2062 Diffley Rd - Inspection FormCity of lia a
Residential Sanitary Sewer Service
Compliance Inspection
• o am
Date t2 11 X? 1 7 Time /.5 • 7 c p
Name 2 , fi t r Disk #
/
PD Number
House Number
Alternative Mailing Address
For information call 651.470.2788
pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piiped
? No sump pump
Service Lateral In4pe tion Findings Number of stacks _ Entered S L at
Roots i" ill
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition: 41 / 0(/ � Length of Service:
White Copy: Properly Owner
Z .C. - )6 / Z Street Name r e ; ()
i r4
v OwnerlOccupant rgnature
0
71--LLN
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
Record Number
L)
Time > ,
Phone rgi ) .i'7 " C C) ( 7
/
/ ;'inspector Signature
Obstruction
Unable to push past
feet
f
• 2, o am
• pm
No Access
O No one in
O Inspection
refused
Final Cleanout: /'J`
[Votes tl 6,
O Access to service
lateral needed
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
,—,,,_, -._
Foundation drains
__...___._.
.
Roof drains
~—
—._ -
City of lia a
Residential Sanitary Sewer Service
Compliance Inspection
• o am
Date t2 11 X? 1 7 Time /.5 • 7 c p
Name 2 , fi t r Disk #
/
PD Number
House Number
Alternative Mailing Address
For information call 651.470.2788
pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piiped
? No sump pump
Service Lateral In4pe tion Findings Number of stacks _ Entered S L at
Roots i" ill
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition: 41 / 0(/ � Length of Service:
White Copy: Properly Owner
Z .C. - )6 / Z Street Name r e ; ()
i r4
v OwnerlOccupant rgnature
0
71--LLN
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
Record Number
L)
Time > ,
Phone rgi ) .i'7 " C C) ( 7
/
/ ;'inspector Signature
Obstruction
Unable to push past
feet
f
• 2, o am
• pm
No Access
O No one in
O Inspection
refused
Final Cleanout: /'J`
[Votes tl 6,
O Access to service
lateral needed
Yellow Copy: City of Eagan Pink Copy: SEH