2104 Shale Lane - Inspection FormResidential Sanitary Sewer Service
Compliance inspection
Date /4 l /
Name )
PID Number
House Number ) i _ Street Name _
Alternative Mailing Address
For information call 651:470.2788
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings Number of stacks Entered S. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 2 / I ('2
4" to b" Tr ansition:
White Copy: Property Owner
Time
Owner /Occupant Signature
2/1
0.5:1 \ q am
• , D pm
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
Yellow Copy: City of Eagan
Record Number
f
Phone r '.
• <J em
time ) • pm
Obstruction
Unable to push past
feet
Length of Service: °)✓
inspector Signature
Final Cleanout: I i f
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
incorrectly Unknown
Notes
Total
Sump pumps
..----`n , `
'2
Foundation drains
2
Roof drains
.1
%
Residential Sanitary Sewer Service
Compliance inspection
Date /4 l /
Name )
PID Number
House Number ) i _ Street Name _
Alternative Mailing Address
For information call 651:470.2788
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings Number of stacks Entered S. at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition 2 / I ('2
4" to b" Tr ansition:
White Copy: Property Owner
Time
Owner /Occupant Signature
2/1
0.5:1 \ q am
• , D pm
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
Yellow Copy: City of Eagan
Record Number
f
Phone r '.
• <J em
time ) • pm
Obstruction
Unable to push past
feet
Length of Service: °)✓
inspector Signature
Final Cleanout: I i f
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH