1479 Lake Park Cir - Inspection Form4 , Pk . City of Fa as
Residential Sanitary Sewer Service
Compliance Inspection
;
Date )( ) / 1 1, • Time
Name
PID Number.
House Number J w 1 5 - Street Name
Compliance
O No foundation drain connection
No roof drain connection
/ /
9 Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
4" to 6" Transition:
White Copy: Property Owner
° € "�' ', Disk #
f ! ti
( d ? rr 1
' 0wnerJOccupant Signature
I.
am
pm
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Alternative Mailing Address Phone
Obstruction
Unable to push past
feet.
•
O am
o pm
Final Cleanout:
No Access
O No one in
Inspector Signature / il/I
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Total
Notes
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
3
f
Foundation drains
IIIII
Roof drains
4 , Pk . City of Fa as
Residential Sanitary Sewer Service
Compliance Inspection
;
Date )( ) / 1 1, • Time
Name
PID Number.
House Number J w 1 5 - Street Name
Compliance
O No foundation drain connection
No roof drain connection
/ /
9 Sump pit not connected to
sanitary sewer
Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
4" to 6" Transition:
White Copy: Property Owner
° € "�' ', Disk #
f ! ti
( d ? rr 1
' 0wnerJOccupant Signature
I.
am
pm
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Alternative Mailing Address Phone
Obstruction
Unable to push past
feet.
•
O am
o pm
Final Cleanout:
No Access
O No one in
Inspector Signature / il/I
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH