840 Ivy Lane - Inspection FormCity of Cap!
Residential ; Sanitary Sewer Service
Compliance Inspection
(f, / ✓ /'
Date
Name 1.7X/f) 17;`- Disk #
PID Number
House Number
Alternative Mailing Address
Roots
Poor Pipe joints
Mineral Deposits
4" to 6" Transition:
White Copy: Property Owner
r> • rid i y`am
T €i r� a _S p pm
' 7 .r 4 F '
6 Street Name _ ` ° • -
Owner /Occupant Signature
For .Information call 651 470 2788
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
C No sump pump
Service Lateral Inspection Findings
Non - Compliance
O Clear water connections to
sanitary sewer
Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Sag /Pipe Deflection
Damaged Pipe ,� it "r
._ ti ! ( r.-•- , J ' - j' I . -
Transition 4`.11:r/,, ,,) , ;a..i Pi, °\!: ,
/
l06
AA:
1 162_1
Number of stacl<s 1 Entered S,L,at
Length of Service: 1/7 (4 Final Cleanotitz- -, .x
Yellow Copy: City of Eagan
.a .,
Record Number
(/
•
i s v1 t{ /0 4
•1 _
Obstruction
Unable to push past
feet
Time
Inspector Signature
4
C
• d am
• opm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
r efused
6p-a--P(i-foN 16
b - 6 - m
pu' jo ck"( & i f 6ifv.
Pink Copy: SEH
Number
Correctly
Discharged
incorrectly
Unknow•
Total
Sump pumps . /
,
:,_.r II
a _M
Foundation drains
� `r--P-_.�-
Roof drains
_ _ ._._ _______
City of Cap!
Residential ; Sanitary Sewer Service
Compliance Inspection
(f, / ✓ /'
Date
Name 1.7X/f) 17;`- Disk #
PID Number
House Number
Alternative Mailing Address
Roots
Poor Pipe joints
Mineral Deposits
4" to 6" Transition:
White Copy: Property Owner
r> • rid i y`am
T €i r� a _S p pm
' 7 .r 4 F '
6 Street Name _ ` ° • -
Owner /Occupant Signature
For .Information call 651 470 2788
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
C No sump pump
Service Lateral Inspection Findings
Non - Compliance
O Clear water connections to
sanitary sewer
Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Sag /Pipe Deflection
Damaged Pipe ,� it "r
._ ti ! ( r.-•- , J ' - j' I . -
Transition 4`.11:r/,, ,,) , ;a..i Pi, °\!: ,
/
l06
AA:
1 162_1
Number of stacl<s 1 Entered S,L,at
Length of Service: 1/7 (4 Final Cleanotitz- -, .x
Yellow Copy: City of Eagan
.a .,
Record Number
(/
•
i s v1 t{ /0 4
•1 _
Obstruction
Unable to push past
feet
Time
Inspector Signature
4
C
• d am
• opm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
r efused
6p-a--P(i-foN 16
b - 6 - m
pu' jo ck"( & i f 6ifv.
Pink Copy: SEH