700 Stonewood Rd - Residential Sanitary Sewer & Compliance FormCity of Ia
Residential Sanitary Sewer Service
Compliance Inspection
Date J(P1 - /
Name ') ,7) / Disk #
PID Number
House Number /Gt2
Alternative Mailing Address
Owner /Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
VC No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe joints
r
Mineral Deposits 0//1"-'- 7
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Prop'r.ty Owner
Time '- • '' d�pm
Street Name
[112]
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
PhoVe
3 O am
Time F �� f• pm
?nspector Signature
Obstruction No Access
Unable to push past 0 No one in
feet.
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: / . // )
Pink Copy: SEH
Total
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`''mil6 6l / —41700
'd,60
Nun.ber:Discharged
. ..:
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
( f
Roof drains
_-------
City of Ia
Residential Sanitary Sewer Service
Compliance Inspection
Date J(P1 - /
Name ') ,7) / Disk #
PID Number
House Number /Gt2
Alternative Mailing Address
Owner /Occupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
VC No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings Number of stacks Entered S L at
Roots
Poor Pipe joints
r
Mineral Deposits 0//1"-'- 7
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Prop'r.ty Owner
Time '- • '' d�pm
Street Name
[112]
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
PhoVe
3 O am
Time F �� f• pm
?nspector Signature
Obstruction No Access
Unable to push past 0 No one in
feet.
O Access to service
lateral needed
O Inspection
refused
Final Cleanout: / . // )
Pink Copy: SEH