2083 Shale Lane - Inspection Form410
Residential Sanitary Sewer Service
Cityu1Fa pfl Compliance Inspection
Date OV/ /5 / /0
Name ..1, Disk #
House Number
Alternative Mailing Address
/ 71!
1.■
White Copy: Property ty Owner
Compliance
W . No foundation drain connection
g No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition: (PV/i_Vo sviti
c,• kam
Time 4•J •
0 pm
PID Number
/
Owner/Occupant Signature
0
c
Street Name 4-4-7
Non
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 1
Roots
Yellow Copy: City of Eagan
Record Number
•
•
Time
phobe
inspector Signature
.7'
For information call 651.470.2788
Length of Service:
Obstruction
Unable to push past
6 feet.
A///'(Y
01 am
0 PM
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at CP
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe h/ 153' 7 -Pc
Transition/' / /4-v/ 661
/ •
Final Cleanout: ,•,„//
Pink Copy: SEH
Total
.6
Notes — el u C 0 t ,...? 6 7' pe1,44 E.) v)
,
_ i - —:, ., i' 0 ( ,0,4
7 7 , f I --C
r's ....- .Z7
m .v.----,
n , .
r'0,cf (..ir 7:).,4--f-
L . i'VCZ:D
.
?3
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
76"'
,---------
---
Foundation drains
5....),
Roof drains
( ---- y
.
410
Residential Sanitary Sewer Service
Cityu1Fa pfl Compliance Inspection
Date OV/ /5 / /0
Name ..1, Disk #
House Number
Alternative Mailing Address
/ 71!
1.■
White Copy: Property ty Owner
Compliance
W . No foundation drain connection
g No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition: (PV/i_Vo sviti
c,• kam
Time 4•J •
0 pm
PID Number
/
Owner/Occupant Signature
0
c
Street Name 4-4-7
Non
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 1
Roots
Yellow Copy: City of Eagan
Record Number
•
•
Time
phobe
inspector Signature
.7'
For information call 651.470.2788
Length of Service:
Obstruction
Unable to push past
6 feet.
A///'(Y
01 am
0 PM
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S L at CP
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe h/ 153' 7 -Pc
Transition/' / /4-v/ 661
/ •
Final Cleanout: ,•,„//
Pink Copy: SEH
1 1W
Cif Y off Ea an
Residential Sanitary Sewer Service
Compliance Inspection
(2
Dates --
Name - i -- °i
a
House Number
J`7
if 1 '
PO Number
a ,..)Street Name
Alternative Mailing Address
Time
l
I • pm
Disk # / .12
(.. (
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
2 11
Transition
4" to 6 "Transition: € f
White Copy: Property Owner
OwnerlOc&pant ' Signature
r 3
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 i
,sl
Record Number .s
- l� l� h f ,rimer i
Length of Service: A`
Yellow Copy: City of Eagan
Time f� e "
P h o n e " "
Obstruction
Unable to push past
feet.
Entered S.L.at
Roots
Inspector Signature
am
'6 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: }` ;`
A, 1
Pink Copy: SEH
Total
Notes
`
} ,
_ f .ten irC_ na
R
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
l
®
Foundation drains
i
�s
Roof drains
1 1W
Cif Y off Ea an
Residential Sanitary Sewer Service
Compliance Inspection
(2
Dates --
Name - i -- °i
a
House Number
J`7
if 1 '
PO Number
a ,..)Street Name
Alternative Mailing Address
Time
l
I • pm
Disk # / .12
(.. (
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
2 11
Transition
4" to 6 "Transition: € f
White Copy: Property Owner
OwnerlOc&pant ' Signature
r 3
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 i
,sl
Record Number .s
- l� l� h f ,rimer i
Length of Service: A`
Yellow Copy: City of Eagan
Time f� e "
P h o n e " "
Obstruction
Unable to push past
feet.
Entered S.L.at
Roots
Inspector Signature
am
'6 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: }` ;`
A, 1
Pink Copy: SEH