2058 Diffley Rd - Inspection FormCity of Capri
Residential Sanitary Sewer Service
Compliance Inspection
For information call 651.470.2788
Compliance
`4 No foundation drain connection
!‘
4.
Date 7Z / 1 !'
Name `(/ f t 1 ✓ �3 Disk #t
PID Number
House Number
Alternative Mailing Address
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
i i,C) No sump pump
Service Lateral Inspection Findings Number of stacks
Roots ,' '.' r r t L1
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
Owner /Occupant Signature
Time A-.." •47 o
7
Street Name /7/ r Z Y t2
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: <l
Yellow Copy: City of Eagan
J 2
Record Number
/0 Time ✓ O pm
1
one,�f
// 4
/ / ;b spector Signature
Entered S..L.at
Notes
r
Obstruction
Unable to push past
feet
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
- "—'°'
Foundation drains
Roof drains
°.`.w°"Y..--.--
•-
_--
City of Capri
Residential Sanitary Sewer Service
Compliance Inspection
For information call 651.470.2788
Compliance
`4 No foundation drain connection
!‘
4.
Date 7Z / 1 !'
Name `(/ f t 1 ✓ �3 Disk #t
PID Number
House Number
Alternative Mailing Address
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
i i,C) No sump pump
Service Lateral Inspection Findings Number of stacks
Roots ,' '.' r r t L1
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
Owner /Occupant Signature
Time A-.." •47 o
7
Street Name /7/ r Z Y t2
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: <l
Yellow Copy: City of Eagan
J 2
Record Number
/0 Time ✓ O pm
1
one,�f
// 4
/ / ;b spector Signature
Entered S..L.at
Notes
r
Obstruction
Unable to push past
feet
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH