2060 Shale Lane - Inspection Form\No
City Ea pi
Residential :Sanitary Sewer Service
Compliance Inspection
Date &Z ! Z 1 1°
Time
r ? �� -r2SC1
Name r � ..
PID Number
House Number () 1)
Alternative MailingAdd_ress
:'
Compliance
/No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
3 Sump pump properly piped
rc3 No sump pump
4" to 6 "Transition
0 Af /
White Copy: Property Owner
Al • , dem
• 0 p
Disk #
Street Name
Owner /Occupant Signature
Non
O
O
O
O
O
0
t'
- Compliance
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
0
I"
Time
Phone
. I [ ti
f' Ins
/%
:'ram
•• O pm
`' ?.) < /X/
Obstruction
Unable to push past
feet
Notes .
t:/ G
ctor Signature
For information call 65
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
a,
Service ateral Inspection Findings Number of stacks Entered S L at
Roots ? 5
Poor Pipe joints
Mineral Deposits _.5
Sag /Pipe Deflection
Damaged Pipe
Transition
1"]
final Cleanout: ,,
- ) ' Liken
r/rf, -tom
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Total
Sump pumps
-
Foundation drains
R
Roof drains
\No
City Ea pi
Residential :Sanitary Sewer Service
Compliance Inspection
Date &Z ! Z 1 1°
Time
r ? �� -r2SC1
Name r � ..
PID Number
House Number () 1)
Alternative MailingAdd_ress
:'
Compliance
/No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
3 Sump pump properly piped
rc3 No sump pump
4" to 6 "Transition
0 Af /
White Copy: Property Owner
Al • , dem
• 0 p
Disk #
Street Name
Owner /Occupant Signature
Non
O
O
O
O
O
0
t'
- Compliance
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
0
I"
Time
Phone
. I [ ti
f' Ins
/%
:'ram
•• O pm
`' ?.) < /X/
Obstruction
Unable to push past
feet
Notes .
t:/ G
ctor Signature
For information call 65
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
a,
Service ateral Inspection Findings Number of stacks Entered S L at
Roots ? 5
Poor Pipe joints
Mineral Deposits _.5
Sag /Pipe Deflection
Damaged Pipe
Transition
1"]
final Cleanout: ,,
- ) ' Liken
r/rf, -tom
Pink Copy: SEH