4784 London Lane - Inspection FormCity at Ea pi
Residential Sanitary Sewer Service
Compliance Inspection
i
Date I
Name
PID Number
House Number 4- 7 - Street Name
Alternativ, Mailing Address
rJ
� /
%
'
Compliance
O No foundation drain connection
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
Sag/Pipe Deflection
4" to 6 "Transition:
White Copy: Proper ty Owner
�� •' a
Time f i • o pm
Owner /Occup Signature
r
Disk #I -
O Flexible sump pump piping
Number of stacks
Length of Service:
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Yellow Copy: City of Eagan
Record Number
Entered S.L at
Damaged Pipe
Transition
•
Time •
Obstruction
Unable to push past
feet
Final Cleanout:
o am
o pro
C?
Phone 4-; .�
ti....� r - i-'X
Inspector Signature /Nd
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Number
Co , tly
Discharged
Incorrectly
Unknown
Notes
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Sump pumps
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Foundation drains
Roof drains
f
City at Ea pi
Residential Sanitary Sewer Service
Compliance Inspection
i
Date I
Name
PID Number
House Number 4- 7 - Street Name
Alternativ, Mailing Address
rJ
� /
%
'
Compliance
O No foundation drain connection
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
Sag/Pipe Deflection
4" to 6 "Transition:
White Copy: Proper ty Owner
�� •' a
Time f i • o pm
Owner /Occup Signature
r
Disk #I -
O Flexible sump pump piping
Number of stacks
Length of Service:
Non - Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Yellow Copy: City of Eagan
Record Number
Entered S.L at
Damaged Pipe
Transition
•
Time •
Obstruction
Unable to push past
feet
Final Cleanout:
o am
o pro
C?
Phone 4-; .�
ti....� r - i-'X
Inspector Signature /Nd
For information call 651.470.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH