2085 Jade Lane - Inspection FormCity of liaftao
Residential Sanitary Sewer Service
Compliance Inspection
Date
f
Name
Time
Disk #
• �' am
• fpm
Record Number
PID Number
House Number i, .. Street Name C� ./ _ r'
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump purnp properly piped
No sump pump
I`- I / -, , 1
Owner /Occupant Signature
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
For information call 651.470.2788
Obstruction
Unable to push past
feet
Service Lat_ ral Inspection Findi gs Number of stacks �f Entered S. at
"/Y 7' �/ �
Roots / �f r ( ; - `? c.:'
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition .? ! < ? °rte F / : /
4" to 6 "Transition:
White Copy: Proper ty Owner
Length of Service:
Yellow Copy: City of Eagan
i f
Phone?" t�
• pa
Time ) • - -�}(� Pm
inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
/'
Foundation drains
Roof drains
L.'
City of liaftao
Residential Sanitary Sewer Service
Compliance Inspection
Date
f
Name
Time
Disk #
• �' am
• fpm
Record Number
PID Number
House Number i, .. Street Name C� ./ _ r'
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump purnp properly piped
No sump pump
I`- I / -, , 1
Owner /Occupant Signature
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
For information call 651.470.2788
Obstruction
Unable to push past
feet
Service Lat_ ral Inspection Findi gs Number of stacks �f Entered S. at
"/Y 7' �/ �
Roots / �f r ( ; - `? c.:'
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition .? ! < ? °rte F / : /
4" to 6 "Transition:
White Copy: Proper ty Owner
Length of Service:
Yellow Copy: City of Eagan
i f
Phone?" t�
• pa
Time ) • - -�}(� Pm
inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH