2053 Emerald Lane - Inspection FormC113 or
Residential Sanitary Sewer service
Compliance Inspection
Date 77 / /(r 1 ' !i l
Name 1 ,' 1 ,` f�
Alternative Mailing Address
7 pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
zi q No sump pump
Transition
'
4" to b" Transition:
(,)f '4
Sump pumps
Foundation drains
Roof drains
White Copy: Proper ry Owner
Total
3
1 ! o am
Time "" pm
` / Di
PID Number
House Number Street Name
OwnerlOccupant Signa'ture
0
O
O
O
0
Service Lateral Inspection Findings
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection___
Damaged Pipe
?._. I ;F�
For information call 65 470.2788
Non - Compliance
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
C
Length of Service: [ - Final Cleanout:
7
�..
Number Discharged
Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Record Number
Fr Time
•
Obstruction
Unable to push past
feet
Entered S.1..at
Notes
I
Phone
Inspector Signature
o am
pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
r efused
>
Pink Copy: SEH