2086 Copper Lane - Inspection FormCity of Fuji
Residential Sanitary Sewers Service
Compliance Inspection
Date 11 1 !P Time (. 7 6 G p
Name 2- [ �/ � fi /r.? Disk #
PIO Number
ti Street Name
House Number
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
F 'No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
Owner /Occupant Signature
r Pry`.
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
Length of Ser vice:
Yellow Copy: City of Eagan
Record Number
LE El
�rJ
r
• L 7 f , rte am
Time ® 0 pm
Phorrei `� � 1 ` °S /1
inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet.
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition L ,� 1
Final Cleanout:
Pink Copy: SEH
Number Discharged
Notes /%7Z- -e / 257
,r; :7 {
Total
Correctly
Incorrectly
Unknown
Sump pumps
_ --
- ____ - -° ~--°
Foundation drains
' = �
-. —_--
__-
° °___
Roof drains
_ . W.�_.�...._
_ _. -
City of Fuji
Residential Sanitary Sewers Service
Compliance Inspection
Date 11 1 !P Time (. 7 6 G p
Name 2- [ �/ � fi /r.? Disk #
PIO Number
ti Street Name
House Number
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
F 'No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
Owner /Occupant Signature
r Pry`.
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
Length of Ser vice:
Yellow Copy: City of Eagan
Record Number
LE El
�rJ
r
• L 7 f , rte am
Time ® 0 pm
Phorrei `� � 1 ` °S /1
inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet.
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Entered S L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition L ,� 1
Final Cleanout:
Pink Copy: SEH