2058 Marble Lane - Inspection FormCity of Pa as
Residential Sanitary Sewer Service
Compliance Inspection
Date 7/ ) I /( )
Name (s L /),/ 1
PID Number
House Number / $.Street Name
, tf i t`iV e Mailing Addr ess
i " ......---72
i j / \
Owner/Occupant Signature
,.Compliance
�f No foundation drain connection
c�7 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral inspection Findings
Roots �� f
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 11;77
.
4" to 6 "Transition:
/
White Copy: Property Owner
-",/
o C�i 1
Time ){ d
Disk #
am
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
Length of Service:
Record Number
Time { •
Phone r I" ( �.
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Number of stacks Entered S L at r'
Notes
r
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
1
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
0
Foundation drains
;,
Roof drains
City of Pa as
Residential Sanitary Sewer Service
Compliance Inspection
Date 7/ ) I /( )
Name (s L /),/ 1
PID Number
House Number / $.Street Name
, tf i t`iV e Mailing Addr ess
i " ......---72
i j / \
Owner/Occupant Signature
,.Compliance
�f No foundation drain connection
c�7 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral inspection Findings
Roots �� f
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 11;77
.
4" to 6 "Transition:
/
White Copy: Property Owner
-",/
o C�i 1
Time ){ d
Disk #
am
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
Length of Service:
Record Number
Time { •
Phone r I" ( �.
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Number of stacks Entered S L at r'
Notes
r
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
1
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH