686 Brentwood Lane - Inspection FormCity of Cain
Residential Sanitary Sewer Service
Compliance Inspection
Date /
y j s
Name /i n /fTi � i ! blDisk#
MD Number
House Number / - -)
Alternative MailingAddress
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
, 3 No sump pump
4" to 6" Transition:
White Copy: Property Owner
I• Qam
Time G pm
V'
Street Name
Owner /Occupant Signature
No
n- Compliance
Length of Service:
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
Record Number
Notes
Inspector Signature
Obstruction
Unable to push past
feet
. '2 �n y r5 .
1, rn
ime '1 ° • m
- �'
Phone
For information call 651
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks _ 4 Entered S.. L.. at -�
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition riff 9( -
•
Final Cleanout: ,.
Yellow Copy: City of Eagan Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
Foundation drains
(!
Roof drains
—
City of Cain
Residential Sanitary Sewer Service
Compliance Inspection
Date /
y j s
Name /i n /fTi � i ! blDisk#
MD Number
House Number / - -)
Alternative MailingAddress
o pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
, 3 No sump pump
4" to 6" Transition:
White Copy: Property Owner
I• Qam
Time G pm
V'
Street Name
Owner /Occupant Signature
No
n- Compliance
Length of Service:
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
Record Number
Notes
Inspector Signature
Obstruction
Unable to push past
feet
. '2 �n y r5 .
1, rn
ime '1 ° • m
- �'
Phone
For information call 651
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks _ 4 Entered S.. L.. at -�
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition riff 9( -
•
Final Cleanout: ,.
Yellow Copy: City of Eagan Pink Copy: SEH