2086 Quartz Lane - Inspection FormCity of Ea
Residential Sanitary Sewer Service
Compliance Inspection
Date e /
Name
/ !� , Time f a a v T pm
�/ j
i J' f Disk #
PID Number
'2 -
House Number 7 Street Name
Alternative Mailing Address
(
For information calI.65 A7
Compliance
O 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 Fin,dings
Roots
Poor PipeJoints
White Copy: Property Owner
0 Signature
4" to 6 "Transition:
r ,.
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
N
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition l
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Time ?
Obstruction
Unable to push past
feet
ber of stacks . ! Entered S L. at
•
•
p am
Pm
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
r i
Final Cleanout:
Pink Copy: SEH
No
/ :--1 ;; i -- ' >'
.,- -� /
i �
j
- j - ' i " - -
15(
I
4
.. f,
-- - -? ;°
Number
Correctly
Discharged:
Incorrectly
Unknown
Total
Sump pumps
Foundation drains
i"' Y , , ,,
7.
�a11
Roof drains
City of Ea
Residential Sanitary Sewer Service
Compliance Inspection
Date e /
Name
/ !� , Time f a a v T pm
�/ j
i J' f Disk #
PID Number
'2 -
House Number 7 Street Name
Alternative Mailing Address
(
For information calI.65 A7
Compliance
O 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 Fin,dings
Roots
Poor PipeJoints
White Copy: Property Owner
0 Signature
4" to 6 "Transition:
r ,.
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
N
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition l
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Time ?
Obstruction
Unable to push past
feet
ber of stacks . ! Entered S L. at
•
•
p am
Pm
Inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
r i
Final Cleanout:
Pink Copy: SEH