2124 Shale Lane - Inspection FormCity ol Playa
Residential Sanitary Sewer Service
Compliance Inspection
1
I 1
1
Ownerlqpcupant Signature
I/
Compliance
O No foundation drain connection
/
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Deflection
Da maged Pipe
Date
fr
Name
PLD Number
House Number
Alternative Mailing Address
, 'Transition
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copyq't opeity Owner
Time
Disk #
, Street Name
)
-+
L-4
A
• 9 am
:e■ Pm
•
For information calI 651.470.2788
it 7
No -Compliance )
Clear water connections to ,j
sanitary sewer - --- --)----, / ,
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer'
O Flexible sump pump piping
Number of stacks
Length of Sr vice:
Yellow Copy: City of Eagan
Record Number
Phone .
inspector Signature
Obstruction
Unable to push past
feet
c ,
Entered S. L at
am
Cleanout:
prr
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Notes )
...... i"
1 ,
) 1/
il ...), /
4-- ---
- i ,-----7_ ,---_
Total
Sump pumps
,,,,.,--.
7' '71
Foundation drains
.2,.
,..___,,
--...----- ,,,----)
,
/
,C__-
Roof drains
_.
City ol Playa
Residential Sanitary Sewer Service
Compliance Inspection
1
I 1
1
Ownerlqpcupant Signature
I/
Compliance
O No foundation drain connection
/
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Deflection
Da maged Pipe
Date
fr
Name
PLD Number
House Number
Alternative Mailing Address
, 'Transition
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copyq't opeity Owner
Time
Disk #
, Street Name
)
-+
L-4
A
• 9 am
:e■ Pm
•
For information calI 651.470.2788
it 7
No -Compliance )
Clear water connections to ,j
sanitary sewer - --- --)----, / ,
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer'
O Flexible sump pump piping
Number of stacks
Length of Sr vice:
Yellow Copy: City of Eagan
Record Number
Phone .
inspector Signature
Obstruction
Unable to push past
feet
c ,
Entered S. L at
am
Cleanout:
prr
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Pink Copy: SEH