2094 Copper Lane - Inspection Form41*
City ni Faa
Residential Sanitary Sewer Service
Compliance Inspection
Date/f7 /
Name
HD Number
House Number
ling Address /
Alternative !II
Owner/Occupant Srature
For irifor.mation call 651470•2788
mpliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6"Transition:
■Nim.mai..■1
Time
Service Lateral Inspection Findings
Street Name
Poor Pipejoints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition L
• pm
Disk #
Non
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 ofstacks_ 1
Roots
Sump pumps
Foundation drains
Roof drains
Nunober Discharged.
Total
/
Correctly Incorrectly Unknown
White Copy: Propel ty Owner
Record Number _
(- )
,
Phone 7 7:1 —
Yellow Copy: City of Eagan
Obstruction
Unable to push past
feet
Entered S L at
C
Length of Service: Final Cleanout:
Notes
, 77 arn
•
Time bpm
ldpector Signature
./
5M ;()
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH