852 Ivy Lane - Inspection FormResidential Sanitary Sewer Service
City o f Capri
Compliance Inspection
Date d 0 1 ZS' / /0
Name 4 /i// f) /LAJ/ /r'1,7r Disk#
PID Number
House Number Street Name 2ii' ` 4--
Alternative MailingAddress
Owner /Occupant Signature
For information call 65
Compliance
O No foundation drain connection
lO No roof drain connection
0•Sump pit not connected to
A s sanitary sewer
O Sump pump properly piped
, O No sump pump
Service Lateral inspection Findings Number of stacks / Entered S L at
Roots /4/ri
Poor Joints
Mineral Deposits
Sag /Pipe Deflection_
Damaged Pipe
Transition f: r4 S
r
4" to 6" Transition:
White Copy: Proper ty Owner
1 f
1.) c ( k,it
• oam
Time i • ()6 o`pm
z.
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:
Record Number
I DI
Time
Obstruction
Unable to push past
feet.
• - •- 0 a
Phone t"_
&i /.' r
Ynspector Signature
r €
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Notes - 9/ Z+ . 1„ v af >�C%'�
�3 l
fief
, / 7
e. C fC '. /571;;---
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cl)J. H ,
{c.
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
(
r-- - - -
Foundation drains
{AI
v' / .
Roof drains
, t�
Residential Sanitary Sewer Service
City o f Capri
Compliance Inspection
Date d 0 1 ZS' / /0
Name 4 /i// f) /LAJ/ /r'1,7r Disk#
PID Number
House Number Street Name 2ii' ` 4--
Alternative MailingAddress
Owner /Occupant Signature
For information call 65
Compliance
O No foundation drain connection
lO No roof drain connection
0•Sump pit not connected to
A s sanitary sewer
O Sump pump properly piped
, O No sump pump
Service Lateral inspection Findings Number of stacks / Entered S L at
Roots /4/ri
Poor Joints
Mineral Deposits
Sag /Pipe Deflection_
Damaged Pipe
Transition f: r4 S
r
4" to 6" Transition:
White Copy: Proper ty Owner
1 f
1.) c ( k,it
• oam
Time i • ()6 o`pm
z.
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:
Record Number
I DI
Time
Obstruction
Unable to push past
feet.
• - •- 0 a
Phone t"_
&i /.' r
Ynspector Signature
r €
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Notes - 9/ Z+ . 1„ v af >�C%'�
�3 l
fief
, / 7
e. C fC '. /571;;---
��
cl)J. H ,
{c.
Yellow Copy: City of Eagan Pink Copy: SEH