4100 Nicols Rd - Inspection FormSump pumps
1,
A _—
,- \
Foundation drains
-- 1
0
Roof drains
•
city of Eag.au
Residential Sanitary Sewer Service
•
Compliance inspection
Date 't2-5 / - /
Name
PID Number
House Number
Alternative flailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
o No roof drain connection
0
0
1
Sump pit not connected to
sanitary sewer
Sump pump properly piped
No sump pump
Owner/Occupant Signature
Service Lat ral Inspection Findings
Roots 6i
Poor Pipe Joints
Mineral Deposits
/0 7
Sag/Pipe Deflection
Damaged Pipe
Transition
4-1
4" to 6" Transition:
White Copy: Property Owner
Jit/ 4.4k1 11 7
Time
Disk #
Street Name
9 am
-41-30 pm
0
s
4/2 (
Non-Compliance
h i. Clear water connections to
sanitary sewer Z8 (2 Zi
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Length of Service:
Number Discharged
Total Correctly Incorrectly Unknown
1
Record Number
7 7-7
k
-
.5r
Time •
infector Signature -
o am
Pm
(e 0? "-.Q5-
Pho •
// /77-i
///
Obstruction No Access
Unable to push past 0 No one in
feet
O Inspection
refused
Number of stacks 1 Entered 5 L at 7
O Access to service
lateral needed
Final Cleanout:
Notes ( 4 et";
L./Ad t '2?-t2 -1
2
f p7-
1
= Yellow Copy: Ci of Eagan
. (i C ; •
P/
Pink Copy: SEH