2054 Jade Lane - Inspection Form'`
Cay of Ca an
Residential Sanitary Sewer Service
Compliance Inspection
Dated / /) / f (1. Time
�r
Name 1 _ W < pisk # l
PID Number
House Number
Compliance
No foundation drain connection
A a( No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
:70 am
Pm
M..
Record Number
/ )
��` Street Name
Alternative Mailing Address Phone
/
Owner /Occupant Signature
For information call 651.470.2788
Service Lateral Inspection Findings Number of stacks Entered S L. at s`
Roots rte- - � ✓ ' "� '-
Poor Pipe joints
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:
Yellow Copy: City of Eagan
am
Time e t / • o prr
inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
1�
-7-4- Final Cleanout:
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
Total
Sump pumps
L`
Foundation drains
--
--
Roof drains
% ' �
_ / ° '(,)1,r/ r- i 6-114f4.
'`
Cay of Ca an
Residential Sanitary Sewer Service
Compliance Inspection
Dated / /) / f (1. Time
�r
Name 1 _ W < pisk # l
PID Number
House Number
Compliance
No foundation drain connection
A a( No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
:70 am
Pm
M..
Record Number
/ )
��` Street Name
Alternative Mailing Address Phone
/
Owner /Occupant Signature
For information call 651.470.2788
Service Lateral Inspection Findings Number of stacks Entered S L. at s`
Roots rte- - � ✓ ' "� '-
Poor Pipe joints
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:
Yellow Copy: City of Eagan
am
Time e t / • o prr
inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
1�
-7-4- Final Cleanout:
Pink Copy: SEH