2016 Zircon Lane - Inspection FormCity of tan
Residential Sanitary Sewer Service
Compliance Inspection
0
;)
Date rip 1 i' /
1
Name j �� -r= �,� � ! I .L ) Disk #
PID Number
House Number J! 1 /
Alternative Mailing Address
For information call 651.470.2788
pliance
No foundation drain connection
No roof drain connection
s
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
A No sump pump
Service Lateral Inspection Findings
Roots /".-
t / 1 -
Pool-Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
f�l
Transition
4" to 6 "Transition:
White Copy: Property Owner
—74 Gj am
Time / • /b pm
Street Name
Owner /Occupant Signature
z
Phone _ ( .. -,
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
Number of stacks Entered 5. at
Yellow Copy: City of Eagan
Record Number
DJE
Length of Service: .
Obstruction No Access
Unable to push past 0 No one in
feet
Time
inspector Signature
Final Cleanout:
am
m
o p
O Access to service.
lateral needed
O inspection
refused
Pink Copy: SEH
Notes
Number
Correctly
Discharged
Incorrectly
Unknown
_
Total
Sump pumps
f
r' 1
Foundation drains
Roof drains
Li
City of tan
Residential Sanitary Sewer Service
Compliance Inspection
0
;)
Date rip 1 i' /
1
Name j �� -r= �,� � ! I .L ) Disk #
PID Number
House Number J! 1 /
Alternative Mailing Address
For information call 651.470.2788
pliance
No foundation drain connection
No roof drain connection
s
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
A No sump pump
Service Lateral Inspection Findings
Roots /".-
t / 1 -
Pool-Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
f�l
Transition
4" to 6 "Transition:
White Copy: Property Owner
—74 Gj am
Time / • /b pm
Street Name
Owner /Occupant Signature
z
Phone _ ( .. -,
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
Number of stacks Entered 5. at
Yellow Copy: City of Eagan
Record Number
DJE
Length of Service: .
Obstruction No Access
Unable to push past 0 No one in
feet
Time
inspector Signature
Final Cleanout:
am
m
o p
O Access to service.
lateral needed
O inspection
refused
Pink Copy: SEH