4271 Moonstone Dr - Inspection FormD � W)
City o tea a
Residential Sanitary Sewer Service
Compliance Inspection
Date 6 1 zz
Name Lie() 7 1-7 Disk #
PID Number
House Number
Alternative Mailing Address
For information call 6S1.470.2788
Compliance
O No foundation drain connection
6 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
.; No sump pump
Service Lateral Inspection Findings Number of stacks_ ( Entered S L .at
Roots
Poor Pipe Joints
Mineral • Deposits , '' S T
l
Sag/Pipe Deflection
Damaged Pipe
Transition
Li A i i t/lie:e
4” to 6" Transition: f t'1i
White Copy: Proper ty_Owuex
Time f %.C. p pm
/ Owner /Occupant Signature
4 ' p ' 7 / Street Name
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone '` �dj ' t
/ 7 •
/�- °:f"rspector Signature
Obstruction
Unable to push past
feet
•
Time
Final Cleanout:
p am
O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
I
``:Pink Copy: SEH
Total
Notes F X 4,1/
;64r --,-,
,) r
' = i,
; - j
i ' r
t s:r1,_ 'er -
9 - ._
'
0- -/ - --
Nunibe.r
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
i
Foundation drains
Roof drains
r /
_•-- ._,w „__�.
. _e___.____._.______
,3,,,,
D � W)
City o tea a
Residential Sanitary Sewer Service
Compliance Inspection
Date 6 1 zz
Name Lie() 7 1-7 Disk #
PID Number
House Number
Alternative Mailing Address
For information call 6S1.470.2788
Compliance
O No foundation drain connection
6 No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
.; No sump pump
Service Lateral Inspection Findings Number of stacks_ ( Entered S L .at
Roots
Poor Pipe Joints
Mineral • Deposits , '' S T
l
Sag/Pipe Deflection
Damaged Pipe
Transition
Li A i i t/lie:e
4” to 6" Transition: f t'1i
White Copy: Proper ty_Owuex
Time f %.C. p pm
/ Owner /Occupant Signature
4 ' p ' 7 / Street Name
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
Length of Service:
Yellow Copy: City of Eagan
Record Number
Phone '` �dj ' t
/ 7 •
/�- °:f"rspector Signature
Obstruction
Unable to push past
feet
•
Time
Final Cleanout:
p am
O pm
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
I
``:Pink Copy: SEH