2095 Shale Lane - Inspection FormSump pumps
Foundation drains
i
Roof drains
,'
S_�
rCity i`Cali]
Residential: Sanitary Sewer Service
Compliance Inspection
Date 7
Name
PFD Number
House Number vY 1C- 4 1- j Street Name
Alternative Mailing Address
For. information . call 651.470.2788
Compliance
(i No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Service Lateral 1nspec ion Findings
Roots .' l i (` i T? ^?
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
1Jlc /1
: 'T
Transition c..�I
4" to 6" Transition:
White Copy: Property Owner
�� • �f am
Time •
Disk #
Owh Signature
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
Length of Service:
Number. Discharged
Total Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Record Number.
7 /7
Entered St at
Notes
am
Time (T) A pm
Phone
Inspector Signature
Obstruction
Unable to push past
feet.
2
a j 72
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: E v 1
Pink Copy: SEH