1940 Carnelian Lane - Inspection Form" City 1' FJa a
Residential Sanitary Sewer Service
Compliance Inspection
4
Date
Name
PJD Number
House Number
4" to 6" Transition:
VI
White Copy: Property Owner
7
2
Alternative MailingAddress
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
•
Time Am
Street Name
erfOccupant Signature
-EN-LE1
For information call 651
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 Entered S.L at
Roots f /?
Poor PipeJoints
Mineral Deposits
SaglPipe Deflection
Damaged - Pipe J
Transition J(7 -4i0 .
Length of Service:
Number. Discharged
Foundation drains
Roof drains
Total
Correctly Incorrectly
Unknown
Yellow Copy: City of Eagan
Record Number
Phone
Time ._�
Obstruction
Notes
Unable to push past
feet
•
•
Final Cleanout:
Inspector Signature
)am
)
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
,/