945 Chloe Lane - Inspection FormSump pumps
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Foundation drains
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Roof drains
City a 1aha
Residential Sanitary Sewer Service
Compliance inspection
Date
Name 3 7 / t Disk #
PID Number
House Number
Alternative Mailing Address
Corrmpliiance
No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
•
4" to 6" Transition:
White Copy: Property Owner
j am
Time / • LAS pm
G -,
St reet Name
Owner /Occupant Signature
For inforrrnation call 651.474.2788
Service Lateral Inspection Findings
Roots
Poor Pipef oints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition �7
Total
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 of stacks �f Entered S L at
Number Discharged
Correctly
I ncorr ectly
1C
Length of Service:�=�
Unknown
Yellow Copy: City of Eagan
Record Number!
Notes
PTime
Phone ° 4 s°7:.
Obstruction
Unable to push past
feet
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P
Inspector Signature
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
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Pink Copy: SEH