2123 Shale Lane - Inspection FormSump pumps
7)
Foundation drains
' f '
Roof drains
w l
City oi'Fa a
Residential Sanitary Sewer Service
Compliance Inspection
Date
l / I ].r
Name ) o .
Alternative Mailing Address
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
1
i No sump pump
4" to 6 "Transition:
F� 11
White Copy: Property Owner
Time
Service Lateral Inspection Findings
isk #
Owner /Occupant Signature
•06, ` `}}ir�'� am
•/O pm
Non - Compliance
O
O
O
O
O
Number of stacks 1
PID Number
House Number Street Name
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
a
i
i
Length of Service: (�
Number Discharged
Total Correctly Incorrectly Unknown
Record Number
Notes
• •
1
Time • •
Phone =- ) °,j r✓ r ' 1 ;
Inspector Signature
Obstruction
Unable to push past
feet
EnteredS �
r
Final Cleanout:
0 pm
am
For information call 65 1.470:2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition / r }.'3; ( ��,I -f
Yellow Copy: City of Eagan Pink Copy: SEH