2070 Quartz Lane - Inspection FormCity of .la
Res identiai Sanitary Sewer Service
Compliance Inspection
Date_ {) 61 - lo / `2
Name
1
House Number 0 777
7, r`° Disk #
PID Number
Alternative Mailing Address
4" to 6" Transition:
( /
OwnerlOccupant Signature
For information call 651.470.2788
Compliance
A F- No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
,;
arJ No sump pump
r\
Service Lateral Inspection Findings Number of stacks
Roots � C ✓ 7
71/
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
White Copy: Property Owner
• •am
Time 7--V • Ca ll o pm
LL7
Street Name G
Phone
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
Damaged Pipe
Transition /2/ /4 !/
Length of Service:
Yellow Copy: City of Eagan
Record Number
a
—_a
Obstruction
Unable to push past
feet
Entered S L.at
2
Time 0 ,
-7 inspector Signature
Final Cleanout:
P am
0 pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Pink Copy: SEH
Notes
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
- ___
Foundation drains
!
Roof drains
- ---
City of .la
Res identiai Sanitary Sewer Service
Compliance Inspection
Date_ {) 61 - lo / `2
Name
1
House Number 0 777
7, r`° Disk #
PID Number
Alternative Mailing Address
4" to 6" Transition:
( /
OwnerlOccupant Signature
For information call 651.470.2788
Compliance
A F- No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
,;
arJ No sump pump
r\
Service Lateral Inspection Findings Number of stacks
Roots � C ✓ 7
71/
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
White Copy: Property Owner
• •am
Time 7--V • Ca ll o pm
LL7
Street Name G
Phone
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
Damaged Pipe
Transition /2/ /4 !/
Length of Service:
Yellow Copy: City of Eagan
Record Number
a
—_a
Obstruction
Unable to push past
feet
Entered S L.at
2
Time 0 ,
-7 inspector Signature
Final Cleanout:
P am
0 pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Pink Copy: SEH