2057 Quartz Lane - Inspection FormSump pumps
( r '
Foundation drains
Roof drains
410-
did ii
_City 0
Residential Sanitary Sewer Service
Compliance Inspection
Date I ;t /
Name
PID Number
) ` Disk #
7•c9J q am
Time ) „s • • k pm
House Number ,„..< r J .5 Street Name
Alternative Mailing Address
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 Inspection Findings
Roots ; —. -'
Poor Pipe Joints
Transition
I
4" to 6" Transition:
_
If 01
White Copy: Property Owner
Total
J
4 ; ,• // mo t.
Owner/Occupant Signature
For information call 651.470.2788
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 Entered S L at
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe '
°
Length of Service:
Number Discharged
Correctly Incorrectly Unknown
Yellow Copy: City of Eagar' r
Record Number
Phone /
Obstruction
Unable to push past
feet
Notes
/
] • �` _._ o am
Time / ,'o • pm
7 ;( 1 ,
Inspector Srg ature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout:
9t ' J"Pink Copy: SEH