1377 Interlachen Dr - Inspection Form4 1. . City or Fa
y a
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 2= (
Name ; J1 +', ✓'� S I.� Disk #
4" to 6" Transition:
PID Number
House Number ; / / Street Name
Alternative MailingAddress
- i i
( / OwnerICfccupa ni Signature II
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
White Copy: Property Owner
� j •�.W�i_��� F am
Time • ! pm
m
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Time
Obstruction
Unable to push past
feet
Final Cleanout:
• O am
• O pm
J
Inspector Signature �� f r ? ? .' j ,,
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered SI at
Pink Copy: SE H
Total
N otes
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_..
/O
•7::: s
.'.'. °
_
r .'f
T
I ' i "r
: .
i`''' s i
.... :
Number
Discharged
Correctly
Incorrectly
Unknown
Su mp pumps
_ -- -
L °,/
/J
-
Foundation drains
Roof drains
®
4 1. . City or Fa
y a
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 2= (
Name ; J1 +', ✓'� S I.� Disk #
4" to 6" Transition:
PID Number
House Number ; / / Street Name
Alternative MailingAddress
- i i
( / OwnerICfccupa ni Signature II
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
White Copy: Property Owner
� j •�.W�i_��� F am
Time • ! pm
m
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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone
Time
Obstruction
Unable to push past
feet
Final Cleanout:
• O am
• O pm
J
Inspector Signature �� f r ? ? .' j ,,
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered SI at
Pink Copy: SE H