2106 Quartz Lane - Inspection Formr City of Ealai
Residential Sanitary Sewer Service
Compliance Inspection
Date (;;;;
✓ I, 1 l6
r
N 7 Disk #
PID Number
House Number � ( �' Street Name
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
0 No foundation drain connection
No roof drain connection
O Sump pic not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral inspection Findings
5 am
Time T • pm
J
For information call 65 .470.2788
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
Roots
Poor Pipe joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner
�j
Length of Service:
Yellow Copy: City of Eagan
Record Number
Lai Phone ,-) t ? c..i
•
Inspector Signature
Obstruction
Unable to push past
feet
i Final Cleanout:
Q am
pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at _ �` �' .__.
Pink Copy: SEH
Number Discharged
Notes
} s
C' 1 / < / di ? ' �' �'
r, ✓� �,� r
`_ f! `
, _,-)
/ } �}
/ �
Total
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
f
/
Roof drains
1
,, J'
.Q i/r7 I.�%[ /
r City of Ealai
Residential Sanitary Sewer Service
Compliance Inspection
Date (;;;;
✓ I, 1 l6
r
N 7 Disk #
PID Number
House Number � ( �' Street Name
Alternative Mailing Address
OwnerlOccupant Signature
Compliance
0 No foundation drain connection
No roof drain connection
O Sump pic not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral inspection Findings
5 am
Time T • pm
J
For information call 65 .470.2788
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
Roots
Poor Pipe joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner
�j
Length of Service:
Yellow Copy: City of Eagan
Record Number
Lai Phone ,-) t ? c..i
•
Inspector Signature
Obstruction
Unable to push past
feet
i Final Cleanout:
Q am
pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at _ �` �' .__.
Pink Copy: SEH