2046 Jade Lane - Inspection FormSump pumps
Foundation drains
Roof drains
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Residential Sanitary Sewer Service
Compliance Inspection
L.
Date /4 1 �r 11 J
i 4
Name r D" €sk#
PID Number
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House Number i / "* Street Name
Alternative MailingAddress
For information call 651.470.2788
ogt} pliance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump pump properly piped
0 No sump pump
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
Owner /Occupant Signature
3 I r?
White Copy: Property Owner
0
O
O
0
0
0am
Time • o pm
Non - Compliance
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks _ .1 Entered 5 L at
Service Lateral Inspection Findings
Roots
Length of Service:
Number Discharged
Total Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Record Number
Phone ( - C, f ° vim
Obstruction
Unable to push past
feet.
Notes
%)
°7 • 1 T - am
Time C:7_7)
Inspector Signature
- Final Cleanout:
• 'O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
t
Pink Copy: SEH