2096 Shale Lane - Inspection FormA ll. City of to as
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name )
PID Number
House Number
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots /--� , 71 - ..
Transition ? - v / - 477"`)
4" to 6" Transition:
White Copy: Proper ty Owner
�_3 o _ am
Time �� pm
Disk #
7 —
OwnerlOccupant Signature
Street Name r .�
Alternative Mailing Address
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
r ,
Number of stacks
PS'agjipe Deflection _-
(--
Damaged Pipe
Record Number
Length of Service: 7`
Yellow Copy: City of Eagan
Phone
For information call 651.470.2788
Obstruction No Access
Unable to push past 0 No one in
feet
Entered S at
Poor Pipe Joints
Mineral Deposits
• I"~O o am
• of pm
inspector Signature
Final Cleanout:
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
N otes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
A ll. City of to as
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name )
PID Number
House Number
Compliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
Roots /--� , 71 - ..
Transition ? - v / - 477"`)
4" to 6" Transition:
White Copy: Proper ty Owner
�_3 o _ am
Time �� pm
Disk #
7 —
OwnerlOccupant Signature
Street Name r .�
Alternative Mailing Address
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
r ,
Number of stacks
PS'agjipe Deflection _-
(--
Damaged Pipe
Record Number
Length of Service: 7`
Yellow Copy: City of Eagan
Phone
For information call 651.470.2788
Obstruction No Access
Unable to push past 0 No one in
feet
Entered S at
Poor Pipe Joints
Mineral Deposits
• I"~O o am
• of pm
inspector Signature
Final Cleanout:
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH