4241 Moonstone Dr - Inspection Form- Cita o r Fa a
Residential Sanitary Sewer Service
Compliance Inspection
Date &x ! .ro / /2
Name /1//7 f
ND Number
House Number
No roof drain connection
4" to 6 "Transition:,
White Copy: Property Owner
Street Name
Alternative Mailing Address
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Compliance
No foundation drain connection
Owner /OCpupant Signature
Service Lateral Inspection Findings
o am
Time • ACS ; pm
Disk #
}
3-
0
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
fJ) Length of Service:
Yellow Copy: City of Eagan
Record Number
7
Time
Obstruction
Unable to push past
feet
• ,/,(.
Final Cleanout:
o am
IPr pm
1
f Phone > 7 4 /7 t. .�
t ' //
r
j 7 ! inspector Signature ture -`
For information call 651
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Number of stacks Entered S.L.at JTM ( .
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH
Number
Correctly
Discharged
Incorrectly Unknown
Notes j) ,, / 6
• '
! f ig, f �
Total
Sump pumps
A.
_e
Foundation drains
--- --
----•
_ ,_
Roof drains
y
, � i
-______-
- Cita o r Fa a
Residential Sanitary Sewer Service
Compliance Inspection
Date &x ! .ro / /2
Name /1//7 f
ND Number
House Number
No roof drain connection
4" to 6 "Transition:,
White Copy: Property Owner
Street Name
Alternative Mailing Address
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
No sump pump
Compliance
No foundation drain connection
Owner /OCpupant Signature
Service Lateral Inspection Findings
o am
Time • ACS ; pm
Disk #
}
3-
0
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
fJ) Length of Service:
Yellow Copy: City of Eagan
Record Number
7
Time
Obstruction
Unable to push past
feet
• ,/,(.
Final Cleanout:
o am
IPr pm
1
f Phone > 7 4 /7 t. .�
t ' //
r
j 7 ! inspector Signature ture -`
For information call 651
No Access
O No one in
O Access to service
lateral needed
O inspection
refused
Number of stacks Entered S.L.at JTM ( .
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
Transition
Pink Copy: SEH