4773 Richard Lane - Inspection FormResidential Sanitary Sewer Service
411111. City ofFa a Compliance Inspection
f� . • j Q am
Date C/ /- 1
'1 _ '/ Time • pm
Name a mr , G- % Disk #
PID Number
House Number
4” to 6 "Transition:
White Copy: Property Owner
/ S treet Name
Address
:
✓ J /' / / /:/ ,fir
f f . t / l7 'Owner/Occupant Signature
1
Compliance
O No foundation drain connection
No roof .drain connection
O Sump pit not connected to
sanitary sewer
O.Sump pump properly piped
No sump pump
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
Time
Phone
O
•
O pm
Obstruction
Unable to push past
feet
Inspector Signature � f/ - y�
For information call 651.470.2788
Service Lateral Inspection Findings Number of stacks Entered S L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
{ t ' „,,-_-,/,,._-. J
Total
Sump pumps
,/
3
n 1:,-'-_-
j )
d
p 1
1.
i
Foundation drains
Roof drains
I
i
, f
/\
Residential Sanitary Sewer Service
411111. City ofFa a Compliance Inspection
f� . • j Q am
Date C/ /- 1
'1 _ '/ Time • pm
Name a mr , G- % Disk #
PID Number
House Number
4” to 6 "Transition:
White Copy: Property Owner
/ S treet Name
Address
:
✓ J /' / / /:/ ,fir
f f . t / l7 'Owner/Occupant Signature
1
Compliance
O No foundation drain connection
No roof .drain connection
O Sump pit not connected to
sanitary sewer
O.Sump pump properly piped
No sump pump
Length of Service:
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
Yellow Copy: City of Eagan
Record Number
Time
Phone
O
•
O pm
Obstruction
Unable to push past
feet
Inspector Signature � f/ - y�
For information call 651.470.2788
Service Lateral Inspection Findings Number of stacks Entered S L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH