4781 London Lane - Inspection FormCity f Ufa ap
Y �
Residential Sanitary Sewer Service
Compliance Inspection
,i fir,
Date /7 i 1. C / / /7 i
Time
j _.
Name / D is k # r�
PID Number
House Number 1 {-
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Street Name
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
Service Lateral Inspection Findings
)6 r
am
O pm
Number of stacks
Record Number
-LI ]1 Time
Length of Ser vice:
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
Yellow Copy: Gity of Eagan
7t
i
obstruction
Unable to push past
feet
Final Cleanout:
O Fm
Alternative Mailing Address Phone ;� )° .} 5 ^ -• E. _
0 am
r _
Inspector Signature jL f ," 7 -_? �i � ,��
�I
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number
Correctly
Discharged
inco Unknown
Notes
% ._ .� f , f f.- c:' -�
„, .; . ,--- 2 �, 7 .�.:1 J y'"l ! f _ .,. .
< . =C.' ( 'i_. r %'
1
f
Total
Sump pumps
6 ! 1-
r
7 ,,- ! } J d e
— ! 7
1 0 q �1 :.
I
)4� yi
Foundation drains
Roof drains
j7
/
City f Ufa ap
Y �
Residential Sanitary Sewer Service
Compliance Inspection
,i fir,
Date /7 i 1. C / / /7 i
Time
j _.
Name / D is k # r�
PID Number
House Number 1 {-
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6" Transition:
White Copy: Property Owner
Street Name
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
Service Lateral Inspection Findings
)6 r
am
O pm
Number of stacks
Record Number
-LI ]1 Time
Length of Ser vice:
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
Yellow Copy: Gity of Eagan
7t
i
obstruction
Unable to push past
feet
Final Cleanout:
O Fm
Alternative Mailing Address Phone ;� )° .} 5 ^ -• E. _
0 am
r _
Inspector Signature jL f ," 7 -_? �i � ,��
�I
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S.L.at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH