2085 Copper Lane - Inspection Form-_J t
Name
t(0)7A
City of Gaya
Residential Sanitary Sewer Service
Compliance Inspection
-�,
Date/: /mil {(.
PID Number
House Number . i .i - �, ._ Street Name
Alternative Mailing Address
l
Compliance
/r Disk #
For information .call 651A70.2788
O No foundation drain connection 0
r No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
l No sump pump
4" to 6 "Transition:
White Copy: Property Owner
OwnerlOccupant Signature
Time
020 ieam
• pm
Non- Compliance
O
O
O
O
r' r
i Phone
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
1 Transition
� I �
Length of Service:
Yellow Copy: City of Eagan
Record Number
,,_._,,
a 7 ,
T ime _—.J •
Inspector Signature
Obstruction
Unable to push past
feet
Entered S.L at
t.`
0 a
Pm
No Access
O No one in
O Inspection
r efused
Pink Copy: SEH
O Access to service .
lateral needed
Final Cleanout: �� (I,
:24
Total
Note f
i /
% /.
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
-
®_
Foundation drains
Roof drains
..._)
-_J t
Name
t(0)7A
City of Gaya
Residential Sanitary Sewer Service
Compliance Inspection
-�,
Date/: /mil {(.
PID Number
House Number . i .i - �, ._ Street Name
Alternative Mailing Address
l
Compliance
/r Disk #
For information .call 651A70.2788
O No foundation drain connection 0
r No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
l No sump pump
4" to 6 "Transition:
White Copy: Property Owner
OwnerlOccupant Signature
Time
020 ieam
• pm
Non- Compliance
O
O
O
O
r' r
i Phone
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
1 Transition
� I �
Length of Service:
Yellow Copy: City of Eagan
Record Number
,,_._,,
a 7 ,
T ime _—.J •
Inspector Signature
Obstruction
Unable to push past
feet
Entered S.L at
t.`
0 a
Pm
No Access
O No one in
O Inspection
r efused
Pink Copy: SEH
O Access to service .
lateral needed
Final Cleanout: �� (I,
:24