2080 Shale Lane - Inspection FormCity of EaR,aa
Residential Sanitary Sewer Service
Compliance Inspection
0 2 J /G
Name !L >" 2 ff /4 V6
PID Number
Date
House Number
Zo
Alternative Mailing Address
Owner /Occupant Signature
Compliance
1`" No foundation drain connection
R I No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
Sump pumps
Foundation drains
Roof drains
White Copy: Property Owner
Total
//• 0 am
Time / G • Al
Disk ##
Street Name
Length of Service:
Service Lateral Inspection Findings
Roots i""_ .
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe 7
Transition Z-'( -`
L/
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
Number of stacks _
Number Discharged
Correctly Incorrectly
Unknown
Yellow Copy: City of Eagan
Record Number
(7
Obstruction
Unable to push past
feet
Entered S L at 46
Notes
C •
•
Time
Inspector Signature
/ p am
/ pm
fi t S Z7
hone -•'7 !./7f
For information call 65
No Access
O No one in
Final Cleanout:
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
.q)
Residential Sanitary Sewer Service
Compliance Inspection
am
Date (l // 6 i / Time d p
Name
ref✓
— LL1 — i —]
Disk#
PID Number
r
House Number
Alternative MailingAddress
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Street Name
Owner /Occupant Signature
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O f=lexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
h
4/ / ,i 0 O '/
- ± - 4 7/// e
P
Time
inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number - of stacks Entered S.L.at
Roots
Poor Pipe joint
Mineral Deposits
Sag /Pipe Deflection .
Damaged Pipe AL kiti .4u f rt.
Final Cieanout:
p am
•
® O pn
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Transition
Pink Copy: SEH r
Num ber •Discharged
Notes
Total
Correctly
Incorrectly
Unknown
; ,
I OW r f ..iii i e
°
ir= 4 �d/�'X / /r / r
1
'
1
p
Sump pumps
Foundation drains
Roof drains
ill`
1/ !
.q)
Residential Sanitary Sewer Service
Compliance Inspection
am
Date (l // 6 i / Time d p
Name
ref✓
— LL1 — i —]
Disk#
PID Number
r
House Number
Alternative MailingAddress
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Street Name
Owner /Occupant Signature
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O f=lexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number
h
4/ / ,i 0 O '/
- ± - 4 7/// e
P
Time
inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number - of stacks Entered S.L.at
Roots
Poor Pipe joint
Mineral Deposits
Sag /Pipe Deflection .
Damaged Pipe AL kiti .4u f rt.
Final Cieanout:
p am
•
® O pn
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Transition
Pink Copy: SEH r