4279 Moonstone Dr - Inspection FormCity of Fa as
Residential Sanitary Sewer Service
Compliance Inspection
Date -- - /
Name L. 5 �a�
PID Number
House Number .. 7/7
Street Name
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
'1
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Owner /Occupant Signature
Time
./3 i
Disk
t
Service Lateral inspection Findings
Roots
4" to 6 "Transition:
White Copy: Propeity Owner
am
Pm
7
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 Entered S L.at
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition ! -'—
Length of Service:
Yellow Copy: City of Eagan
Notes
1
Record Number
Time J-
i 1 /
Phone �-t
_ lns�c�or 5ig`ria "cure -
Obstruction
Unable to push past
feet
/ �t- t A} f.
7 ./../.4 — Final Cleanout: - .. 1 1 2 .4
•
•
pm
pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH
Total
Number
Discharged
Correctly
incorrectly Unknown
Sump pumps
}
Foundation drains
Roof drains
City of Fa as
Residential Sanitary Sewer Service
Compliance Inspection
Date -- - /
Name L. 5 �a�
PID Number
House Number .. 7/7
Street Name
Alternative Mailing Address
For information call 651.470.2788
Compliance
O No foundation drain connection
'1
No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Owner /Occupant Signature
Time
./3 i
Disk
t
Service Lateral inspection Findings
Roots
4" to 6 "Transition:
White Copy: Propeity Owner
am
Pm
7
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 Entered S L.at
Poor PipeJoints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition ! -'—
Length of Service:
Yellow Copy: City of Eagan
Notes
1
Record Number
Time J-
i 1 /
Phone �-t
_ lns�c�or 5ig`ria "cure -
Obstruction
Unable to push past
feet
/ �t- t A} f.
7 ./../.4 — Final Cleanout: - .. 1 1 2 .4
•
•
pm
pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Pink Copy: SEH