2092 Shale Lane - Inspection FormCity of Fain
Residential Sanitary Sewer Service
Compliance Irnspection
Date l / ,
Name
7, # pi [
ND Number
House Number f (/2 1
Alternative Mailing Address
Compliance
O No foundation drain connection 0 Clear water connections to
sanitary sewer
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings Number of stacks
Rocs
Poo ipej rots Fl, ' .J -----' �', " � °>
Mine I eposits .i -�-`' -,�'- : "
Sa /P Deflection / `` , � � -°,�' . /
D,i`naged,Pipe i2-- -7 r ="c' -) �-
Transition : 2' 7--r2,_ --/-74
4" to 6" Transition:
White Copy: Property Owner
��. .9tam
Time r • p
r
Owner /Occupant Signature
Non - Compliance
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number /
Time
4,
Street Name �(
o am
•
• o pm
Phone
inspector Signature
For information call 65
Obstruction
Unable to push past
feet
Final Cleanout:
No Access
O No one in
Entered S.L at
Access to service
lateral rKeded
O Inspection ���
refused
Pink Copy: SEH
'Number
Correctly
Discharged
Notes
Total
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
City of Fain
Residential Sanitary Sewer Service
Compliance Irnspection
Date l / ,
Name
7, # pi [
ND Number
House Number f (/2 1
Alternative Mailing Address
Compliance
O No foundation drain connection 0 Clear water connections to
sanitary sewer
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings Number of stacks
Rocs
Poo ipej rots Fl, ' .J -----' �', " � °>
Mine I eposits .i -�-`' -,�'- : "
Sa /P Deflection / `` , � � -°,�' . /
D,i`naged,Pipe i2-- -7 r ="c' -) �-
Transition : 2' 7--r2,_ --/-74
4" to 6" Transition:
White Copy: Property Owner
��. .9tam
Time r • p
r
Owner /Occupant Signature
Non - Compliance
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number /
Time
4,
Street Name �(
o am
•
• o pm
Phone
inspector Signature
For information call 65
Obstruction
Unable to push past
feet
Final Cleanout:
No Access
O No one in
Entered S.L at
Access to service
lateral rKeded
O Inspection ���
refused
Pink Copy: SEH