2074 Emerald Lane - Inspection FormCity off' Ea ao
Residential - ,Sanitary: Sewer Se rvice
Compliance inspection
r7 /l { f 7
Date /- %1 ) / /
Name
PID Number
House Number
Alternative
e,! < Disk#
No roof drain connection
4" to 6 "Transition:
flailing Address
t ..
White Copy: Proper ry Owner
Street Name
OwnerlOccupant Signature
Compliance
O No foundation drain connection
t
( O Sump pit not connected to
sanitary sewer
XN0 O Sump pump properly piped
sump pump
Transition 1 / 7 �i r
71,
I /70 am
Time • / pm
-J
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
J Length of Service:
Record Number
rf
'Time !/ •
olam
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
Service Lateral inspection Findings Number of stacks Fn-ter ci S L. at
hoots f / i t r
Yellow Copy: City of Eagan
Phone > r
For information call 651
Inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Final Cleanout: / I1 +1
( !
Pink Copy: SEH
Total
Notes
(' /r' ' K719 t -r� .: C- (% �.. ✓ = 1 — - 1 L .f
II I i
~
t, 7'7
�`
j ,/� /�
L/ l�f'/I�! I
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
I
Foundation drains
/
Roof drains
)
City off' Ea ao
Residential - ,Sanitary: Sewer Se rvice
Compliance inspection
r7 /l { f 7
Date /- %1 ) / /
Name
PID Number
House Number
Alternative
e,! < Disk#
No roof drain connection
4" to 6 "Transition:
flailing Address
t ..
White Copy: Proper ry Owner
Street Name
OwnerlOccupant Signature
Compliance
O No foundation drain connection
t
( O Sump pit not connected to
sanitary sewer
XN0 O Sump pump properly piped
sump pump
Transition 1 / 7 �i r
71,
I /70 am
Time • / pm
-J
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
J Length of Service:
Record Number
rf
'Time !/ •
olam
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
Service Lateral inspection Findings Number of stacks Fn-ter ci S L. at
hoots f / i t r
Yellow Copy: City of Eagan
Phone > r
For information call 651
Inspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Final Cleanout: / I1 +1
( !
Pink Copy: SEH