4230 Moonstone Dr - Inspection FormsResidential Sanitary Sewer Service
Compliance Inspection
Date O6 1 C 5 1 /0
Name .77r //if? ✓ A.,67-„<",, , ,p , Disk#
PID Number
House Number 4'
Alternative MailingAddress
Compliance
O 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
Time 07 , CO 'o pm
OwnerlOccupant Si ature
Street Name
z
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 Lateral Inspection Findings Number of stacks
O
Roots 3C1/2
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Entered S.L.at
Obstruction
Unable to push past
feet
114 Pef
j am .
dam
Time - • .. O pm
Phon 6- I !2 -
/ 4
� / , Ynispector Signature
For information :call 651A70.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Clean out: 1 mote, ` '
Notes ' I/47,0 zzAi .
�� ^�- C r.,.' /,
(PPr. it .;_ate
7
Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
Unknown
Sump pumps
�~
�,..
Foundation drains
�w
Roof drains
r ��--
Residential Sanitary Sewer Service
Compliance Inspection
Date O6 1 C 5 1 /0
Name .77r //if? ✓ A.,67-„<",, , ,p , Disk#
PID Number
House Number 4'
Alternative MailingAddress
Compliance
O 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
Time 07 , CO 'o pm
OwnerlOccupant Si ature
Street Name
z
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 Lateral Inspection Findings Number of stacks
O
Roots 3C1/2
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Entered S.L.at
Obstruction
Unable to push past
feet
114 Pef
j am .
dam
Time - • .. O pm
Phon 6- I !2 -
/ 4
� / , Ynispector Signature
For information :call 651A70.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Clean out: 1 mote, ` '
Notes ' I/47,0 zzAi .
�� ^�- C r.,.' /,
(PPr. it .;_ate
7
Pink Copy: SEH
Residential Sanitary Sewer Service
Compliance Inspection
Date O6 1 C 5 1 /0
Name .77r //if? ✓ A.,67-„<",, , ,p , Disk#
PID Number
House Number 4'
Alternative MailingAddress
Compliance
O 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
Time 07 , CO 'o pm
OwnerlOccupant Si ature
Street Name
z
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 Lateral Inspection Findings Number of stacks
O
Roots 3C1/2
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Entered S.L.at
Obstruction
Unable to push past
feet
114 Pef
j am .
dam
Time - • .. O pm
Phon 6- I !2 -
/ 4
� / , Ynispector Signature
For information :call 651A70.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Clean out: 1 mote, ` '
Notes ' I/47,0 zzAi .
�� ^�- C r.,.' /,
(PPr. it .;_ate
7
Pink Copy: SEH
Total
Number Discharged
Correctly
Incorrectly
Unknown
Sump pumps
�~
�,..
Foundation drains
�w
Roof drains
r ��--
Residential Sanitary Sewer Service
Compliance Inspection
Date O6 1 C 5 1 /0
Name .77r //if? ✓ A.,67-„<",, , ,p , Disk#
PID Number
House Number 4'
Alternative MailingAddress
Compliance
O 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
Time 07 , CO 'o pm
OwnerlOccupant Si ature
Street Name
z
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 Lateral Inspection Findings Number of stacks
O
Roots 3C1/2
Poor Pipe Joints
Mineral Deposits
Sag/Pipe Deflection
Damaged Pipe
Transition
Length of Service:
Yellow Copy: City of Eagan
Record Number
Entered S.L.at
Obstruction
Unable to push past
feet
114 Pef
j am .
dam
Time - • .. O pm
Phon 6- I !2 -
/ 4
� / , Ynispector Signature
For information :call 651A70.2788
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Final Clean out: 1 mote, ` '
Notes ' I/47,0 zzAi .
�� ^�- C r.,.' /,
(PPr. it .;_ate
7
Pink Copy: SEH
4 1 , 111. Cif al Eap
Residential Sanitary Sewer Service
Compliance Inspection
Date 65---" 1 S / -° (
Time
PID Number.
House Number !(-- µ t 6 Street Name ZJG:r A.✓i._J - /: ;r,,,- (-- ,1),,
Alternative Mailing Address Phone . / .. g. r s ') Z 7 '" ' :' r�` ,�'
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
• o am
• o pm
,11111..
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 Lateral Inspection Findings Number of stacks
Roots
f f � 4
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet
Entered S. at
Inspector Signature
Final Cleanout:
• O am
• O pm
No Access
7 No one in
O Access to service
lateral needed
O Inspection
refused
C
Pink Cody: SEH
t
Number
Correctly
Discharged •
Incorrectly Unknown
Notes 1
_
f ] f , 1,.„.,z---
/ j j 1
k
1 ( elF{( r' ' (.
S
?Il
P
Total
Sump pumps
Foundation drains
Roof drains
4 1 , 111. Cif al Eap
Residential Sanitary Sewer Service
Compliance Inspection
Date 65---" 1 S / -° (
Time
PID Number.
House Number !(-- µ t 6 Street Name ZJG:r A.✓i._J - /: ;r,,,- (-- ,1),,
Alternative Mailing Address Phone . / .. g. r s ') Z 7 '" ' :' r�` ,�'
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
4" to 6" Transition:
White Copy: Property Owner
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
• o am
• o pm
,11111..
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 Lateral Inspection Findings Number of stacks
Roots
f f � 4
Length of Service:
Yellow Copy: City of Eagan
Record Number
Time
Obstruction
Unable to push past
feet
Entered S. at
Inspector Signature
Final Cleanout:
• O am
• O pm
No Access
7 No one in
O Access to service
lateral needed
O Inspection
refused
C
Pink Cody: SEH
t