4850 Sheffield Lane - Inspection FormCity a all
Y
Residential Sanitary Sewer Service
Compliance Inspection
Date if L/ / 1 /
Name i"^`
PID Number
Compliance
O No foundation drain connection
Ck No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6"Transition:
Wkrite Copy: Property Owner
,, a rq am
Time • +p pm
Disk #
Owner /Occupant Signature
Number ,. � x S[reet Name
House Numb I
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
Length of Service:
Record Number
Notes
Time
ra
Alternative Mailing Address .. Phone 4.--)
.."
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
oam
O Pm
No Access
O No one in
For information call 651.470.2788
O Access to service
lateral needed
O inspection
refused
Service Lateral Inspection Findings Number of stacks Entered 5 I_ at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SE H
� 4„ ` 1 ``' l td - %�.
Number
Discharged
Total
Correctly
Incorrectly
Unknown
Sump pumps
y j
MI
Foundation drains
r
i
--
Roof drains
City a all
Y
Residential Sanitary Sewer Service
Compliance Inspection
Date if L/ / 1 /
Name i"^`
PID Number
Compliance
O No foundation drain connection
Ck No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6"Transition:
Wkrite Copy: Property Owner
,, a rq am
Time • +p pm
Disk #
Owner /Occupant Signature
Number ,. � x S[reet Name
House Numb I
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
Length of Service:
Record Number
Notes
Time
ra
Alternative Mailing Address .. Phone 4.--)
.."
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
oam
O Pm
No Access
O No one in
For information call 651.470.2788
O Access to service
lateral needed
O inspection
refused
Service Lateral Inspection Findings Number of stacks Entered 5 I_ at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Yellow Copy: City of Eagan Pink Copy: SE H
� 4„ ` 1 ``' l td - %�.