4316 Nicols Rd - Inspection FormSump pumps
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Foundation drains
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Roof drains
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r City of JdlaR
Residential Sanitary Sewer Service
Compliance Inspection
Date 67 6 / / Z / /6.?
Name (7C4(7 l Disk #
P1D Number
House Number
Alternative Mailing Address
-ter
Compliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
FJ' No sump pump
4" to b " Tr ansition:
White Copy: Proper ty Owner
• f
Time /,- .•
0%;tiper /Occupant Signature
Street Name
ej am
0 pm
1- L z kJ
Non - Compliance
O
O
O
O
O
/f'ci j - 2
Clear water connections to
sanitary sewer.
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number Discharged
Total Correctly Incorrectly Unknown
Yellow Copy: City of Eagan
Record Number J
• =t7 am
Time // • O pm
Phone_
'._.
lrisffector Signature
i
For information call 65I ."
Obstruction
Unable to push past
J/'
Entered S L.at
C)
lir ,'-7. .
No Access
O No one in
O Access to service .
lateral needed
O Inspection
refused
Service Lateral Inspection Findings Number of stacks )
Roots q w
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Length of Service: 2 Final Cleanout:
Notes ~° (
r•
Pink Copy: SEH
City of }aaao
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 1 ° Time i • `% " o pm
Name 4,1
PID Number
c Street Name°'
r
House Number `���`�� -
Alternative Mailing Address
For information call 6.51.470.2788
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
Poor Pipe joints
Mineral Deposits
4" to 6" Transition:
; 7 - c'r { -pi
Owner/Q Signature
Service Lateral Inspection Findings
Roots 0
r, J
F ,
Sag /Pipe Deflection _S
Damaged Pipe
Transition
White Copy: Property Owner
O
Non - Compliance
O
O
O
O
L'?
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
ngth of Service: 6 �' f -.__
Record Number �✓ ff
i fi • ' j a m
Time • c o p m
Phone /� / lrZ7
/
•
Inspector Signature
Obstruction
Unable to push past
feet
Entered St at /•V
Notes
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
�- —
Yellow Copy: City of Eagan Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly
Unknown
Total
Sump pumps
Foundation drains
r r r ;V-j
Roof drains
(..
4 1 i% v
ii I v
City of }aaao
Residential Sanitary Sewer Service
Compliance Inspection
Date 1 1 ° Time i • `% " o pm
Name 4,1
PID Number
c Street Name°'
r
House Number `���`�� -
Alternative Mailing Address
For information call 6.51.470.2788
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
Poor Pipe joints
Mineral Deposits
4" to 6" Transition:
; 7 - c'r { -pi
Owner/Q Signature
Service Lateral Inspection Findings
Roots 0
r, J
F ,
Sag /Pipe Deflection _S
Damaged Pipe
Transition
White Copy: Property Owner
O
Non - Compliance
O
O
O
O
L'?
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
ngth of Service: 6 �' f -.__
Record Number �✓ ff
i fi • ' j a m
Time • c o p m
Phone /� / lrZ7
/
•
Inspector Signature
Obstruction
Unable to push past
feet
Entered St at /•V
Notes
Final Cleanout:
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
�- —
Yellow Copy: City of Eagan Pink Copy: SEH