1484 Thomas Lane - Inspection FormCity of Capri
Residential Sanitary Sewer Service
Compliance Inspection
Date /( .:i l . )c / t
Name , Disk #
PID Number
House Number
Alternative Mailing Address
Service Lateral Inspection Findings
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
f C Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
• ` :./.1 am
Time • pm
� 2 ) Street Name
OwnerlOccupant Signature
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
Number of stacks Entered S L. at
Length of Service:
MEMO
Yellow Copy: City of Eagan
Record Number f /
Time
) 7
Phone 1 ,
Obstruction
Unable to push past
feet
Final Cleanout:
• o am
• o pm
Inspector Signature
/) -
No Access
O No one in
. ` j
r
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SE
Total
Motes
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7723:
f
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
/7 4? s
;
` ` % ' r
g ' i` 1' "/
Foundation drains
Roof drains
-
V
City of Capri
Residential Sanitary Sewer Service
Compliance Inspection
Date /( .:i l . )c / t
Name , Disk #
PID Number
House Number
Alternative Mailing Address
Service Lateral Inspection Findings
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
f C Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Proper ty Owner
• ` :./.1 am
Time • pm
� 2 ) Street Name
OwnerlOccupant Signature
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
Number of stacks Entered S L. at
Length of Service:
MEMO
Yellow Copy: City of Eagan
Record Number f /
Time
) 7
Phone 1 ,
Obstruction
Unable to push past
feet
Final Cleanout:
• o am
• o pm
Inspector Signature
/) -
No Access
O No one in
. ` j
r
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SE