2106 Jade Lane - Inspection Form411111- M or lia fl
Residential Sanitary Sewer Service
Compliance Inspection
Date.
Name )
House Number
PID Number
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots 7 f al �/1
Poor PipeJoints y_.../ %3
4" to 6 "Transition:
s *O r D €sk #
I i f ) Street Name
Owner /Occupant Signature
White Copy: Property Owner
am
Time • 'O pm
5 ) t
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:
Record Number
Notes
ime(
f'
Alternative MailiingAddress /� Phone
Inspector Signature
For information calf 651.470.2788
Obstruction
Unable to push past
feet
Number,. (stacks Entered S L at
•
• ,,? am
• , o pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition /---
F Cleanout:
,!.
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly Unknown
Sump pumps
('
Foundation drains
Roof drains
(3
411111- M or lia fl
Residential Sanitary Sewer Service
Compliance Inspection
Date.
Name )
House Number
PID Number
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
Roots 7 f al �/1
Poor PipeJoints y_.../ %3
4" to 6 "Transition:
s *O r D €sk #
I i f ) Street Name
Owner /Occupant Signature
White Copy: Property Owner
am
Time • 'O pm
5 ) t
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:
Record Number
Notes
ime(
f'
Alternative MailiingAddress /� Phone
Inspector Signature
For information calf 651.470.2788
Obstruction
Unable to push past
feet
Number,. (stacks Entered S L at
•
• ,,? am
• , o pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition /---
F Cleanout:
,!.
Yellow Copy: City of Eagan Pink Copy: SEH