2035 Shale Lane - Inspection FormDate 07/ c/ 1
PID Number_
Damaged Pipe
Transition 4 -
4" to 6"Transition:
Compliance
'No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
White Copy: Pr opet ty Owner
City ot tapo
Residential Sanitary Sewer Service
•
Compliance Inspection
Name Disk #
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
7/ • 0 am
Time c,') • gf pm
House Number. Street Name
Owner/Occupant Signature
•
Alternative Mailing Address
For iilformation call 651.470.2788
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 k L ber of stacks Entered S at r'
Length of Service:
Yellow Copy: City of Eagan
Record Number _
T ime
Obstruction
Unable to push past
feet
/ M Y '
Notes
•••■ „••■- ■••■•••• ■•■■■■ •
• ts pa;
• _
(
/
Rhone
4711
j-ze
inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SE H