4352 Nicols Rd - Inspection FormSump pumps
Foundation drains
!�
Roof drains
City of a R
Residential Sanitary Sewer Service
Compliance Inspection
Name, i sfc #
ND Number
House Number - -- 3 A Street Name
Alternative Flailing Address
For information call 651.470.2788
o 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
Service Lateral inspection Findings
Roots
4" to 6" Transition:
I cc- (9_ t
Owner/Occupant Signature
White Copy: Propel ry Owner
/ 4 / 6
am
Time
) pm
0
O
O
O
0
Non - Compliance
Poor Pipe Joints
Mineral Deposits 1 1
(SaglRipe Deflection (5 `Th
Damaged Pipe
Transition
Clear water connections to
sanitary sewer
Service lateral defects
Defective manholes
Sump pump connected to sanitary
sewer
Flexible sump pump piping
Number of stacks
Length of Service:
Number Discharged
Total Correctly incorrectly Unknown
Record Number
Notes
Phone
pospamp
X
am
Time e
Obstruction
Unable to push past
feet
inspector Signature
Entered S . at
r1
f Final Cleanout:
Na Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Yellow Copy: City of Eagan Pink Copy: SEH