2061 Quartz Lane - Inspection Form. City of Ca pit
Residential Sanitary Sewer Service
Compliance Inspection
( !% j Time • A pm
j J • )�
Name , t l ` / 7/J !7 Disk#
PID Number
'.2 /-' j
House Number ' 7 / Street Name
Date
No sump pump
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit noc connected co
sanitary sewer
O Sump pump properly piped
4" to 5" Transition:
White Copy: Pr Owner
•
am
Owner /Occupant Signature
0- ° 7' _
Phone ( , ) . ` ) ° L ;) -- ° ��
For information call 65
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
• r
Number of stacks Entered S L at
Service La1l ' Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition !
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
Inspector Signature
Final Cleanout:
am
Pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
/ /
Pink Copy: SEH
Number Discharged
Notes
Total
Correctly
incorrectly
Unknown
Sump pumps
Li
Foundation drains
U--
Roof drains
i
. City of Ca pit
Residential Sanitary Sewer Service
Compliance Inspection
( !% j Time • A pm
j J • )�
Name , t l ` / 7/J !7 Disk#
PID Number
'.2 /-' j
House Number ' 7 / Street Name
Date
No sump pump
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
O Sump pit noc connected co
sanitary sewer
O Sump pump properly piped
4" to 5" Transition:
White Copy: Pr Owner
•
am
Owner /Occupant Signature
0- ° 7' _
Phone ( , ) . ` ) ° L ;) -- ° ��
For information call 65
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
• r
Number of stacks Entered S L at
Service La1l ' Findings
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition !
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
Inspector Signature
Final Cleanout:
am
Pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
/ /
Pink Copy: SEH