861 Ivy Lane - Inspection Formr City of lia o
Residential Sanitary Sewer Service
Compliance Inspection
Dat /
Time
1 f .
Name
Alternative Mailing Address
Compliance
0 No foundation drain connection
11
Sump pit not connected to
,sanitary sewer
/L.
0 No sump pump
No roof drain connection
Sump pump properly piped
Transition
4" to b" Transition: (
White Copy: Property Owner
PID Number
House Number .>5 ▪ i ! Street Name
Owner /Occupant Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
am
• pm
isk
V
For information .call 65 1.470.2788
Non - Compliance
O Clean 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 of stacks
II 1' 7 1 f,
Length of Ser vice:
/ i
Record Number
Time
•
• o pm
i
Phone '?2
Inspector Signature
Obstruction
Unable to push past
feet
final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
EnteredSL.at
-
Yellow Copy: City of Eagan J Io R ? P
SE,1 i
C fY
Notes
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Nunsber
Correctly
Disch ,
Incorrectly
ged
Unknown
Total
Sump pumps
Foundation drains
5
Roof drains
I "
r City of lia o
Residential Sanitary Sewer Service
Compliance Inspection
Dat /
Time
1 f .
Name
Alternative Mailing Address
Compliance
0 No foundation drain connection
11
Sump pit not connected to
,sanitary sewer
/L.
0 No sump pump
No roof drain connection
Sump pump properly piped
Transition
4" to b" Transition: (
White Copy: Property Owner
PID Number
House Number .>5 ▪ i ! Street Name
Owner /Occupant Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
am
• pm
isk
V
For information .call 65 1.470.2788
Non - Compliance
O Clean 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 of stacks
II 1' 7 1 f,
Length of Ser vice:
/ i
Record Number
Time
•
• o pm
i
Phone '?2
Inspector Signature
Obstruction
Unable to push past
feet
final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
EnteredSL.at
-
Yellow Copy: City of Eagan J Io R ? P
SE,1 i
C fY