2004 Emerald Lane - Inspections FormCity of EaOal
SANITARY SEWER SYSTEM
CERTIFICATE OF COMPLIANCE for
INFLOW & INFILTRATION
City of hp
City of Eagan, Minnesota
Property Address: E -W { C--_ (CL Q\ �.
COMPLIANCE WIIH INITIAL INSPECTION
his is to certify that the property listed above has been inspected by authorized City personnel on `L i , 201
and found to be in compliance with Section 3.40 of the City Code and no corrective work was required.
COMPLIANCE AFTER CORRECTIVE WORK PERFORMED
n This is to certify that the property listed above has been found to be in compliance with Section 3.40 of the City Code
after satisfactorily completing the required corrective repair work under (check all that apply):
n City Sanitary Sewer Permit n City Plumbing Permit
NOTE: Applicable only if box is checked used on a review of the Sewer Service video inspection/report on, file, it is
recommended that periodic cleaning or future inspections be performed to minimize a potential blockage due to;
Grease Build-up, Root Intrusion, Dip/Settlement in Pipe, Other„
City Approved: 1 kNV 1 /�. r C 1-a5) / /C4 -Xi
Print name V Signature Date
White Copy: Property Owner
Yellow Copy: City of Eagan (Parcel File)
rev. 2.23 2010
City of ERPTI
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name J)
PID Number
House Number �� �` Street Name
Alternative MailingAddress
Compliance
Owner /Occupant Signature
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
/ } • Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
0e (9 Yam
Time
�f 0 pm
1
(Ti ) )l'�
Disk #
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: ,/
Phone
For information call 651.470.2788
Yellow Copy: City of Eagan
Record Number
/f ,�CL am
Time / (.3 q pm
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks 4 2
i Entered S,I_,at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 2
Pink Copy: SEH
Notes
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
Foundation drains
t,___/
Roof drains
:'a
City of ERPTI
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name J)
PID Number
House Number �� �` Street Name
Alternative MailingAddress
Compliance
Owner /Occupant Signature
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
/ } • Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6" Transition:
White Copy: Property Owner
0e (9 Yam
Time
�f 0 pm
1
(Ti ) )l'�
Disk #
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: ,/
Phone
For information call 651.470.2788
Yellow Copy: City of Eagan
Record Number
/f ,�CL am
Time / (.3 q pm
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Number of stacks 4 2
i Entered S,I_,at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 2
Pink Copy: SEH