4875 Richard Lane - Inspection FormMy of Ea an
Residential Sanitary Sewer Service
Compliance Inspection
Date / 21 1. 'S1 7 J
Name "� �
PID Number
House Number
Alternative Mailing Address
l ; f
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
4" to 6" Transition:
11 I
2
White Copy: Property Owner
r -`4
I •.:'. J c am
Time r . ` • / pm
Disk #
�-�
`Street Name
Owner /Occupant Signature
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:
Yellow Copy: City of Eagan
Record Number
33
Phone =i1. I ° �%
inspector Signature N.
Obstruction
Unable to push past
feet
Final Cleanout:
• o am
Time • o pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral inspection Findings Number of stacks Entered S. i_ at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
/ ""
Pink Copy: SEH
Total
Notes
n
, >
� .
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
„'
Foundation drains
Roof drains
My of Ea an
Residential Sanitary Sewer Service
Compliance Inspection
Date / 21 1. 'S1 7 J
Name "� �
PID Number
House Number
Alternative Mailing Address
l ; f
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
4" to 6" Transition:
11 I
2
White Copy: Property Owner
r -`4
I •.:'. J c am
Time r . ` • / pm
Disk #
�-�
`Street Name
Owner /Occupant Signature
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:
Yellow Copy: City of Eagan
Record Number
33
Phone =i1. I ° �%
inspector Signature N.
Obstruction
Unable to push past
feet
Final Cleanout:
• o am
Time • o pm
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral inspection Findings Number of stacks Entered S. i_ at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
/ ""
Pink Copy: SEH