4124 Nicols Rd - Inspection FormCity oL ,dal
Residential Sanitary Sewer Service
Compliance inspection
Date Z'� ll f(
Name .!3i'3/�.1
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
J D' No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
✓0 No sump pump
Ser vice Lateral Inspection Findings
Roots ref-"'' r r (.) , FJ
Poor Pipe Joints
Mineral Deposits
4" to 6"Transition:
White Copy: Property Owner
Time
Disk #
Street Name
Owner /Occupant Signature
0--.X.J o am
• Pm
O Flexible sump pump piping
1dJ _ [TLi
riit Time
I ( )
Phone I °V I ,
Non — Compliance
O Clear water connections to
A sanitary sewer
Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Number of stacks
Sag /Pipe Deflection { T J ` r
Damaged Pipe (.../�,y --/ /s ;I/ % -y -) / r y
i �-
Transition / ° 7 % .,• / ( r t.� t _)
1
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
Entered S L.at
Notes
O
• • ( cj Pm
Inspector Signature
am
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
F�
` - cd ' .
Final Cleanout:
,t f7/...
e` 4"J
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
,'( �_
Foundation drains
t,
)' ----
Roof drains
:...__...
City oL ,dal
Residential Sanitary Sewer Service
Compliance inspection
Date Z'� ll f(
Name .!3i'3/�.1
PID Number
House Number
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
J D' No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
✓0 No sump pump
Ser vice Lateral Inspection Findings
Roots ref-"'' r r (.) , FJ
Poor Pipe Joints
Mineral Deposits
4" to 6"Transition:
White Copy: Property Owner
Time
Disk #
Street Name
Owner /Occupant Signature
0--.X.J o am
• Pm
O Flexible sump pump piping
1dJ _ [TLi
riit Time
I ( )
Phone I °V I ,
Non — Compliance
O Clear water connections to
A sanitary sewer
Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Number of stacks
Sag /Pipe Deflection { T J ` r
Damaged Pipe (.../�,y --/ /s ;I/ % -y -) / r y
i �-
Transition / ° 7 % .,• / ( r t.� t _)
1
Length of Service:
Yellow Copy: City of Eagan
Record Number
Obstruction
Unable to push past
feet
Entered S L.at
Notes
O
• • ( cj Pm
Inspector Signature
am
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
F�
` - cd ' .
Final Cleanout:
,t f7/...
e` 4"J
Pink Copy: SEH