4734 Hazeltine Lane - Inspection FormSump pumps
S
J
Foundation drains
Roof drains
Z•\
411i City of to an
Residential Sanitary Sewer Service
Compliance Inspection
:J
Date; 11 1l % I
Name
PIE) Number
House Number Street Name
Alternative Mailing Address
! 1
j
OwnerlOccupant Signature
For information call 651.470.2788
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
e No sump pump
4" to 6 "Transition:
Service Lateral Inspection Findings
White Copy: Property Owner
Time
Disk #
• '! JO am
• 16 pm
-m
,,-
Phone /7 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
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Number Discharged
Total
Correctly
Incorrectly
Unknown
Yellow Copy: City of Eagan
.n�3
Record Number
- °" t
Obstruction
Unable to push past
feet.
Notes
Time
0 am
•
• O Pm
Final Cleanout:
I nspector Signature \ i ,
No Access
O No one in
O Inspection
r efused
O Access to service
lateral needed
Entered S L.at
Pink Copy: SEH