2025 Jade Lane - Inspection FormSump pumps
Mill
Foundation drains
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Roof drains
/
City of Paoli
Residential Sanitary Sevier Service
Compliance Inspection
Date / / l
Name
fi
PID Number
/`)
House Number ■ Street Name
Alternative Mailing Address Phone
For information call 651:470.2788
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
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
Service Lateral Inspection Findings Number of stacks Entered S.L at
Roots
Poor Pipe Joints
Mineral Deposits
.�!
(lag ipe Deflection -4
Damaged Pipe
) r , J
Transition � . s i �n �- °a ,� )' <:..s 4s' F' °��
T 1
4" to 6" Transition:
White Copy: Property Owner
Time it • pm
Disk #
Own 'Occupant Signature
Length of Service:
Number. Discharged
Total Correctly
Incorrectly Unknown
r
Record Number
Notes
Time ! j
Inspector Signature
Obstruction
Unable to push past
feet
am
O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH
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