4340 Nicols Rd - Inspection FormSalad
Residential Sanitary Sewer Service
Compliance Inspection
• C(am
Date f2 / 27 / /62 Time 07 :OCi Q p
,2 te( s
Name d � °7, t .- � ' : �/( , !%'"/ Disk#
PID Number
House Number 2 /2 -(7 /; . Street Name _ t'L� rj G'C, f x'/1
Alternative Mailing Address
f
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
t.
4" to 6" Transition:
White Copy: Property Owner
Owner /Occupant Signature
�J- LL1 -[1_J
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
Yellow Copy: City of Eagan
Phone
/
/
For information call 651A70.2788
Record Number
• Q am :
Time • o pm
7 / inspector Signature
_Q
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks Entered 5 L at
Roots
Poor
Min - D- :.sits
7? c
No Access
O No one in
ipe D - ec ' 2 / 7 f a,-.77r7e,t4/ „.x- gf / 7 , /t im e ' 7
pe e
sition !\ A { { i� ^iR1 fArf �! �/r d WAfre �1, r i s / / '��C iS ' �E ✓ 1�
.771// 7
Length of Service: Final Cleanout:
Access to service
lateral needed
O Inspection
refused
Notes4... ” / 6 , f
°
r`
Pink Copy: SEH
Total
Number.
•
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
Roof drains
Salad
Residential Sanitary Sewer Service
Compliance Inspection
• C(am
Date f2 / 27 / /62 Time 07 :OCi Q p
,2 te( s
Name d � °7, t .- � ' : �/( , !%'"/ Disk#
PID Number
House Number 2 /2 -(7 /; . Street Name _ t'L� rj G'C, f x'/1
Alternative Mailing Address
f
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
t.
4" to 6" Transition:
White Copy: Property Owner
Owner /Occupant Signature
�J- LL1 -[1_J
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
Yellow Copy: City of Eagan
Phone
/
/
For information call 651A70.2788
Record Number
• Q am :
Time • o pm
7 / inspector Signature
_Q
Unable to push past
feet
Service Lateral Inspection Findings Number of stacks Entered 5 L at
Roots
Poor
Min - D- :.sits
7? c
No Access
O No one in
ipe D - ec ' 2 / 7 f a,-.77r7e,t4/ „.x- gf / 7 , /t im e ' 7
pe e
sition !\ A { { i� ^iR1 fArf �! �/r d WAfre �1, r i s / / '��C iS ' �E ✓ 1�
.771// 7
Length of Service: Final Cleanout:
Access to service
lateral needed
O Inspection
refused
Notes4... ” / 6 , f
°
r`
Pink Copy: SEH