2084 Shale Lane - Inspection Form' City of I';a p
Residential Sanitary, Sewer Service
Compliance Inspection
Datel 1 f
PID Number
House Number
Alternative Mailing Address
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
Time
Owier/Occupant Signature
For information call 65
o�n pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral irs pection Findings
Roots
Disk #
I
• am
• pm
Street Name
1
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 '
CT
Length of Service:
Number Discharged
Sump pumps
Foundation drains
Roof drains
Total
Correctly Incorrectly Unknown
White Copy: Property Owner
Record Number
f;'
Phone
Obstruction
Unable to push past
feet.
N otes
Time
r
lnspect'nr Signature
Entered S L at - zr1
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
X 7 1 Final Cleanout: f
Yellow Copy: City of Eagan Pink Copy: SEH