2065 Quartz Lane - Inspection FormSump pumps
1
Foundation drains
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Roof drains;'
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City of hp
Residential Sanitary Sewer Service
Compliance Inspection
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Date 04// j' / / Time / -• O o o pam m
Name __ ��1�. , Disk #
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PID Number
House Number r' f1
Alternative Mailing Address
Roots
4" to 6" Transition:
Owner /Occupant Signature
Compliance
s?,No foundation drain connection
No roof drain connection
7
Street Name
For information call 651,470.2788
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
Sump pit not connected to
0 Defective manholes
( sanitary sewer
0 Sump pump connected to sanitary
O Sump pump properly piped sewer
O No sump pump AV Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks 1 Entered S.L at
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Ai/ray-x!, :57/, Length of Service:
Number Discharged
Total Correctly Incorrectly Unknown
White Copy: Ptoperty Owner
Yellow Copy: City of Eagan
Record Number
T
me
t e m
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Phone
,
v v
f I nspector Signature
/
Obstruction No Access
Unable to push past 0 No one in
feet.
Final Cleanout:
Notes
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O am
0" pm
O Access to service
lateral needed
O Inspection
refused
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Pink Copy: SEH