature
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewe r
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
• -
Time t . • O pm
Phone ) l9 (
Obstruction
Unable to push past
feet
1
1
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
i I ( ,u
Final Cleanout: 7`7 r j ) ▪ .
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
N ottes
)? f G,11
f
ii r
i
Total
Sump pumps
.._,,.,--
Foundation drains
Roof drains
, /
City of to
Residential Sanitary Sewer Service
Compliance Inspection
Date 11
I
Name Disk #
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
/ No sump pump
Service Lateral lnspectionj`indin'gs Number of stacks / Entered S L at " >" '-:k - r *
Roots - "
-
PoorPipe joints
Mineral Deposits
; /S i /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
1 ti < 777:
White Copy: Property Owner
v am
Time • O p
Street Name
Owner /Occupant Signature
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewe r
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
• -
Time t . • O pm
Phone ) l9 (
Obstruction
Unable to push past
feet
1
1
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
i I ( ,u
Final Cleanout: 7`7 r j ) ▪ .
Pink Copy: SEH