4814 Eriks Blvd - Inspection Form', Ciiy of Elm
Residential Sanitary Sewer Service
Compliance Inspection
Date
U'1 1 -1 C )
Name
PID Number
House Number r /-/- Street Name
Alternative Mailing Address
( c_
Compliance
O No foundation drain connection
A No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
CC�Y No sump pump
Service Lateral Inspection Findi
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
Disk#
Owner /Occupant Signature
• ✓v O am
• d Pm
Record Number
•
Time _ • o pm
7Y
Phone 4 7 " - /r
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
ngs Number of stacks
Length of Service:
Entered S L at
Notes
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 am
) P \ • Ufa /;
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Correctly
Discharged
Incorrectly
Unknown
Sump pumps
f
31
,—, `c
j
i
1 , ,
Foundation drains
Roof drains
,.
', Ciiy of Elm
Residential Sanitary Sewer Service
Compliance Inspection
Date
U'1 1 -1 C )
Name
PID Number
House Number r /-/- Street Name
Alternative Mailing Address
( c_
Compliance
O No foundation drain connection
A No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
CC�Y No sump pump
Service Lateral Inspection Findi
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Time
Disk#
Owner /Occupant Signature
• ✓v O am
• d Pm
Record Number
•
Time _ • o pm
7Y
Phone 4 7 " - /r
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
ngs Number of stacks
Length of Service:
Entered S L at
Notes
Inspector Signature
Obstruction
Unable to push past
feet
Final Cleanout:
0 am
) P \ • Ufa /;
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH