4134 Nicols Rd - Inspection Form4
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
• • Oam
Date (24 / ..e. / Z 2 Time , A • /J.. : g: pm
Name .4-/ s s "7i ,: 707,6Disk #
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
gi,rNo sump pump
6 / 7 Street Name
White Copy: Pr operty Owner
4" to 6" Transition:
i - %'
///
Ownei'ibccupdnt Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition , +A I / (2O ki A, •f ' C 55
Non - Compliance
O Clear water connections to
sanitary sewer
O Ser vice lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacics
Length of Service: +1,
Yellow Copy: City of Eagan
Record Number
Time
•
Phone Y, /r Z' - t
Inspector Signature
Obstruction
Unable to push past
feet.
Entered S. L. at
Final Cleanout:
c p am
p
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Number
Correctly
Discharged.
Incorrectly
Unknown
Notes —
e � A
.
, 1r f �/•k Ai C3 4,-- te _. s L . e - x , 5:7 r . r J ,--.
i �° r7 C � -. =-C c t�
' , - -•d� ,may
d
Total
Sump pumps
.__.__-__
Foundation drains
--
Roof drains
4
City of hp
Residential Sanitary Sewer Service
Compliance Inspection
• • Oam
Date (24 / ..e. / Z 2 Time , A • /J.. : g: pm
Name .4-/ s s "7i ,: 707,6Disk #
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
gi,rNo sump pump
6 / 7 Street Name
White Copy: Pr operty Owner
4" to 6" Transition:
i - %'
///
Ownei'ibccupdnt Signature
Service Lateral Inspection Findings
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition , +A I / (2O ki A, •f ' C 55
Non - Compliance
O Clear water connections to
sanitary sewer
O Ser vice lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Number of stacics
Length of Service: +1,
Yellow Copy: City of Eagan
Record Number
Time
•
Phone Y, /r Z' - t
Inspector Signature
Obstruction
Unable to push past
feet.
Entered S. L. at
Final Cleanout:
c p am
p
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH