4785 Richard Lane - Inspection FormResidential Sanitary Sewer Service
Cit o E a ii Compliance Inspection
� P P
Date /f
/ "/".?
PID Number
House Number
Alternative Mailing Address
(\ \VV a.
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
4" to b" Transition:
White Copy: Property Owner
9
Wpm Time;_ _.• ( pm
.i t '' Disk ft
r.
treet Name ? 2 /�'
Owner /Occupant Signature
CD -[l7 �l
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 Discharged
Sump pumps
Foundation drains
Roof drains
Total
_.
Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Record Number
Notes
f r'
r
•
0 am
Time • o pm
Phone
For information call 551.470.2788
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks Entered S.L at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Length of Service: Final Cleanout:
Inspector Signature
r'
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH