2036 Diffley Rd - Inspection FormSump pumps
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Foundation drains
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Roof drains
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Residential Sanitary Sewer Service
Compliance Inspection
Date _2 X , I ( ,�
i
Name 1'
PID Number
House Number
e _
Alternative Mailing Address Phone r
(7/9
7
� ti 1 Street Name
OwnerlOccupant Signature
For information call 651
pliance
No foundation drain connection
t� F
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral InspectionJFindings
Roots , (
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition - 1
4" to 6" Transition:
White Copy: Proper ty Owner
Total
J. de)
Time s
Disk #
i-
am
Pm
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
Number of stacks
t �f
Length of Service:
Number Discharged
Correctly Incorrectly Unknown
77
Record Number
O am
Time f.�pm
•
Obstruction
Unable to push past
feet
Entered S.L at = t
Notes
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
!/ / / /
Final Cleanout: ,"
Yellow Copy: City of Eagan Pink Copy: SEH