4146 Nicols Rd - Inspection Form44111
_City of Fa an
Residential Sanitary Sewer Service
Compliance Inspection
Date_ On 7 2 1 /6)
Name Disk #
('A,.,..*# L cl
PID Number
House Number
Compliance
CD/No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
J
Owner /Occupant Signature
Time /' a 7r Pm
vc
7
f
Street Name��S��JP J r
Alternative Mailing Address
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
c
Time /
• Pho e / ) o f
1 � W
fris pector Signature
Obstruction
Unable to push past
feet
O-'am
0 p
For information call 651.470.2788
No Access
O No one in
Entered S , at _ f %' �✓
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition /1/2
Final Clea
i� ✓� ? c' qtr )
Pink Copy: SEH
Notes C O 6 - - �
7
` ?1., i1i ii_; "'"e--7'—,
Number Discharged
Total
Correctly Incorrectly
MEI
_m._
IMMI
Unknown
Sump pumps
Foundation drains
Roof drains
44111
_City of Fa an
Residential Sanitary Sewer Service
Compliance Inspection
Date_ On 7 2 1 /6)
Name Disk #
('A,.,..*# L cl
PID Number
House Number
Compliance
CD/No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Inspection Findings
4" to 6 "Transition:
White Copy: Property Owner
J
Owner /Occupant Signature
Time /' a 7r Pm
vc
7
f
Street Name��S��JP J r
Alternative Mailing Address
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
c
Time /
• Pho e / ) o f
1 � W
fris pector Signature
Obstruction
Unable to push past
feet
O-'am
0 p
For information call 651.470.2788
No Access
O No one in
Entered S , at _ f %' �✓
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition /1/2
Final Clea
i� ✓� ? c' qtr )
Pink Copy: SEH