2099 Shale Lane - Inspection FormCity of EaR Ii
Residential :Sanitary Sewer Service
Compliance Inspection
Date , 1 1 /a
Name / ✓i, ZI 2ck°VL Disk #
PID Number
House Number. l Street Name
Alternative Mailing Address
j l
OwnerlOccupari' Signature
For information call 651.470.2788
Co liance
Ai No foundation drain connection
,P6 No roof drain connection
p ' Sump pic not connected to
sanitary sewer
O Sump pump properly piped
0 No sump pump
Tr at sition
4" to b "Transition:
White Copy: Property Owner
Time /nd s r
0
Service Lateral inspection Findings
Roots z— , -
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe/
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 Entered S L. at
of Service:
Yellow Copy: City of Eagan
Record Number
Time /
Obstruction
Unable to push past
feet.
Phone /; %� .. ✓� .
,
inspector Signature
Final Cleanout:
Notes
t
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
L44 .
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorr ectly
Unknown
Sump pumps
1
1
Foundation drains
--
_
_.. 'w
Roof drains
✓
_ .____._
_ _ ___..
__.___.., .
City of EaR Ii
Residential :Sanitary Sewer Service
Compliance Inspection
Date , 1 1 /a
Name / ✓i, ZI 2ck°VL Disk #
PID Number
House Number. l Street Name
Alternative Mailing Address
j l
OwnerlOccupari' Signature
For information call 651.470.2788
Co liance
Ai No foundation drain connection
,P6 No roof drain connection
p ' Sump pic not connected to
sanitary sewer
O Sump pump properly piped
0 No sump pump
Tr at sition
4" to b "Transition:
White Copy: Property Owner
Time /nd s r
0
Service Lateral inspection Findings
Roots z— , -
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe/
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 Entered S L. at
of Service:
Yellow Copy: City of Eagan
Record Number
Time /
Obstruction
Unable to push past
feet.
Phone /; %� .. ✓� .
,
inspector Signature
Final Cleanout:
Notes
t
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
L44 .
Pink Copy: SEH