2065 Shale Lane - nspection Form!Ci1yof Ea H
Residential Sanitary Sewer Service
Compliance Inspection
Date r i,c;
Name,, fl h i d (" Disk #
PID Number
dd
House Number j Street Name I�
Alternative Mailing Address
For information call 651.470.2788
Copliance
No foundation drain connection
f
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
(r
Owner /Occupant Signature
No roof drain connection
Time
Service Lateral Inspection Findings
Roots
4" to 6" Transition:
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
Number of stacks 1 Entered S L.at
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition.!._ , 1 - ' ::_
Length of Service:
White Copy: Proper ty Owner
Record Number
Notes
7 Time
Phone �a i
inspector Signature k J
Obstruction
Unable to push past
feet
am
/ 0 pm
fl
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
•;� f�i na1 Cleanout: ) 2
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
7r2)
Roof drains
i , 4
!Ci1yof Ea H
Residential Sanitary Sewer Service
Compliance Inspection
Date r i,c;
Name,, fl h i d (" Disk #
PID Number
dd
House Number j Street Name I�
Alternative Mailing Address
For information call 651.470.2788
Copliance
No foundation drain connection
f
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
(r
Owner /Occupant Signature
No roof drain connection
Time
Service Lateral Inspection Findings
Roots
4" to 6" Transition:
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
Number of stacks 1 Entered S L.at
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition.!._ , 1 - ' ::_
Length of Service:
White Copy: Proper ty Owner
Record Number
Notes
7 Time
Phone �a i
inspector Signature k J
Obstruction
Unable to push past
feet
am
/ 0 pm
fl
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
•;� f�i na1 Cleanout: ) 2
Yellow Copy: City of Eagan Pink Copy: SEH