817 Ivy Lane - Inspection FormCity of Capri
Residential Sanitary Sewer, Service
Compliance inspection
Date 671 1 /0 Time //
Name 2 ZAf
P1D Number.
House Number
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
✓QttNo sump pump
Service Lateral Inspection Findings
Transition
4" to 6"Transition:
White Copy: Property Owner
Disk#
Owner /Occupant Signature
• O pm
0
f Street Name
i
For information call 651.470.2788
Non - Compliance
O
O
O
O
0
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
24/
Length of Service:
Yellow Copy: City of Eagan
Record Number
1 (Z 1'
/ am
Time / • �' .8 pm
•
/ /Inspector Signoture
Obstruction No Access
Unable to push past 0 No one in
feet.
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
—?cssriS t
O Access to service
lateral needed
O Inspection
refused
Number of stacks 1 Entered S L. at
Final Cleanout:
Notes / lt,J,t-' (LA- : ( c.
Lc /2077(
f \) ; , (ft../NN C C 1�
Pink Copy: SEH
Total
Number,
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
/
Roof drains
2 /..-
City of Capri
Residential Sanitary Sewer, Service
Compliance inspection
Date 671 1 /0 Time //
Name 2 ZAf
P1D Number.
House Number
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
✓QttNo sump pump
Service Lateral Inspection Findings
Transition
4" to 6"Transition:
White Copy: Property Owner
Disk#
Owner /Occupant Signature
• O pm
0
f Street Name
i
For information call 651.470.2788
Non - Compliance
O
O
O
O
0
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
24/
Length of Service:
Yellow Copy: City of Eagan
Record Number
1 (Z 1'
/ am
Time / • �' .8 pm
•
/ /Inspector Signoture
Obstruction No Access
Unable to push past 0 No one in
feet.
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
—?cssriS t
O Access to service
lateral needed
O Inspection
refused
Number of stacks 1 Entered S L. at
Final Cleanout:
Notes / lt,J,t-' (LA- : ( c.
Lc /2077(
f \) ; , (ft../NN C C 1�
Pink Copy: SEH
411111- of taxi
Residential Sanitary Sewer Service
Compliance Inspection
Date r2of !_ 0KV Y
Name ' ` 17. :g "
PID Number
House Number
Alternative Mailing Address
4" to 6" Transition:
/ ,e? Po4t/ Disk #
Compliance
O No foundation drain connection
O No roof drain connection
O Surnp.pit not connected to
sanitary"s'evy„err
O Sump pump properly piped
O No sump pump
White Copy: Property Owner
Time /v • i/6 o p
Street Name if
t Signature
No - Compliance
O fear water connections
sa tary sewe
O Sery e lateral deb
O Defe man QI Rss
O Sump pu p l o ec ec}4o sani
sewer /
O Flexible sum' pump piping
Service Lateral inspection Findings ° ~ "" lumber,.° tack
Roots
Poor Pipe joints
Mineral Deposits
SaglPipe Deflection Aio
Damaged Pipe ENO
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
En
i
Phone
Bred
Notes
Time
/ { spectar Signature
For information call 651.470.2788
Obstruction
Unable to push pas
feet
at
Final Cleanout:
rz _
• „aj am
• • '' pm
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Ir
r
Pink Copy: SEH
Number Discharged
Total
Correctly
MOM
incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
411111- of taxi
Residential Sanitary Sewer Service
Compliance Inspection
Date r2of !_ 0KV Y
Name ' ` 17. :g "
PID Number
House Number
Alternative Mailing Address
4" to 6" Transition:
/ ,e? Po4t/ Disk #
Compliance
O No foundation drain connection
O No roof drain connection
O Surnp.pit not connected to
sanitary"s'evy„err
O Sump pump properly piped
O No sump pump
White Copy: Property Owner
Time /v • i/6 o p
Street Name if
t Signature
No - Compliance
O fear water connections
sa tary sewe
O Sery e lateral deb
O Defe man QI Rss
O Sump pu p l o ec ec}4o sani
sewer /
O Flexible sum' pump piping
Service Lateral inspection Findings ° ~ "" lumber,.° tack
Roots
Poor Pipe joints
Mineral Deposits
SaglPipe Deflection Aio
Damaged Pipe ENO
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
En
i
Phone
Bred
Notes
Time
/ { spectar Signature
For information call 651.470.2788
Obstruction
Unable to push pas
feet
at
Final Cleanout:
rz _
• „aj am
• • '' pm
No Access
No one in
O Access to service
lateral needed
O Inspection
refused
Ir
r
Pink Copy: SEH