1516 Thomas Lane - Inspection FormCity f' Eqpt
y �
Residential Sanitary Sewer Service
Compliance Inspection
Date_) / / 1 i Time
Name , >! 1 Disk # L
PID Number
)
House Number / 1 ' Street Name
Alternative Mailing Address
4" to 6 "Transition:
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
White Copy: Property Owner
am
pm
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
Length of Service:
Yellow Copy: City of Eagan
Record Number - . .
• Q am
Time _ • o pm
Phone /<_. °r f f -r-
D
Obstruction
Unable to push past
feet.
Inspector Signature ') l td ,ii
Service Lateral Inspection Findings Number of stacks Entered S.I at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
/-
1
Notes
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Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
5
i
2
Foundation drains
Roof drains
City f' Eqpt
y �
Residential Sanitary Sewer Service
Compliance Inspection
Date_) / / 1 i Time
Name , >! 1 Disk # L
PID Number
)
House Number / 1 ' Street Name
Alternative Mailing Address
4" to 6 "Transition:
Sump pit not connected to
sanitary sewer
Sump pump properly piped
0 No sump pump
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
White Copy: Property Owner
am
pm
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
Length of Service:
Yellow Copy: City of Eagan
Record Number - . .
• Q am
Time _ • o pm
Phone /<_. °r f f -r-
D
Obstruction
Unable to push past
feet.
Inspector Signature ') l td ,ii
Service Lateral Inspection Findings Number of stacks Entered S.I at
Roots
Poor Pipe joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH