1392 Interlachen Dr - Inspection FormCity 01 Eagan
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
PFD Number
House Number : Street Name
Alternative Mailing Address
For information call 651.470.2788
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
Roots
Poor Pipe Joints
Mineral Deposits
4" to 6 "Transition:
White Copy: Proper ty Owner
.7/3
Time jj •
/Disk #L
Owner /Occupant Signature
am
Pm
Non - Compliance
O
O
O
O
O
Li+
Clear water. connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Record Number
Notes
Time
Phone i
Obstruction
Unable to push past
feet.
Entered S.L,.at
•
•
Inspector Signature
Final Cleanout:
• f_7 ,, 7
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
0 a
O pm
Yellow Copy: City of Eagan Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
Unknown
Sump pumps
�,.::.
Foundation drains
Roof drains
City 01 Eagan
Residential Sanitary Sewer Service
Compliance Inspection
Date
Name
PFD Number
House Number : Street Name
Alternative Mailing Address
For information call 651.470.2788
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
Roots
Poor Pipe Joints
Mineral Deposits
4" to 6 "Transition:
White Copy: Proper ty Owner
.7/3
Time jj •
/Disk #L
Owner /Occupant Signature
am
Pm
Non - Compliance
O
O
O
O
O
Li+
Clear water. connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Record Number
Notes
Time
Phone i
Obstruction
Unable to push past
feet.
Entered S.L,.at
•
•
Inspector Signature
Final Cleanout:
• f_7 ,, 7
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
0 a
O pm
Yellow Copy: City of Eagan Pink Copy: SEH