4376 Nicols Rd - Inspection FormCity of Eapii
(Residential Sanitary Sewer Service
Compliance Inspection
Date f l /
,
Name �> I � r Disk#
PID Number
}-louse Number —) `7 Street Name
Alternative Mailing Address
1
i
Compliance
No foundation drain connection
�tX? No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Poor PipeJoints
4" to 6" Transition: 7 j sref
White Copy: Property Owner
am
Tim s Pm
Owner /Occupant Signature
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
Yellow Copy: City of Eagan
Record Number
Notes
- ' ; )0 '
am
Time • O pm
Phone
Inspector Signature
For information call 65
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stack l tered S.L at .
Roots /
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition i /c2,./7 °y
Length of Ser vice: ' Final Cleanout: /,__•-
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown.
Sump pumps
/3
( i
Foundation drains
(J
Roof drains
City of Eapii
(Residential Sanitary Sewer Service
Compliance Inspection
Date f l /
,
Name �> I � r Disk#
PID Number
}-louse Number —) `7 Street Name
Alternative Mailing Address
1
i
Compliance
No foundation drain connection
�tX? No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Poor PipeJoints
4" to 6" Transition: 7 j sref
White Copy: Property Owner
am
Tim s Pm
Owner /Occupant Signature
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
Yellow Copy: City of Eagan
Record Number
Notes
- ' ; )0 '
am
Time • O pm
Phone
Inspector Signature
For information call 65
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stack l tered S.L at .
Roots /
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
'Transition i /c2,./7 °y
Length of Ser vice: ' Final Cleanout: /,__•-
Pink Copy: SEH