4863 Richard Lane - Inspection FormCit y of Ea pa
Residential Sanitary Sewer Service
Compliance Inspection
Date )( 1,
Name
PID Number
House Number</, Street Name
Alternative !"failing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer.
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
am
Disk#
Owner /Occupant Signature
C
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
�i L r
Phone _b
Number of stacks Entered S.L. at
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
•
obstruction
Unable to push past
feet
•
Inspector Signature j \je,-` '- -j) f
Final Cleanout:
O am
O pm
No Access
O No one in
/)
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes s
_)�y
-- f , - ' %-r = ?
r .l--� ''' : '/ ' /r' — ` .�....
_ ' "1 L" 1= . 7J
' f
Total
Sump pumps
R--..
.-
,
JC%'
I,
r ,�'' �.
Foundation drains
Roof drains
Cit y of Ea pa
Residential Sanitary Sewer Service
Compliance Inspection
Date )( 1,
Name
PID Number
House Number</, Street Name
Alternative !"failing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
sanitary sewer.
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
am
Disk#
Owner /Occupant Signature
C
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
�i L r
Phone _b
Number of stacks Entered S.L. at
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
•
obstruction
Unable to push past
feet
•
Inspector Signature j \je,-` '- -j) f
Final Cleanout:
O am
O pm
No Access
O No one in
/)
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH