2103 Shale Lane - Inspection FormSump pumps
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Foundation drains
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Roof drains
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City of a an
Residential Sanitary Sewer Service
Compliance Inspection
Date K/1 /; / /c
Name % ✓ ter; /���Jr� Disk # LI
PID Number
House Number X0.3' Street Name .f Z
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 Ins ection Findings Number of stacks
Roots Z G? i . 5 - Fr
Poor Pipe Joints !! !
Mineral Deposits __ 7- 9 ^ , il;✓j°
Sag /Pipe Deflection
Damaged Pipe 0 Y' . 6t,- )
1
Transition 1 4 1 A. , f\./ ( Aj C ()h 6 t/
4" to 6 "Transition: AI
White Copy: Property Owner
fC�• � O am
Time •— d "pm
OwnerlOccupent Signature
S1
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:
Total Correctly Incorrectly Unknown
r`3
Number Discharged
Yellow Copy: City of Eagan
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Record Number• l`
r
Notes
Time
,Inspector Signature
Obstruction
Unable to push past
feet
Entered S L at —3711°K c
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH