2041 Jade Lane - Inspection FormCity of Eagan
Residential Sanitary Sewer' Service
Compliance Inspection
Date 1) ) /
j
Name - 4 1 f . ' f C/ ? Disk #
f -'
PID Number
Alternative MailingAddress
Compliance
No foundation drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No roof drain connection
No sump pump
Service Lateral inspection
r r - ?
Roots ) _" )
Poor Pipe joints
Transition f - 1 (V
4" to 6" Transition:
Sump pumps
Foundation drains
Roof drains
4 /2-(
f 127.
White Copy: Property Owner
Total
err
Time • !q p
k ,L't!e t4 a /t
OwnerlOccupant Signat5re
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Correctly
am
Incorrectly
House Number e '!y 1 1 Street Name _ ✓ �' r
Non
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:
Number Discharged
Unknown
Yellow Copy: City of Eagan
Record Number 4 €.
Notes
Time
I .._ / 2 ,
Phone ..
Obstruction
Unable to push past
feet
0
Inspector Signature
''.. am
0 pm
For .information call 651:470.2788
No Access
O No one in
1 3 Final Cleanout:
O Access to service
lateral needed
O Inspection
refused
Findings Number of st as ,.. Entered S. L at t —
Pink Copy: SEH