4080 Nicols Rd - Inspection Formr City or Eapn
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 1!-11: J'
Name
PID Number
House Number • i
Alternative Mailing Address
1
Compliance
No foundation drain connection
i
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Poor Pipe Joints
4" to 6" Transition:
White Copy: Property Owner
Time
Owner/Occupant Signature
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition �-
.,,?
Disk #
Street Name
•
•d am
• pm
J
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
Service Lateral Inspection Findings Number of stack
Roots .� t .;, ?. �.' .
Yellow Copy: City of Eagan
Record Number ?
•.��
Time ) •
•
Phone
For information call 65
Obstruction
Unable to push past
feet
Entered S.L at
Inspector Signature
Length of Service: - Final Cleanout:
J
pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Notes
Number
Discharged
Cor rectly
Incorr ectly
Unknown
Sump pumps
f / `
Foundation drains
'
f`
Roof drains
r City or Eapn
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 1!-11: J'
Name
PID Number
House Number • i
Alternative Mailing Address
1
Compliance
No foundation drain connection
i
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Poor Pipe Joints
4" to 6" Transition:
White Copy: Property Owner
Time
Owner/Occupant Signature
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition �-
.,,?
Disk #
Street Name
•
•d am
• pm
J
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
Service Lateral Inspection Findings Number of stack
Roots .� t .;, ?. �.' .
Yellow Copy: City of Eagan
Record Number ?
•.��
Time ) •
•
Phone
For information call 65
Obstruction
Unable to push past
feet
Entered S.L at
Inspector Signature
Length of Service: - Final Cleanout:
J
pm
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Pink Copy: SEH