2081 Jade Lane - Inspection FormsResidential Sanitary Sewer Service
Compliance Inspection
27/j � •.� � am
Date 2 / / / )l i Time • ppm
Name ( J Disk # JJ
PID Number
House Number
LLJ
Street Name r / .. •
Alternative%Mailing Address
11
( r1
G,�t
_r1
Record Number
LLI
Time
) �)
Owner/Occupant Signature
• 0 am
• 0 pm
Phone rr ,_-1 s�
inspector Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
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
Obstruction
Unable to push past
_ feet
No Access
O No one in
Access to service
lateral nee
O Inspection r
refused
Service Lateral Inspection Findings Number of stacks
Entered S .. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Length of Ser vice:
Final Cleanout:
Notes
I
•
Ft -
White Copy: Proper ty Owner
Yellow Copy: City of Eagan Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
Foundation drains
Roof drains
Notes
I
•
Ft -
White Copy: Proper ty Owner
Yellow Copy: City of Eagan Pink Copy: SEH
City of Ca ai
Residential Sanitary Sewer Service
Compliance Inspection
Date 1'2(/ / 7 / /' Time /f1p'J
Name ]/r'r�✓ Disk #
./P/A' J
PID Number
0
5 -
House Number -G Street Name
Alternative Mailing Address
7
Record Number
0
fr
Adam
Time So1�pm
Phone 4-.7
4
Owner/Occupant Signature
nspector Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
66 No roof drain connection
O Sump pit not connected to
sanitary sewer
,`O Sump pump properly piped
No sump pump
Non -Compliance
0
O
O
O
0
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings
Roots
Number of stacks f ntered S L at '/':.Ptfiq`,.,7"_ 7 1n 7
/ JQ /Cell)
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
f 1
Damaged Pip
/* i,� �
Transition !rr /r�(7' 1 %rte O
4" to 6" Transition:
a/44 '/Length of Service:
Final Cleanout: r/�,
White Copy: Property Owner
Yellow Copy: City of Eagan
Pink Copy: SEH
Number Discharged.
Notes--v.-1,�, , s--.L-(-72-e=4,-4,2Q-77.7"---1
TotalTotalif
Correctly
Incorrectly Unknown
ic r'''.— (1./. ....
Sump pumps
,:
l
_..-�.._..�,—•_�
.
,
jki
eJ '�tef t?7 .
Alf -- :7,=JGi'u
Foundation drains
7x-,' i
Roof drains
- -®-
White Copy: Property Owner
Yellow Copy: City of Eagan
Pink Copy: SEH