1500 Pinetree Tr - Inspection Form4 City of liotao
Residential Sanitary Sewer Service
Compliance Inspection
Date)! // / /
Name
)
RID Number
, r ---
House Number : / Street Name
Alternative Mailing Address
r
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
i l k sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6"Transition:
White Copy: Property Owner
Pi am
Time • pm
Disk #
O wnerlOccupant Signature
Record Number j 7
•
Time •
o am
o pm
• l I" ;) 7
Phone /7.,
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered St at
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
)
Inspector Signature j
I ° I I • 7 7
Total
Notes
)
1 —
,./
I
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
4 City of liotao
Residential Sanitary Sewer Service
Compliance Inspection
Date)! // / /
Name
)
RID Number
, r ---
House Number : / Street Name
Alternative Mailing Address
r
Compliance
O No foundation drain connection
O No roof drain connection
Sump pit not connected to
i l k sanitary sewer
O Sump pump properly piped
O No sump pump
Service Lateral Inspection Findings
4" to 6"Transition:
White Copy: Property Owner
Pi am
Time • pm
Disk #
O wnerlOccupant Signature
Record Number j 7
•
Time •
o am
o pm
• l I" ;) 7
Phone /7.,
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
Number of stacks
Length of Service:
Yellow Copy: City of Eagan
For information call 651.470.2788
Obstruction
Unable to push past
feet
Entered St at
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
)
Inspector Signature j
I ° I I • 7 7