4751 Cypress Pt - Inspection FormCay of Lapp
Residential Sanitary Sewer Service
Compliance Inspection
Date I I / l / l
Name d Disk #
PID Number
House Number
Alterntive i tailingAddress
/1
:,_i am
Time _ pm
Street Name
OwnerlOccupant Signature
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
-m-
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
4" to.6 "Transition:
White Copy: Proper Owner
Length of Service:
Yellow Copy: City of Eagan
Record Number i ' 1
Time
•
•
0 a
O pm
/- - ._
Phone r - ._t :
Entered S Lat
Inspector Signature
Obstruction
Unable to push past
feet
! ,f
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
i
`"7, / . L
c. ! /V,�, l r '
' , _ .
I !l i -- . c = a s ` ,:. -, ,-._ . m �.
_ ' i ce - / 1,,m,,.
Total
Sump pumps
�! ,././ lt %�
s ir''
,.-
i
Foundation drains
Roof drains
j -
1 1
.
Cay of Lapp
Residential Sanitary Sewer Service
Compliance Inspection
Date I I / l / l
Name d Disk #
PID Number
House Number
Alterntive i tailingAddress
/1
:,_i am
Time _ pm
Street Name
OwnerlOccupant Signature
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
-m-
For information call 651.470.2788
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
Service Lateral Inspection Findings Number of stacks
Roots
Poor Pipe Joints
4" to.6 "Transition:
White Copy: Proper Owner
Length of Service:
Yellow Copy: City of Eagan
Record Number i ' 1
Time
•
•
0 a
O pm
/- - ._
Phone r - ._t :
Entered S Lat
Inspector Signature
Obstruction
Unable to push past
feet
! ,f
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
Pink Copy: SEH