2024 Shale Lane - Inspection FormCity of Ca r
Residential San1t„a.ry Sewer Service
Compliance Inspect
Date/ )(?
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner
Time
Name ,} ) (2 A/ Disk #
Owner /rupant Signature
Service Lateral Inspection Findings
Roots
'fit• o f Yam
/• 6 pm
PID Number
House Number Street Name
en A
Alternative MailingAddress Phone !
For information call 651.470.2788
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
J-LL
Number of stacks Entered S L.at
Length of Service:
Record Number
Notes
Time
Obstruction
Unable to push past
feet
• O am
• O pm
1 5fr 1
Inspector Signature
No Access
O No one in
/`
Access to service
later i ne
0 Ins /
pection if
refused
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
Foundation drains
Roof drains
City of Ca r
Residential San1t„a.ry Sewer Service
Compliance Inspect
Date/ )(?
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6 "Transition:
White Copy: Property Owner
Time
Name ,} ) (2 A/ Disk #
Owner /rupant Signature
Service Lateral Inspection Findings
Roots
'fit• o f Yam
/• 6 pm
PID Number
House Number Street Name
en A
Alternative MailingAddress Phone !
For information call 651.470.2788
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
J-LL
Number of stacks Entered S L.at
Length of Service:
Record Number
Notes
Time
Obstruction
Unable to push past
feet
• O am
• O pm
1 5fr 1
Inspector Signature
No Access
O No one in
/`
Access to service
later i ne
0 Ins /
pection if
refused
Final Cleanout:
Yellow Copy: City of Eagan Pink Copy: SEH