2125 Quartz Lane - Inspection FormCity or ER PH
Residential Sanitary Sewer Service
Compliance Inspection
Date 07/ 1 S / /ry
Name 4.4i Oridt /> t Disk #
PID Number
House Number
Alternative MailingAddress
For information call 1551.470.2788
Compliance
d No foundation drain connection
No roof drain connection
i 0 Sump pit not connected to
sanitar y sewer
0 Surnp pump properly piped
O sump pump
Sag /Pipe Deflection
Damaged Pipe
C
Transition 1 y� r 4i
4" to 6 "Transition:
Sump pumps
Foundation drains
Roof drains
`',_S Street Name
OwnerlOccupant Signature
Total
s
White Copy: Property Owner
• o am
Time ! , sa- pm
„fr
Non - Compliance
0
O
O
O
O
Service Lateral Inspection Findings
Roots —
Poor Pipe Joints
Mineral Deposits e
/,- -Z_•.
J -W
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
W � ~ Number of stacks Entered S L at
Length of Service:
Number :Discharged
Correctly
Incorrectly
Unknown
J 0)
Record Number
Phone
Notes
•! 0 a
Time / • 1.-1 rm
ci`.. /f C-6
!n pe; ar Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
71 0
Final Cleanout: fit.
Yellow Copy: City of Eagan Pink Copy: SEH