2121 Carnelian Lane - Inspection FormsCity of.Fa an
Residential Sanitary Sewer Service
Compliance inspection
Date j / ! l 1 !
Name
PID Number
Rouse Number
Alternative MailingAddress
4" to 6 "Transition:
White Copy: Pr opeity Owner
v./ am
Time • Pm
Disk #
1 - Street Name
Owner /Occupant Signature
For information call 651:470,2788
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
r7'.toc.-4
Non - Compliance
0
O
O
O
Service Lateral Inspection Findings
Roots
0
LLJ-
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone < - -�17
Notes
Time
Inspector
Obstruction
Unable to push past
feet
Final Cleanout:
o am
_O pm
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L,at
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City of.Fa an
Residential Sanitary Sewer Service
Compliance inspection
Date j / ! l 1 !
Name
PID Number
Rouse Number
Alternative MailingAddress
4" to 6 "Transition:
White Copy: Pr opeity Owner
v./ am
Time • Pm
Disk #
1 - Street Name
Owner /Occupant Signature
For information call 651:470,2788
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
r7'.toc.-4
Non - Compliance
0
O
O
O
Service Lateral Inspection Findings
Roots
0
LLJ-
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone < - -�17
Notes
Time
Inspector
Obstruction
Unable to push past
feet
Final Cleanout:
o am
_O pm
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L,at
Pink Copy: SEH
Sump pumps
.
Foundation drains
Roof drains
City o F Ja jo
Residential Sanitary Sewer Service
Compliance Inspection
r
Date: ! �•f ( .,:
Name
PID Number
House Number
No sump pump
4" to 6" Transition:
Alternative Mailing Address
inspector Signature
For information call 651.4703788
Compliance
Q No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
fl
Service Lateral / Inspection Findings
Roots ) .' 7 f '
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe - ) ` -r w _ / r , .
Transition t / = Wit._ �� r �`
White Copy: Property Owner
Total
am
Time % • pm
OwnerlOccupant Signature
Street Name s
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
Correctly
Length of Service:
Number Discharged
Incor rectly Unknown
Record Number
Time
Phone
Obstruction
Unable to push past
feet
Entered S.L.
r f'
Notes
Final Cleanout:
X10
am
pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Yellow Copy: City of Eagan Pink Copy: SEH
Sump pumps
.
Foundation drains
Roof drains
City o F Ja jo
Residential Sanitary Sewer Service
Compliance Inspection
Date �: ? 1'. �� � .,•'
Name
PID Number
House Number
No sump pump
4" to 6" Transition:
Alternative Mailing Address
inspector Signature
For information call 651.4703788
Compliance
Q No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
fl
Service Lateral / Inspection Findings
Roots > 7 f '
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe - ) ` -r w _ / r , .
Transition t / = Wit._ (-...-12,..,..4-.- r �`
White Copy: Property Owner
Total
am
Time % • pm
OwnerlOccupant Signature
Street Name s
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
Correctly
Length of Service:
Number Discharged
Incorrectly Unknown
Record Number
Time
Phone
Obstruction
Unable to push past
feet
Entered S.L. at
r f'
Notes
I
Final Cleanout:
X10
am
pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH
City of.Fa an
Residential Sanitary Sewer Service
Compliance inspection
Date j / ! l 1 !
Name
PID Number
Rouse Number
Alternative MailingAddress
4" to 6 "Transition:
White Copy: Pr opeity Owner
v./ am
Time • Pm
Disk #
1 - Street Name
Owner /Occupant Signature
For information call 651:470,2788
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
r7'.toc.-4
Non - Compliance
0
O
O
O
Service Lateral Inspection Findings
Roots
0
LLJ-
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone < - -�17
Notes
Time
Inspector
Obstruction
Unable to push past
feet
Final Cleanout:
o am
_O pm
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L,at
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City of.Fa an
Residential Sanitary Sewer Service
Compliance inspection
Date j / ! l 1 !
Name
PID Number
Rouse Number
Alternative MailingAddress
4" to 6 "Transition:
White Copy: Pr opeity Owner
v./ am
Time • Pm
Disk #
1 - Street Name
Owner /Occupant Signature
For information call 651:470,2788
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
r7'.toc.-4
Non - Compliance
0
O
O
O
Service Lateral Inspection Findings
Roots
0
LLJ-
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone < - -�17
Notes
Time
Inspector
Obstruction
Unable to push past
feet
Final Cleanout:
o am
_O pm
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Entered S,L,at
Pink Copy: SEH