3775 Elrene Rd - Inspection Form1 City of Cap
Residential Sanitary Sewer Service
Compliance Inspection
Date's . / ; / /I
- i
n
Name Disk # W
..� ICI
PID Number
House Number Street Name
Alternative Mailing Address
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
Mingo! Deposits ' 1/,;- ) °--' I
S glPrpe Deflection --, -1
Damaged Pipe
Transition r ✓� .. ..:-'-
White Copy: Proper Owner
Time
am
• O pm
LL-LJi ri Time
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacl«
Roots _ > - ' -- 4-- ;A r . ) . ,i6",„...,,,,,,,,,<--
f Alf -?
i
; .. --- r „ if
. ' , . ✓. "
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
inspector Signature
Final Cleanout:
• O am
• o pm
Phone's (� i
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Entered S L at
Pink Copy: SEH
Number
Correctly
Discharged
Notes
Total
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
1 City of Cap
Residential Sanitary Sewer Service
Compliance Inspection
Date's . / ; / /I
- i
n
Name Disk # W
..� ICI
PID Number
House Number Street Name
Alternative Mailing Address
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
Mingo! Deposits ' 1/,;- ) °--' I
S glPrpe Deflection --, -1
Damaged Pipe
Transition r ✓� .. ..:-'-
White Copy: Proper Owner
Time
am
• O pm
LL-LJi ri Time
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacl«
Roots _ > - ' -- 4-- ;A r . ) . ,i6",„...,,,,,,,,,<--
f Alf -?
i
; .. --- r „ if
. ' , . ✓. "
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
inspector Signature
Final Cleanout:
• O am
• o pm
Phone's (� i
No Access
O No one in
Access to service
lateral needed
O Inspection
refused
Entered S L at
Pink Copy: SEH