4328 Nicols Rd - Inspection FormCity') Ea
Residential, Sanitary Sewer Service
Compliance Inspection
Date 1 / /t
Name�z=l! /.z/ C ✓17V
PID Number
House Number
Alternative Mailing Address
/
Damaged Pipe
Transition L)
A
4" to 6" Transition:
' f2f
White Copy: Property Owner
lam
Time o pm
Disk #
Street Name
OwnerlOccupant Signature
For informatiorw call 651.470.2788
n,:pliance
tiNo foundation drain connection
V No roof drain connection
O Surnp pit not connected to
sanitary sewer
O Sump pump properly piped
?C7 No sump pump
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
it/ �- , Z -
' 1 ' 7(r A
1
Record Number
Time
Phone .:' .'J }111)) —
/ f // s ,
/'Inspector Signature
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks 6 Entered $ L at e ( -t`-
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection_ ? - l.- /
Yellow Copy: City of Eagan
e S-0 dam
f ; C3
• o pm
Length of Service: 7 Final Cieanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SFH
Total
Notes
Number
Discharged
Correctly
Incorr ectly
Unknown
Sump pumps
Foundation drains
drains
City') Ea
Residential, Sanitary Sewer Service
Compliance Inspection
Date 1 / /t
Name�z=l! /.z/ C ✓17V
PID Number
House Number
Alternative Mailing Address
/
Damaged Pipe
Transition L)
A
4" to 6" Transition:
' f2f
White Copy: Property Owner
lam
Time o pm
Disk #
Street Name
OwnerlOccupant Signature
For informatiorw call 651.470.2788
n,:pliance
tiNo foundation drain connection
V No roof drain connection
O Surnp pit not connected to
sanitary sewer
O Sump pump properly piped
?C7 No sump pump
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
it/ �- , Z -
' 1 ' 7(r A
1
Record Number
Time
Phone .:' .'J }111)) —
/ f // s ,
/'Inspector Signature
Obstruction
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks 6 Entered $ L at e ( -t`-
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection_ ? - l.- /
Yellow Copy: City of Eagan
e S-0 dam
f ; C3
• o pm
Length of Service: 7 Final Cieanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SFH