4064 Nicols Rd - Inspection FormsDated g / # (� Time
Nam J i`isk #
PID Number
Street Name
House Number
Alternative Mailing Address
7
4" to 6 "Transition:
White Copy: Property Owner
Owner/Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
City of End afl
Residential Sanitary Sewer Service
Compliance Inspection
Non - Compliance
,1_9
Record Number
Notes
Time
Phone c)
For information call 651.470.2788
Obstruction
inspector Signature
O Clear water connections to Unable to push past
sanitary sewer feet.
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 stacks Entered S.L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service: Final Cleanout:
Yellow Copy: City of Eagan��y 1,,
• O am
• O pm
No Access
O No one in
Access to service
lateral neede
O Inspection
refused
� c r 1 -,
▪ 7
` J l
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
Dated g / # (� Time
Nam J i`isk #
PID Number
Street Name
House Number
Alternative Mailing Address
7
4" to 6 "Transition:
White Copy: Property Owner
Owner/Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
City of End afl
Residential Sanitary Sewer Service
Compliance Inspection
Non - Compliance
,1_9
Record Number
Notes
Time
Phone c)
For information call 651.470.2788
Obstruction
inspector Signature
O Clear water connections to Unable to push past
sanitary sewer feet.
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 stacks Entered S.L at
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service: Final Cleanout:
Yellow Copy: City of Eagan��y 1,,
• O am
• O pm
No Access
O No one in
Access to service
lateral neede
O Inspection
refused
� c r 1 -,
▪ 7
` J l
Pink Copy: SEH
Sump pumps
Foundation drains
Roof drains
Cit! of Fa u
Residential Sanitary Sewer Service
Compliance Inspection
Date / / � 1
Name 1 1.0
Alternative Mailing Address
ompliance
Transition
4" to 6" Transition:
/ 7 F
White Copy: Property Ownex
Total
Time
Disk#
PO Number
House Number l ' Street Name
OwnerlOccupant Signature
For information call 65
No foundation drain connection 0
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump 0
Service Lateral inspection Findings
A
•
•
O
O
O
am
Pm
Non- Compliance
1
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Number Discharged
Correctly Incorrectly Unknown
Phone
r.:
Record Number. •
f� Time • y{ PanIni
Notes
Inspect Signature
Obstruction
Unable to push past
feet
Roots
No Access
O No one in
Length of Service: f 9 Anal Cleanout:
O Access to service
lateral needed
O Inspection
refused
Entered S at
\ f
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe .
Yellow Copy: City of Eagan Pink Copy: SEH