4844 Eriks Blvd - Inspection FormSump pumps
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Foundation drains
Roof drains
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City of Eapii
Residential Sanitary Sewer Service
Compliance Inspection
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Date 1<r‹
Name
Alternative Mailing Address
if
Compliance
O 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
4" to 6" Transition:
White Copy: Pr oper ty Owner
Time
/It
Service Lateral Inspection Findings
Disk #
PID Number'
--7 ,
House Number s -7 Street Name
CA4ne'r/Occupant Signature
Oiam
• pm
r
Phone
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
Record Number
Time
/
Inspector Signature
Obstruction
Unable to push past
feet
am
•
• 0 pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Entered S at
Roots
Poor Pipe Joints
Mineral Deposits
SaglPipe Deflection
Damaged Pipe
Transition
Length of Service:
Number Discharged
Total Correctly Incorrectly
Unknown
Yellow Copy: City of ag-an
Notes
Final Cleanout:
Pink Copy: SEH