4189 Topaz Dr - Inspection FormResidential Sanitary Sewer Servi
Compliance Inspection
Datell
Name
House Number
4" to 6 "Transition:
1_4
White Copy: Propel ty Owner
7 •00 O am
Time s X pm
Disk #
PID Number
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
Street Name
OwnerlOccupant Signature
O
0
O
0
Service Lateral Inspection Findings
0
r
Alternative Mailing Address
Non - Compliance
�L .r_ _ 1-
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
Time
O am
•
• _O pm
Phone j - -/ SJ
Inspector Signature
For information call 65 1.470.2788
Obstruction
Unable to push past
feet
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH
Number
Correctly
Discharged
Notes
Total
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
Residential Sanitary Sewer Servi
Compliance Inspection
Datell
Name
House Number
4" to 6 "Transition:
1_4
White Copy: Propel ty Owner
7 •00 O am
Time s X pm
Disk #
PID Number
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
Street Name
OwnerlOccupant Signature
O
0
O
0
Service Lateral Inspection Findings
0
r
Alternative Mailing Address
Non - Compliance
�L .r_ _ 1-
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
Time
O am
•
• _O pm
Phone j - -/ SJ
Inspector Signature
For information call 65 1.470.2788
Obstruction
Unable to push past
feet
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH