2105 Quartz Lane - Inspection FormResidential Sanitary Sewer Service
Compliance Inspection
Date 07 /Z- I -1
;/j, /-1,-/e.5/Z. /FL/
17isk#
Name
House Number
Alternative Mailing Address
/
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
Set' vice,Lateral Inspection Findings
Roots /• ( -
Poor Pipe Joints -
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition-
4" to 6" Transition: / , 1,;;E
Sump pumps
Foundation drains
Roof drains
• .00'am
Time • C ` o pre
Owner /Occupant Signature
PID Number
f L� Street Name
For information. call '651.47
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
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
2'No sump pump
Entered S. L at Yv
Number of stacks _
Length of Service:
Yellow Copy: City of Eagan
White Copy: Property Owner
Record Number —
•
Time _ • -
esz) <"
,/r7
;7` lnspector Signature
Obstruction
Unable to push past
feet
Notes
Final Cleanout:
;' am
o pm
f.
1J f 7 —
✓l f!sG ri
Pink Copy: SEH