2097 Quartz Lane - Inspection FormCitY of
Residential Sanitary Sewer Service
Compliance inspection
Date s'?l 2e l rj2
Name 1' C' � / Disk #
I.
PID Number
House Number 2 - (7 .7' 7
Alternative Mailing Address
Owner /Occupant Signature
Compliance
C o foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
.+ • No sump pump
Service Lateral Inspection Findings
Roots X
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged PI
Transition , ki11 ,
4" to 6 "Transition:
White Copy: Property Ownei
f " . X
Time /� � pm
.
b.v
Street Name "�
For information call 65
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
ength of Service:
Yellow Copy: City of Eagan
Record Number.
Phan
Time •
//A, ,/
Inspectdr Signature
- am
!O pm
Obstruction No Access
Unable to push past 0 No one in
feet
O Access to service
lateral needed
O Inspection
r efused
)
Entered S.L.. at �,� (
Final Cleanout:
Pink Copy; SEH
Number
Correctly
Notes
Discharged
Total
lncorrectly
Unknown
Sump pumps
e
w .- . ----�- �----
—
-.
Foundation drains
Roof drains
r' =
- -._ _ ___�__ -
._ _._.
CitY of
Residential Sanitary Sewer Service
Compliance inspection
Date s'?l 2e l rj2
Name 1' C' � / Disk #
I.
PID Number
House Number 2 - (7 .7' 7
Alternative Mailing Address
Owner /Occupant Signature
Compliance
C o foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
.+ • No sump pump
Service Lateral Inspection Findings
Roots X
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged PI
Transition , ki11 ,
4" to 6 "Transition:
White Copy: Property Ownei
f " . X
Time /� � pm
.
b.v
Street Name "�
For information call 65
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
ength of Service:
Yellow Copy: City of Eagan
Record Number.
Phan
Time •
//A, ,/
Inspectdr Signature
- am
!O pm
Obstruction No Access
Unable to push past 0 No one in
feet
O Access to service
lateral needed
O Inspection
r efused
)
Entered S.L.. at �,� (
Final Cleanout:
Pink Copy; SEH