1481 Lake Park Cir - Inspection Form41116
City of hap
Residential Sanitary Sewer Service
Compliance Inspection
V,)
Date il
Name )
PID Number
House Number 1
Alternative Mailing Address
e.
4" to 6"Transition:
White Copy: Pi operty Owner
Compliance
0 No foundation drain connection
o No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump purnp proppily piped
7r(-
0 No sump pump
am
Time
b pm
Street Name
OwnerlOccupant Signature
Disk # [1] -L
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer -r
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number — f
Time
•
•
)
o am
o pm
Phone )
Inspector Signature
)N1
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S L at
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots . I 7
• 3 -3
P Poor ipeJoihts ;4 ) .77 / V
i
Min < j___,--
ecal posits f. ',..-- .,-, / -7) ./ 4.....--- I." /--) ... - r7 - -:, - : --------,-/ ,- , ,.---- ,_ ----x , =2/
__.,
.. , I •
;''' ' N I ' i . • . . '
Sag/P Deflection 4( -:-J . 17 .4......:01 2 ) , .-/----_-;/..---",,-----:-') — ---9--:-..,-: :::::-:-.1.-..../ ) , ..,- / <--.. .:/: ./..
V
i .,.., .., .., i _1
Darv‘ge
f ., ....°
....—. ) .---' I ...77 /
L. ..-
',1 r
Transition'
/ \ i ..,.._„,
,....
,..-
Pink Copy: SEH
Notes
,/, ---=',.,. - — -- / _.,--
7( -- 1 :--- 721/ j -..-_-;- :.---.) ----- 77-',i1 ---
I l i.L3•.<:-` 3, .7. -- fle-3---? -- 7 ,- ,-.:',-.: c2 -
• i,,
:
- "'" - W
Number
Correctly
Discharged
incorrectly
Unknown
Total
pumps
Sump pumps
i
Foundation drains
Roof drains
L_/.
v
,
41116
City of hap
Residential Sanitary Sewer Service
Compliance Inspection
V,)
Date il
Name )
PID Number
House Number 1
Alternative Mailing Address
e.
4" to 6"Transition:
White Copy: Pi operty Owner
Compliance
0 No foundation drain connection
o No roof drain connection
Sump pit not connected to
sanitary sewer
0 Sump purnp proppily piped
7r(-
0 No sump pump
am
Time
b pm
Street Name
OwnerlOccupant Signature
Disk # [1] -L
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer -r
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Length of Service:
Yellow Copy: City of Fagan
Record Number — f
Time
•
•
)
o am
o pm
Phone )
Inspector Signature
)N1
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered S L at
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots . I 7
• 3 -3
P Poor ipeJoihts ;4 ) .77 / V
i
Min < j___,--
ecal posits f. ',..-- .,-, / -7) ./ 4.....--- I." /--) ... - r7 - -:, - : --------,-/ ,- , ,.---- ,_ ----x , =2/
__.,
.. , I •
;''' ' N I ' i . • . . '
Sag/P Deflection 4( -:-J . 17 .4......:01 2 ) , .-/----_-;/..---",,-----:-') — ---9--:-..,-: :::::-:-.1.-..../ ) , ..,- / <--.. .:/: ./..
V
i .,.., .., .., i _1
Darv‘ge
f ., ....°
....—. ) .---' I ...77 /
L. ..-
',1 r
Transition'
/ \ i ..,.._„,
,....
,..-
Pink Copy: SEH
CR! of Eapn
Residential Sanitary Sewer Service
Compliance Inspection
Date /
)
Name 2 "/ ) ?f Disk #
..•
PID Number
House Number
Alternative Mailing Address
Owner/Occupant Signature
Compliance
O No foundation drain connection
k o 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
Roots ,
Poo Pipe J'ints
Mineral Deposits
Sag/Pip'e Deflection
DaMaged Pipe
Transition
4" to 6"Transition:
White Copy: Property Owner
Street Name
a am
Time • q3 pm
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
p Defective manholes
Sump pump connected to sanitary
sewer
O Flexible sump pump piping
)
Length of Service:
Yellow Copy: City of Eagan
Record Number k
Time
Obstruction
Unable to push past
feet.
Entered 5 Lax
,
Phone =
• •
Inspector Signature )
For information call 651.470.2788
Final Cleanout:
0 am
•
• OPfl
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
7
.1; • 4.
f /
I K1 7 ) 1 7 e '''1: A k"
44 ---
•i=7,
7).
At>
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
.4--, sr . J.-, )
--• , -i' .,:c "---.,--
.!„.;::::::),:f5 I i .:='_...,, I. ir ___-.7
/ /
?9 ._- - ?„,-,..,.-,,,,,,,...' ,..1 , j.,.••• ..-.2
,....-_,,,,,_ 4- ?..• ../.../,e„.- i.,...e.,.. ., ,
' .
- .....-
L
Total
Sump pumps
.
A
Foundation drains
.-
Roof drains
)
\,"
.".,/
CR! of Eapn
Residential Sanitary Sewer Service
Compliance Inspection
Date /
)
Name 2 "/ ) ?f Disk #
..•
PID Number
House Number
Alternative Mailing Address
Owner/Occupant Signature
Compliance
O No foundation drain connection
k o 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
Roots ,
Poo Pipe J'ints
Mineral Deposits
Sag/Pip'e Deflection
DaMaged Pipe
Transition
4" to 6"Transition:
White Copy: Property Owner
Street Name
a am
Time • q3 pm
Non-Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
p Defective manholes
Sump pump connected to sanitary
sewer
O Flexible sump pump piping
)
Length of Service:
Yellow Copy: City of Eagan
Record Number k
Time
Obstruction
Unable to push past
feet.
Entered 5 Lax
,
Phone =
• •
Inspector Signature )
For information call 651.470.2788
Final Cleanout:
0 am
•
• OPfl
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
7
.1; • 4.
f /
I K1 7 ) 1 7 e '''1: A k"
44 ---
•i=7,
7).
At>
Pink Copy: SEH