2041 Shale Lane - Inspection FormCitY of 1aPi1 ..
Residential Sanitary Sewer Service
Compliance Inspection
Date
/_7
Name f f % / J'/' //7 b'' Disk #
PID Number
House Number Street Name 1/LC
Alternative Mai li ng Addr ess
CC Upa n t Signature
For information ;call 651A70.2788
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
Serviice,i_ateral Inspection Findings
Roots A � r7"--
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection_ $ $6
Damaged Pipe
d , �
Transition L- i ! fr
4" to 6" Transition:
White Copy: Pr operty Owner
#:1)1)1 Yy ` ( L.ength of Service:
L. # A e " AI g>
• am
Time o
• pm
Non-Complianc
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
7E19
[llJ
Pho
24
Record Number
Entered S.L. at
Yellow Copy: City of'Eagan
r, f ?rr- : rl / k f r9
Time / •
U ble to push past
,. 3 feet
0
▪ 0( 4/ Final Cleanout: (Ai
rPFO1r. , A
am
Pm
(o)
4ns15ctor Signature
Obst3ction No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
(7 4 C
Notes
4-7 Al
1
- ✓ifs / f�
Pink Copy: SEH
f 4.% n
./ " t .1
Number-
Discharged
Total
Correctly
Incorrectly
Unknown
S ump pumps
.._.__
-•W-- •--- _-
_°.—..._
--
Foundation drains
Roof drains
i
" �'°"'°"
""`_-°,
CitY of 1aPi1 ..
Residential Sanitary Sewer Service
Compliance Inspection
Date
/_7
Name f f % / J'/' //7 b'' Disk #
PID Number
House Number Street Name 1/LC
Alternative Mai li ng Addr ess
CC Upa n t Signature
For information ;call 651A70.2788
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
Serviice,i_ateral Inspection Findings
Roots A � r7"--
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection_ $ $6
Damaged Pipe
d , �
Transition L- i ! fr
4" to 6" Transition:
White Copy: Pr operty Owner
#:1)1)1 Yy ` ( L.ength of Service:
L. # A e " AI g>
• am
Time o
• pm
Non-Complianc
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
7E19
[llJ
Pho
24
Record Number
Entered S.L. at
Yellow Copy: City of'Eagan
r, f ?rr- : rl / k f r9
Time / •
U ble to push past
,. 3 feet
0
▪ 0( 4/ Final Cleanout: (Ai
rPFO1r. , A
am
Pm
(o)
4ns15ctor Signature
Obst3ction No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
(7 4 C
Notes
4-7 Al
1
- ✓ifs / f�
Pink Copy: SEH
f 4.% n
./ " t .1
City of Ea o
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
MD Number
I -louse Number
Alternative Mailing Address
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
Service Lateral Inspection Findings
Roots , . � ;
Poor Pipe Joints
4" to 6 "Transition: t .j
White Copy: Property Owner
d isk
ILL) Street Name
Time
nprccupont Signature
• _`a am
• pm
Length of Service:
Yellow Copy: City of Eagan
Record Number 2
Phone
Notes
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
,,,klurrlyer of stacks Entered St at -�
i
Time
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
• ._ pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits ��,,' " 4 / '''''') '''''Zr "y ,..-r, w ''''''' e )
�1 `•' _
5 a fpi a Deflection r .,. "`�
gip a'� > e l f ' . '' . 4- . Z i ) '' .- .' I I . - ,1 " <1 r
Damaged Pipe�. .
� j
i'�' I
Transition it j r r �: /' r � %
4 :.
7 --t,- -.
Final Cleanout:
Pink Copy: SEH
Total
Number
Correctly
Discharged
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
„.
City of Ea o
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
MD Number
I -louse Number
Alternative Mailing Address
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
Service Lateral Inspection Findings
Roots , . � ;
Poor Pipe Joints
4" to 6 "Transition: t .j
White Copy: Property Owner
d isk
ILL) Street Name
Time
nprccupont Signature
• _`a am
• pm
Length of Service:
Yellow Copy: City of Eagan
Record Number 2
Phone
Notes
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
,,,klurrlyer of stacks Entered St at -�
i
Time
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
• ._ pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits ��,,' " 4 / '''''') '''''Zr "y ,..-r, w ''''''' e )
�1 `•' _
5 a fpi a Deflection r .,. "`�
gip a'� > e l f ' . '' . 4- . Z i ) '' .- .' I I . - ,1 " <1 r
Damaged Pipe�. .
� j
i'�' I
Transition it j r r �: /' r � %
4 :.
7 --t,- -.
Final Cleanout:
Pink Copy: SEH
City of Eaftafl
Residential Sanitary Sewer Service
Compliance Inspection
Date
Compliance
O No foundation drain connection
O No roof drain connection
O Sump,pitnot connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Time mfr 1
p # �T
1 . ask 7
PID Niirrtber•
House Number s ?Aa,• Street Name
Alternative Mailing Address Phone.u:
' QwnerlOccupant Signature
For information call 651.470.2788
Non—Compliance
O Clear water connections to
sewer
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
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 a
•
• O pm
o A ccess
No one in
O Access to service
lateral needed
O Inspection
refused
- sS.ervice Lateral Inspection Findings Number of stacks Entered S.L. at
Roots
PoorPipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
+z,
Number
Correctly
Discharged
Incorrectly
Unknown
Notes
Total
Sump pumps
MIMI
1111111111111-
Foundation drains
Roof drains
City of Eaftafl
Residential Sanitary Sewer Service
Compliance Inspection
Date
Compliance
O No foundation drain connection
O No roof drain connection
O Sump,pitnot connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Time mfr 1
p # �T
1 . ask 7
PID Niirrtber•
House Number s ?Aa,• Street Name
Alternative Mailing Address Phone.u:
' QwnerlOccupant Signature
For information call 651.470.2788
Non—Compliance
O Clear water connections to
sewer
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
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 a
•
• O pm
o A ccess
No one in
O Access to service
lateral needed
O Inspection
refused
- sS.ervice Lateral Inspection Findings Number of stacks Entered S.L. at
Roots
PoorPipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
+z,