4777 London Lane - Inspection FormCity of ,a
Residential Sanitary Sewer Service
Compliance Inspection
Date / ,i
Name
House Number
4" to 6" Transition:
l i /j/
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
White Copy: Property Owner
Time . • r"(_J p am
pm
Disk #[ [T]
PID Number.
777 Street Name
Kj Owner /Occupant Signature
-FL
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
Length of Service:
Yellow Copy: City of Eagan
Record Number / r `""
,
Time
Phone c '5
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S L at
1 �?
Final Cleanout:
O am
•
• O pm
;e J am '' C f E f f •
Inspector Signature p„,/...-%:? 1 1
s i I ,�� 1 i� 7 e
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Num
Correctly
ber Discharged
Incorrectly Unknown
Notes
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1
7
Total
Sump pumps
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}
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Foundation drains
Roof drains
•
City of ,a
Residential Sanitary Sewer Service
Compliance Inspection
Date / ,i
Name
House Number
4" to 6" Transition:
l i /j/
Alternative Mailing Address
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
White Copy: Property Owner
Time . • r"(_J p am
pm
Disk #[ [T]
PID Number.
777 Street Name
Kj Owner /Occupant Signature
-FL
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
Length of Service:
Yellow Copy: City of Eagan
Record Number / r `""
,
Time
Phone c '5
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S L at
1 �?
Final Cleanout:
O am
•
• O pm
;e J am '' C f E f f •
Inspector Signature p„,/...-%:? 1 1
s i I ,�� 1 i� 7 e
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH