4322 Nicols Rd - Inspection Form`I!R° City of liaRai
Residential Sanitary Sewer Service
Compliance Inspection
Date 'l 1f
PO Number
House Number
Alternative Mailing Address
)b-&- =tom . - --
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
Time
Name
Ser vice Lateral Inspection Findings
Street Name
Owner /Occupant Signature
am
pm
For information call 65
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
Number of stacks Entered S..L..at
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Record Number .
Inspector Signature
Obstruction
Unable to push past
feet.
Final Cleanout:
ain
Pm
Phone cl/ . ..
No Access
O } No one in
�7 Access to service
later ] eeded
O Insipection
refused
� �f!� , inlr CopCopp SEH
Yellow Copy: City of Eagan v (� ��- � �(.- 1 �i
Total
Notes
/ l
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n ,_ , ( " p i
_ � /ii.. /lA> > -. .f �, _
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/ 4 y
Number
Discharged
Correctly
incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
`I!R° City of liaRai
Residential Sanitary Sewer Service
Compliance Inspection
Date 'l 1f
PO Number
House Number
Alternative Mailing Address
)b-&- =tom . - --
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
4" to 6 "Transition:
White Copy: Property Owner
Time
Name
Ser vice Lateral Inspection Findings
Street Name
Owner /Occupant Signature
am
pm
For information call 65
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
Number of stacks Entered S..L..at
Roots
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Record Number .
Inspector Signature
Obstruction
Unable to push past
feet.
Final Cleanout:
ain
Pm
Phone cl/ . ..
No Access
O } No one in
�7 Access to service
later ] eeded
O Insipection
refused
� �f!� , inlr CopCopp SEH
Yellow Copy: City of Eagan v (� ��- � �(.- 1 �i
4 City of Eapi
Residential Sanitary Sewer Service
Compliance Inspection
Date:
Name 1
House Number
Compliance
Sr
PID Number
Alternative Mailing Address
No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Ir,sp`ection Findings
Roots
.1
�` ��.,
4" to 6 "Transition:
White Copy: Property Owner
Owner /Occupant Signature
a
Disk #
Time ') -
-I
am
0 pm
1
Street Name ..� .. .
For information call 651.470.2788
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
Number of stacks 1
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number .'
1
Phone
. ( • am
Time J o pm
Entered S . at
Obstruction
Unable to push past
feet
Inspector Signature
I;
r - „ °- ;". .. Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
I
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes
Total
Sump pumps
;° 'g
Foundation drains
,....
Roof drains
4 City of Eapi
Residential Sanitary Sewer Service
Compliance Inspection
Date:
Name 1
House Number
Compliance
Sr
PID Number
Alternative Mailing Address
No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Service Lateral Ir,sp`ection Findings
Roots
.1
�` ��.,
4" to 6 "Transition:
White Copy: Property Owner
Owner /Occupant Signature
a
Disk #
Time ') -
-I
am
0 pm
1
Street Name ..� .. .
For information call 651.470.2788
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
Number of stacks 1
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number .'
1
Phone
. ( • am
Time J o pm
Entered S . at
Obstruction
Unable to push past
feet
Inspector Signature
I;
r - „ °- ;". .. Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
I
Pink Copy: SEH