2053 Jade Lane - Inspection FormCity O tdfI
Residential Sanitary Sewer Service '.
Compliance inspection
Date f / /
Name :t' V 9,72< Disk #
Time )
Alternative Mailing Address
r
Owner /Occupant Signature
Compliance
No foundation drain connection
No roof drain connection
r }
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
( No sump pump
Service Lateral Inypection Findings
Roots
4" to 6" Transition:
White Copy: Pr operty Owner
• C1f
•
o am
® Pm
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
Record Number
[Jyflme
PID Number
House Number ! <; .i � Street Name
For information call 651.470.2788
Obstruction
Unable to push past
feet
Number of stacks - 4 Entered S.L at
Yellow Copy: City of Eagan
y�
inspector Signature
f
Length of Service: I Final Cleanout:
�
Pm
Phone /..� -'.,,�
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe i
i i ,,- i i i . -' ---7) i
i'
Transition l� � lp/ / ttl� �. 7 !' ;-
Pink Copy: SEH
Total
Notes
Nu.
ber
Correctly
Incorrectly
Unknown
Sump pumps
/1
(f/
Foundation drains
Roof drains
City O tdfI
Residential Sanitary Sewer Service '.
Compliance inspection
Date f / /
Name :t' V 9,72< Disk #
Time )
Alternative Mailing Address
r
Owner /Occupant Signature
Compliance
No foundation drain connection
No roof drain connection
r }
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
( No sump pump
Service Lateral Inypection Findings
Roots
4" to 6" Transition:
White Copy: Pr operty Owner
• C1f
•
o am
® Pm
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
Record Number
[Jyflme
PID Number
House Number ! <; .i � Street Name
For information call 651.470.2788
Obstruction
Unable to push past
feet
Number of stacks - 4 Entered S.L at
Yellow Copy: City of Eagan
y�
inspector Signature
f
Length of Service: I Final Cleanout:
�
Pm
Phone /..� -'.,,�
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe i
i i ,,- i i i . -' ---7) i
i'
Transition l� � lp/ / ttl� �. 7 !' ;-
Pink Copy: SEH