4152 Nicols Rd - Inspection FormCity of boil
Residential Sanitary Sewer Service
Compliance Inspection
Date ' 1
r
Name / ; l�"?"� Disk #
PID Number
House Number )_ ) 2 Street Name
Alternative Mailing Address
/"
4" to 6" Transition:
White Copy: Property Owner
Time
Ownerldccupant Signature
Compliance
O No foundation drain connection
A Y I No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe —
Transition i ��' -°� 1 '
am
0 pm
Service Lateral Inspection Findings N umber of stacks _
Length of Service:
Record Number
7--
Non — Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
Yellow Copy: City of Eagan
Phone
1.
{"
1 T I L i
Time ' • 'pm
•
Inspector Signature
Obstruction
Unable to push past
feet
Entered S. L at
Final Cleanout:
For information call 651A70.2788
1 -57 111 Y)
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
3
p1C f
1 j � /
Notes r , ;
0 / jam c _
l r #
i c� "J�'
g
I 4 "o..! '�i�...= c _/ °mil ,//
Pink Copy: SEH
Total
Number
Correctly
Discharged
Incorrectly
Unknown
Sump pumps
3
1
J
/' \
Foundation drains
rl
Roof drains
i '
City of boil
Residential Sanitary Sewer Service
Compliance Inspection
Date ' 1
r
Name / ; l�"?"� Disk #
PID Number
House Number )_ ) 2 Street Name
Alternative Mailing Address
/"
4" to 6" Transition:
White Copy: Property Owner
Time
Ownerldccupant Signature
Compliance
O No foundation drain connection
A Y I No roof drain connection
Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe —
Transition i ��' -°� 1 '
am
0 pm
Service Lateral Inspection Findings N umber of stacks _
Length of Service:
Record Number
7--
Non — Compliance
O Clear water connections to
sanitary sewer
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
Flexible sump pump piping
Yellow Copy: City of Eagan
Phone
1.
{"
1 T I L i
Time ' • 'pm
•
Inspector Signature
Obstruction
Unable to push past
feet
Entered S. L at
Final Cleanout:
For information call 651A70.2788
1 -57 111 Y)
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
3
p1C f
1 j � /
Notes r , ;
0 / jam c _
l r #
i c� "J�'
g
I 4 "o..! '�i�...= c _/ °mil ,//
Pink Copy: SEH