2119 Quartz Lane - Inspection FormSump pumps
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Foundation drains
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Roof drains
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Residential Sanitary Sewer Service
Compliance inspection
Date! )q, ), Time
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Name LL cy
Alternative Mailing Address
4" to 6" Transition:
4
Compliance
S 1 No foundation drain connection
1
No roof drain connection
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Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Service Lateral Inspection Findings Number of stacks__
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition . J ) /' ~217-.1)
White Copy: Property Owner
rierlOccupant Signature
Disk #
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Length of Service:
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 Discharged
Total Correctly incorrectly Unknown
Record Number
1
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Time
PID Number
House Number ) 1 Street Name - ('� ,t'JI
Phone fr,�,.` 7 / L_., : f J
Inspector Signature
For information call 651.470.2788
Obstrction
Unable to push past
feet
S am
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No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
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Entered S.L.at . ""r '` %
Notes
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Final Cleanout:
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✓- 2 /f
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11Y yid �.
Yellow Copy: City of Eagan/!/ )4 �4 b/
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