2062 Quartz Lane - Inspection FormSump pumps
Foundation drains
/
L
Roof drains
City of Fa lan
Residential Sanitary Sewer Service
Compliance Inspection
"r
Name
RD Number
House Number
Alternative Mailing Address
Compliance
No foundation drain connection
No roof drain connection
/i
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
J
l No sump pump
Mineral Deposits
/Sag/Pipe Deflection
4" to 6" Transition:
i/
White Copy: Property Owner
Time I/ `•
/7 7 2 -2 Street Name
Disk #
Owner /Occupant Signa ure
Damaged Pipe
I � E S
Transition 1 --7 i t )/i .
am
pm
Non - Compliance
For information call 651.470.2788
O Clear water connections to Unable to push past
sanitary sewer feet
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 stacks `I
Roots
Poor Pipe Joints
Number Discharged
Total Cor rectly Incorrectly Unknown
Record Number
am
1 Time / its o pm
Phone ` •. °_ !? ,�
1
Obstruction
/J Entered S•L.a
Length of Service: L 5 J -� Final Cleanout:
Notes
inspector Signature
No Access
O No one in
O Access to service
lateral needed
O Inspection
r efused
Yellow Copy: City of Eagan Pink Copy: SEH