4053 Mica Tr - Inspection FormCity of to [I
Residential Sanitary Sewer Service
Compliance Inspection
/' I ,-s
Date .4 1 1 °7 ! (
Name C �7
PID Number
House Number
I
i ) Disk #
•_ Street Name
OwnerlOccupant Signature
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
X No sump pump
4" to b" Transition:
White Copy: Pr Owner
a 0
Time
0
O
U
O
Service Lateral Inspection Findings
Roots
Poor Pipe joints
0
o am
Pm
Non - Compliance
I
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Mineral Deposits
Sag /Pipe Deflection - II
Damaged Pipe f 3
Transition ; f 0/'�' — /9r"
Length of Service:
Record Number
Phone <"<":17-- /'") ) ,
Notes
•`.� -
Time
Inspector Signature
For information :call 651:470 2
O bstruction
Unable to push past
feet
Entered S..L..at -
Final Cleanout:
N o Access
O No one in
am
pm
O Access to service .
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
r'i
.
Foundation drains
; '
Roof drains
City of to [I
Residential Sanitary Sewer Service
Compliance Inspection
/' I ,-s
Date .4 1 1 °7 ! (
Name C �7
PID Number
House Number
I
i ) Disk #
•_ Street Name
OwnerlOccupant Signature
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
X No sump pump
4" to b" Transition:
White Copy: Pr Owner
a 0
Time
0
O
U
O
Service Lateral Inspection Findings
Roots
Poor Pipe joints
0
o am
Pm
Non - Compliance
I
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Mineral Deposits
Sag /Pipe Deflection - II
Damaged Pipe f 3
Transition ; f 0/'�' — /9r"
Length of Service:
Record Number
Phone <"<":17-- /'") ) ,
Notes
•`.� -
Time
Inspector Signature
For information :call 651:470 2
O bstruction
Unable to push past
feet
Entered S..L..at -
Final Cleanout:
N o Access
O No one in
am
pm
O Access to service .
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH