2111 Shale Lane - Inspection Form4 City of Capp
Residential Sanitary Sewer Service
Compliance Inspection
Date / / /
Name T ,rf,4r= '
Compliance
O No foundation drain connection
Pc. No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
fp No sump pump
Sag /Pipe Deflection
Damaged Pipe
Transition L l°''i
4" to 6 "Transition: ti /V
White Copy: Property Owner
Time /CJ iJ '
pm
PID Number
House Number f Street Name _ f":1776
Alternative Mailing Address
Owner /Occupant Signature
For information call 651.470.2788
Disk #
Non - Compliance
O
O
O
O
0
4/
Service L feral Ins ection Findings
Roots ff
Poor Pipe Joints /-
Mineral Deposits / 6 1 /,f, r >, fu
•
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
t,J
• Z
Time •
Obstruction
Unable to push past
feet
o am
pm
Phone e3_ - A''/,
r
-
f e -Inspector Signature
No Access
O No one in
Final Cleanout: ,
O Access to service
lateral needed
O Inspection
refused
Entered S L at 5 r c -- (
//c7 f S -
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
0
Roof drains
/
_._.__,— ..- .• -----
4 City of Capp
Residential Sanitary Sewer Service
Compliance Inspection
Date / / /
Name T ,rf,4r= '
Compliance
O No foundation drain connection
Pc. No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
fp No sump pump
Sag /Pipe Deflection
Damaged Pipe
Transition L l°''i
4" to 6 "Transition: ti /V
White Copy: Property Owner
Time /CJ iJ '
pm
PID Number
House Number f Street Name _ f":1776
Alternative Mailing Address
Owner /Occupant Signature
For information call 651.470.2788
Disk #
Non - Compliance
O
O
O
O
0
4/
Service L feral Ins ection Findings
Roots ff
Poor Pipe Joints /-
Mineral Deposits / 6 1 /,f, r >, fu
•
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
Record Number
t,J
• Z
Time •
Obstruction
Unable to push past
feet
o am
pm
Phone e3_ - A''/,
r
-
f e -Inspector Signature
No Access
O No one in
Final Cleanout: ,
O Access to service
lateral needed
O Inspection
refused
Entered S L at 5 r c -- (
//c7 f S -
Pink Copy: SEH