2140 Jade Pt - Inspection Formn
Number Discharged
Notes -�' j�����
� f) / 13-° P -
Total
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
t
Roof drains
City DI Eapfl
Residential Sanitary Sewer Service
Compliance Inspection
Date t ef . : 1 1 /r)
Name >'`
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
j0 No sump pump
Poor. Pipe joints
Mineral Deposits iL 7
Sag /Pipe Deflection 10 1
Damaged Pipe
is
Transition
ft l,O N l
4" to 6" Transition:
White Copy: Proper Owner
ner /Occupant Signature
Time /G' � CL) t
L(Iiv CL jL
Disk #
1
1r
0
PID Number
1
House Number ` 1 it C' Street Name r - IDE: 1 T
1Cernative MailingiAdd •ess
Ai ..-
\F
\
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
Service Lateral Inspection Findings Number '. of stacks 1 Entered S..L.at *. / C2 V.
Roots 1 J L 9 -' ($
i
0e rvLt. UF- 7g2' a'r 1 - f k.:. /i
Length of Service: ISO , r
Yellow Copy: City of Eagan
0
Record Number
Time' o pm
��
`Rhone -1/9 a; C.0
/ inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
am
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH