1411 Rebecca Lane - Inspection Form'` City of Ia an
Residential Sanitary Sewer Service
Compliance Inspection
)
Date i/ /!/ ▪ 7'
.rte
Name(' -'- / :71r
PID Number
House Number 1 - � Street Name
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
f sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral inspection Findings
4" to 6" Transition:
White Copy: Property Owner
1 •,.V am
Time / J • !p pm
Disk #
Owner /Occupant Signature
Non - Compliance
O
O
O
O
O
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number _ t'
Time
Phone f�.., .....�.
Obstruction
Unable to push past
feet
Number of stacks Entered S L at
Final Cleanout:
Dam
•
• 0 pm
No Access
O No one in
Inspector Signature
/
1`
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipejoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number Discharged
Notes
_. _
-`' "` f -~ ' 4„--Ii--- ;--
t // e..---- '1 3f 1 r -
Total
Correctly
Incorrectly
Unknown
Sump pumps
f y ,
j `
Foundation drains
Roof drains
t ✓
'` City of Ia an
Residential Sanitary Sewer Service
Compliance Inspection
)
Date i/ /!/ ▪ 7'
.rte
Name(' -'- / :71r
PID Number
House Number 1 - � Street Name
Alternative Mailing Address
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
f sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral inspection Findings
4" to 6" Transition:
White Copy: Property Owner
1 •,.V am
Time / J • !p pm
Disk #
Owner /Occupant Signature
Non - Compliance
O
O
O
O
O
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Length of Service:
Yellow Copy: City of Eagan
Record Number _ t'
Time
Phone f�.., .....�.
Obstruction
Unable to push past
feet
Number of stacks Entered S L at
Final Cleanout:
Dam
•
• 0 pm
No Access
O No one in
Inspector Signature
/
1`
For information call 651.470.2788
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipejoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH