2110 Jade Lane - Inspection Form4 _0 1 ' City of hp
Residential Sanitary Sewer Service
Compliance Inspection
7, 7)
Date, /4
Name ) , #
PID Number
House Number ) i/( Street Name
Sag/Pipe Deflection
Damaged Pipe
4" to 6" Transition:
Alternative Mailing Addr ess
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
•
White Copy: Property Owner
Time (9° ° arn
ime )
• pm
Owner10761Cant Signature
Service Lateral inspection Findings
Roots
) 1
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
Yellow Copy: City of Eagan
Record Number
2
Number of stacks '- Entered S.
)Time
4
•
0 am
mP
Phone
Inspector Signature
For information call 651.470.2788
Obstruction No Access
Unable to push past 0 No one in
feet
at
Poor PipeJoints
Mineral Deposits
Transition
Length of Service: Cleanout:
O Access to service
lateral needed
O Inspection
refused
)
Pink Copy: SPH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
i .3 ki bi 1!)1-1
611 LC/00
Total
Sump pumps
,"--\
i i
Foundation drains
•
Roof drains
\---
4 _0 1 ' City of hp
Residential Sanitary Sewer Service
Compliance Inspection
7, 7)
Date, /4
Name ) , #
PID Number
House Number ) i/( Street Name
Sag/Pipe Deflection
Damaged Pipe
4" to 6" Transition:
Alternative Mailing Addr ess
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
•
White Copy: Property Owner
Time (9° ° arn
ime )
• pm
Owner10761Cant Signature
Service Lateral inspection Findings
Roots
) 1
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
Yellow Copy: City of Eagan
Record Number
2
Number of stacks '- Entered S.
)Time
4
•
0 am
mP
Phone
Inspector Signature
For information call 651.470.2788
Obstruction No Access
Unable to push past 0 No one in
feet
at
Poor PipeJoints
Mineral Deposits
Transition
Length of Service: Cleanout:
O Access to service
lateral needed
O Inspection
refused
)
Pink Copy: SPH