4779 Richard Lane - Inspection Form°e. City of Fa ao
Residential Sanitary Sewer Service
Compliance Inspection
Date .! !�°K / „ f
Name
House Number
Alternative Mailing Address
/7
r
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Time •
? - ✓; i Disk #
PID Number
Compliance
O No foundation drain connection
O No roof drain connection
— % Street Name
Owner /Occupant Signature
am
p
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 i
Time
Phone c_
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
•
•
Final Cleanout:
o am
O pm
n
:
j \ / 1-'alt
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S . at
Roots
Poor Pipejoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Total
Notes
t
1 •
-� i
i•
��
)
r 1
/
`� .
�•
;
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
-
•
-
f
i,,�?)
i_�
!
1
9f.✓
3
Foundation drains
Roof drains
f!.
/
1
°e. City of Fa ao
Residential Sanitary Sewer Service
Compliance Inspection
Date .! !�°K / „ f
Name
House Number
Alternative Mailing Address
/7
r
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Time •
? - ✓; i Disk #
PID Number
Compliance
O No foundation drain connection
O No roof drain connection
— % Street Name
Owner /Occupant Signature
am
p
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 i
Time
Phone c_
Inspector Signature
For information call 651.470.2788
Obstruction
Unable to push past
feet
•
•
Final Cleanout:
o am
O pm
n
:
j \ / 1-'alt
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks Entered S . at
Roots
Poor Pipejoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH