2126 Quartz Lane - Inspection FormCity of as
Residential Sanitary Sewe Service
Compliance Inspection
Date / (2 /
Name
PID Number
House Number
Alternative Mailing Address
.7
4" to 6" Transition:
I /1 / / )- isk
White Copy: Property Owner
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
' sanitary sewer
fC Sump pump properly piped
O No sump pump
0
Time
▪ Street Name
Owner /Occupant Signature
p
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition i4-
r
For information call 651.4701788
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 inspe Lion Findings Number of stacks _ ` L Entered S.L at -`-,
Roots . i�
4 -
/ 1)
Length of Service:
Yellow Copy: City of Eagan
Phone • �-C `/ ' �5
Inspector Signature
Record Number 1
,,r Time 1 ./.^\ e i pm
Obstruction
Unable to push past
feet
J . . 21L Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
4 Inspection
refused
Pink Copy: SEH
Total
Notes
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Number
Discharged
Correctly
incorrectly
Unknown
Sump pumps
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Foundation drains
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Roof drains
r r
City of as
Residential Sanitary Sewe Service
Compliance Inspection
Date / (2 /
Name
PID Number
House Number
Alternative Mailing Address
.7
4" to 6" Transition:
I /1 / / )- isk
White Copy: Property Owner
Compliance
O No foundation drain connection
No roof drain connection
Sump pit not connected to
' sanitary sewer
fC Sump pump properly piped
O No sump pump
0
Time
▪ Street Name
Owner /Occupant Signature
p
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition i4-
r
For information call 651.4701788
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 inspe Lion Findings Number of stacks _ ` L Entered S.L at -`-,
Roots . i�
4 -
/ 1)
Length of Service:
Yellow Copy: City of Eagan
Phone • �-C `/ ' �5
Inspector Signature
Record Number 1
,,r Time 1 ./.^\ e i pm
Obstruction
Unable to push past
feet
J . . 21L Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
4 Inspection
refused
Pink Copy: SEH