4334 Nicols Rd - Inspection FormSump pumps
Jj
Foundation drains
Roof drains
City ol
Residential Sanitary Sealer Service
Compliance Inspection
Date 2 f %' / /L/
Name
PID Number
House Number -f a,
Alternative Mailing Address
f frri
pliance
No foundation drain connection
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
4" to 6" Transition:
White Copy: Property Owner
Total
•< ��' Q)am
Time pm
Disk #
Owner /Occupant Signature
'Street Name I c:
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
Service Later�all spec n FJ Number of stacks Entered S. L at - ' '� 1 '_.- (,,
Roots ..� '
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition �'T
Length of Service:
Correctly
Incorrectly Unknown
Record Number
Time
Phone .I ` ( i k ��° - CC
Inspector Signature
Obstruction
Unable to push past
feet
Notes
am
Pm
No Access
O No one in
r
O Inspection
refused
Final Cleanout:
O Access to service
lateral needed
Yellow Copy: City of Eagan Pink Copy: SEH