2089 Jade Lane - Inspection Formg 5
Residential Sanitary Sewer Service
Compliance Inspection
Date 6- / /42
Name 67.,-Agy7t.--' #
PD Number
House Number
Alternative Mailing Address
(
. „
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
.,"") "7 • 0
Time C-/- • c-lC) o pm
Street Name --17- ZA/
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
0 am
•
• 0 Pm
Phone (4)
/ ".
Inspector Signature
For information call 651.470.2788
Obttruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks Entered 5 L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Notes
Final Cleanout:
-toe
/1/6 (
/
• A 7 ' 7 . c
'46 •
No Access
O No one in
.•
10' Access to service
\ lateral needed
O Inspection
refused
/./
Pink Copy: SEH
Total
Number
Discharged
Correctly
incorrectly Unknown
Sump pumps
1111
ill
Foundation drains
Roof drains
g 5
Residential Sanitary Sewer Service
Compliance Inspection
Date 6- / /42
Name 67.,-Agy7t.--' #
PD Number
House Number
Alternative Mailing Address
(
. „
OwnerlOccupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
.,"") "7 • 0
Time C-/- • c-lC) o pm
Street Name --17- ZA/
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
0 am
•
• 0 Pm
Phone (4)
/ ".
Inspector Signature
For information call 651.470.2788
Obttruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks Entered 5 L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Notes
Final Cleanout:
-toe
/1/6 (
/
• A 7 ' 7 . c
'46 •
No Access
O No one in
.•
10' Access to service
\ lateral needed
O Inspection
refused
/./
Pink Copy: SEH
Sump pumps
,--er
.`
____L______
.w..,_" _._~--
Foundation drains
,,IY
Roof drains
-----
`T ��
—
"City of Fa ii
Residential Sanitary Sewer Service
Compliance Inspection
Date <I / '/'` Time Y:
Name
/ 7
.
PID Number
House Number Street Name
Alternative Mailing Address
For information call 651 :470.2788
Compliance
iti •No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
A . No sump pump
Service Lateral Inspection Findings Number of stacks / Entered S . at J C
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
"Transition C !`ti'I`1/ q 1'^.1 c
4" to 6" Transition:
White Copy: Property Owner
Or
Total
Disk #
OwnerlOccupant Signa
Correctly
0 an
erpm
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
Length of Service:
Incorrectly
Unknown
Record Number
E
Obstruction No Access
Unable to push past 0 No one in
feet
Time {- s ea
Inspector Signature
Final Cleanout:
am
pm
O Access to service
lateral needed
O Inspection
refused
4
Notes C. CO t , - ` 6 ' 4 1 9 ' 1 , s 2
Yellow Copy: City of Eagan Pink Copy: SEH