2115 Shale Lane - Inspection Form" City of ll
Residential Sanitary Sewer Service
Compliance Inspection
Name
Compliance
Roots
Poor Pipe Joints_
Mineral Deposits
Alternative Mailing Address
c )
No foundation drain connection 0
No roof drain connection
O Sump pit not connected to
sanitary sewer
o pump properly piped
No sump pump 0
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
Disk#
PID Number
House Number - Street Name
Owner /Occupant Signature
O
O
O
am
Pm
Non - Compliance
3
Sag /Pipe Deflection
Damaged Pipe
Transition ) I / / 1
Yellow Copy: City of Eagan
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Record Number
sme •
Phone
Inspector Signature
Obstruction
Unable to push past
feet
1
Length of Service: 4 Cleanout:
p ,am
Pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L..at - • 7 '
Pink Copy: SEH
Number
Correctly
Discharged
Notes
/ 5 7
Total
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
iJ
j //
" City of ll
Residential Sanitary Sewer Service
Compliance Inspection
Name
Compliance
Roots
Poor Pipe Joints_
Mineral Deposits
Alternative Mailing Address
c )
No foundation drain connection 0
No roof drain connection
O Sump pit not connected to
sanitary sewer
o pump properly piped
No sump pump 0
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
Disk#
PID Number
House Number - Street Name
Owner /Occupant Signature
O
O
O
am
Pm
Non - Compliance
3
Sag /Pipe Deflection
Damaged Pipe
Transition ) I / / 1
Yellow Copy: City of Eagan
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Record Number
sme •
Phone
Inspector Signature
Obstruction
Unable to push past
feet
1
Length of Service: 4 Cleanout:
p ,am
Pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L..at - • 7 '
Pink Copy: SEH