2049 Quartz Lane - Inspection FormSump pumps
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Foundation drains
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Roof drains
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City of Ea o
Residential Sanitary Sewer Service
Compliance .Inspection
Date k 1 1
J
Name , J / '- /fir ff Disk #
AID Number
House Number
Alternative Mailing Address
. 2
O Sump pit riot connected to
sanitary sewer
O Sump pump properly piped
11
m No sump pump
Roots
4" to 6" Transition:
White Copy: Property Owner
• °(:)/g Time s • • . am
pm
r; f
OwnerlOccupant Signature
Compliance
No foundation drain connection
No roof drain connection
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition j --r
,r . y°
1 Street Name
Length of Service:
Number Discharged
Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
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
Record Number
Notes
Time
Service Lateral Inspection Findings . Number of stacks _ Entered S L at
r)
Phone
7
inspector Signature
Obstruction
Unable to push past
feet
• am
O pm
For information call 65
No Access
O No one in
c,t,„)
O Access to service .
lateral needed
O Inspection
refused
Final Cleanout:
Pink Copy: SEH