2069 Quartz Lane - Inspection Formriy of }a au
Residential Sanitary Sewer Service
Compliance Inspection
Date l L /
Name v s l / 4 / . Z.'
PID Number
House Number
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
1 .
7
Time •
Disk #
Own er /Occupant Signature
Compliance
4 3,. -No foundation drain connection
Ng' No roof drain connection
S"ump pit not connected to
■sanitary sewer
,C Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
am
L
Street Name 6 / ? 7
For information cal! 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
Number of stacks (. Entered S.L. at - --5%�'
Roots
Poor Pipe joints
Mineral Deposits - 77 --
Sag/Pipe Deflection
Damaged Pipe
Transition
4 e Length of Service:
Yellow Copy: City of Eagan
6
Record Number
Phon
Notes 0
Time i'Z
9 am
'6 pm
I nspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Final Cleanout: /VA'
Pink Copy: SEH
Total
Number Discharged
•
Correctly
Incorr ectly
Unknown
Sump pumps
(
1
Foundation drains
--°°-
—
Roof drains
_.-
riy of }a au
Residential Sanitary Sewer Service
Compliance Inspection
Date l L /
Name v s l / 4 / . Z.'
PID Number
House Number
Alternative Mailing Address
4" to 6" Transition:
White Copy: Property Owner
1 .
7
Time •
Disk #
Own er /Occupant Signature
Compliance
4 3,. -No foundation drain connection
Ng' No roof drain connection
S"ump pit not connected to
■sanitary sewer
,C Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings
am
L
Street Name 6 / ? 7
For information cal! 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
Number of stacks (. Entered S.L. at - --5%�'
Roots
Poor Pipe joints
Mineral Deposits - 77 --
Sag/Pipe Deflection
Damaged Pipe
Transition
4 e Length of Service:
Yellow Copy: City of Eagan
6
Record Number
Phon
Notes 0
Time i'Z
9 am
'6 pm
I nspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Final Cleanout: /VA'
Pink Copy: SEH