2119 Shale Lane - Inspection FormCity of liapa
Residential Sanitary Sewer Service
Compliance Inspection
Date(2? / Or / 4
Name ! 4/ Disk #
PlD Number
House Number
Alternative Mailing Address
�E.
For information call 651:470 2788
Compliance
-O No foundation drain connection
1 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
� No sump pump
Service Lateral Inspection Findings
Roots 71, 4 /- S /
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
2//7
OwnehOccupant Signature
4" to 6" Transition: y s
� am
Time 4/ : e',.;,,,:);-
f
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
,4 Length of Service:
Number of stacks Entered S.L.at
White Copy: Property Owner
Record Number
Street Name
,�. l <. ` -
��"
Ph f,
f
/,
o am
Time it ® 7 r .,d pm
Obstruction
Unable to push past
feet
Notes
r7
Inspector Signature
-> .i,5 1, ' � , L. f '
C, i
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH
Number Discharged
Total
Correctly
Incorrectly
Unknown
Sump pumps
, i�..1..
_��=,_v_._....a••-
,�.•..- --�-" a......�.�.
�u
Foundation drains;
Roof drains
— 7 .
______
__..__ _. .._____.__._.__
City of liapa
Residential Sanitary Sewer Service
Compliance Inspection
Date(2? / Or / 4
Name ! 4/ Disk #
PlD Number
House Number
Alternative Mailing Address
�E.
For information call 651:470 2788
Compliance
-O No foundation drain connection
1 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
� No sump pump
Service Lateral Inspection Findings
Roots 71, 4 /- S /
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
2//7
OwnehOccupant Signature
4" to 6" Transition: y s
� am
Time 4/ : e',.;,,,:);-
f
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
,4 Length of Service:
Number of stacks Entered S.L.at
White Copy: Property Owner
Record Number
Street Name
,�. l <. ` -
��"
Ph f,
f
/,
o am
Time it ® 7 r .,d pm
Obstruction
Unable to push past
feet
Notes
r7
Inspector Signature
-> .i,5 1, ' � , L. f '
C, i
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH