4254 Moonstone Dr - Inspection Form11111
City of tapo
Residential Sanitary Sewer Service
Compliance Inspection
Date 7 / /
/7) i,-**/ Disk # " i
Name
PID Number
House Number
—/ Street Name
..---• I , ,
o ,4
Alternative Mailing Address Phone. /I
. i
7) / / /2 /
..-
/ / /
,.—
, .
Owner/Occupant Signature
Compliance c tLonmCompbanc,,e _
O No foundation drain connection( it 2' Clear water CO ections o k 1
l - r
tp No roof drain connection .
sanitary sewer
P
\ -...,....:L . \ 0ervice lateral defects
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
6
ts i - P-----
1
Roo 0 7 Z) 7
Service Entered S. L, at S7.
ateral Inspection Findings Number of stacks i
,
Poor Pipejoints
K -
Mineral Deposits Ioe
• - ; Sag/Pipe Deflection 7
Damaged Pipe `cF- f f)
Transition
4" to 6" Transition:
White Copy: Property Owner
• j .6„ am
Time •-- o Pro
0
3
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
j 4 - (
,y•
/ 0
I • e Length of Service:
Yellow Copy: City of Eagan
Record Number
Time //
, ACI am
•
• 0 Pm
/
Jaspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Clea out:
T
Notes ci e
fi /Z,.;*
— K- ? C
Pink Copy: SEH
Total
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
7
__,..----
---.
Foundation drains
i
! 7 :?-/-, -,.:
4/ ( • ,-- 1
'.." i. ; '''''
1111111=111
Roof drains
/ 71
11111
City of tapo
Residential Sanitary Sewer Service
Compliance Inspection
Date 7 / /
/7) i,-**/ Disk # " i
Name
PID Number
House Number
—/ Street Name
..---• I , ,
o ,4
Alternative Mailing Address Phone. /I
. i
7) / / /2 /
..-
/ / /
,.—
, .
Owner/Occupant Signature
Compliance c tLonmCompbanc,,e _
O No foundation drain connection( it 2' Clear water CO ections o k 1
l - r
tp No roof drain connection .
sanitary sewer
P
\ -...,....:L . \ 0ervice lateral defects
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
6
ts i - P-----
1
Roo 0 7 Z) 7
Service Entered S. L, at S7.
ateral Inspection Findings Number of stacks i
,
Poor Pipejoints
K -
Mineral Deposits Ioe
• - ; Sag/Pipe Deflection 7
Damaged Pipe `cF- f f)
Transition
4" to 6" Transition:
White Copy: Property Owner
• j .6„ am
Time •-- o Pro
0
3
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
j 4 - (
,y•
/ 0
I • e Length of Service:
Yellow Copy: City of Eagan
Record Number
Time //
, ACI am
•
• 0 Pm
/
Jaspector Signature
Obstruction
Unable to push past
feet
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Clea out:
T
Notes ci e
fi /Z,.;*
— K- ? C
Pink Copy: SEH